Promoting Health in Extened Care for Health Issues- myassignmenthelp

Question: Discuss about thePromoting Health in Extened Care for Health Issues. Answer: Ageing being an irreversible and a gradual process of development, requires specialized nursing care. Ageing is associated with physiological, psychological, physical and mental health issues and should be put into consideration. This essay will discuss the major health issues highlighted in the case study of Amalie. Amalie is a female client with an age of 89 years. She is a German but she stays in Australia where she was married by a sailor who died two years ago due to lung cancer. In the past two years, Amalies health status has been worsening gradually forcing her to withdraw from all kind of the activities she had engaged herself in including losing contact with the community. Recently, Amalie developed dry macular degeneration and problems with mobility due to rheumatoid and osteoarthritis. She has a positive medical history of hypothyroidism, macular degeneration and arthritis. The three priorities of nursing care to be discussed are risk of falls, pain management and activities of daily living (ADL). The Millers Functional Consequences model and Levette-Jones Clinical Reasoning cycle will be used in identification, assessment, implementation and evaluation of nursing care. Body The first priority of nursing care is activities of daily living. From the scenario, Amalie is not able to conduct the various activities of daily living due to her health deterioration. She developed rheumatoid and osteoarthritis which made her develop mobility issues. Additionally, according to the referral letter from her GP, Amalie is stated to have joint stiffness, limited movement of joints, painful joints, swollen feet and joints and occasional dizziness. Due to dry macular degeneration, she is reported to have vision deficits which also contributed to her limited movements from her house. Additionally, Amalie is reported to have isolation behaviors, inadequate feeding and weight loss. Generally, these are some of the factors which largely contributed to reduced ability to carry out daily activities of living (Clement, Ploennigs Kabitzsch, 2012). Activities of Daily Living refers to basic form of activities that are performed by people every day important for independent life in the community and at home. ADLs can be categorized into five which include dressing, eating, continence maintenance and personal hygiene which involves grooming, bathing and oral care (Clement, Ploennigs Kabitzsch, 2012). Transferring oneself from one point to another is also an ADL. Instrumental Activities of Daily Living (IADLs) refers to the actions that enable an individual have an independent life. They are important to the health care professionals as they guide on the level and kind of assistance needed by the patient (Capezuti, Boltz, Cline, Dickson, Rosenberg, Wagner Nigolian, 2012). The IDLS include basic skills of communication, transportation which involves driving, preparation of meals, shopping and medication. Management of medications without missing doses and housework are also other useful IADLs. Geriatric assessment is a multidisciplinary and multidimensional and it is sued in evaluation of the functioning ability, cognitive functioning, physical health, socio-economic situations and mental health of an old patient (Clement, Ploennigs Kabitzsch, 2012). The multidisciplinary team involved should conduct a complete assessment to detect potential issues such as falls, confusions, incontinence and immobility. The multidisciplinary team should adopt a structured approach of conducting the assessment to obtain all the information required to make a proper diagnosis, implement and evaluate care. The assessment should incorporate people like nutritionists, physicians, nurses, social workers and occupational therapists (Ward Reuben, 2016). Physical assessment should be systematic to capture the musculoskeletal which should include reduced range of movement, pain and swelling of legs, osteoarthritis and gait disturbances. When assessing the eyes, they should ask about loss of central vison which is associated with age-related macular degeneration. On general assessment, they should ask on depression, isolation and unintentional loss of weight which impact on ones ability to carry out daily activities (Karlsson, Magnusson, Schewelov Rosengren, 2013) The second priority in Amalies scenario is risk of falls. Amalie is age-89 years with rheumatoid and osteoarthritis which pose a great risk of falls to her. She has a positive medical history of arthritis which can lead to falls risk. Based on the scenario she has vision deficits, joint stiffness, painful joints, dizziness and swollen and painful joints which could lead to falls (Karlsson, Magnusson, Schewelov Rosengren, 2013) Falls are regarded as a marker of immobility, frailty, chronic and acute impairment of health in the elderly. Falls diminish ones level of functioning causing fear of falling, activity limitations, injury and mobility loss. Most injuries such as fractures of forearm, pelvis, humerus or hips among old people result from falls (Gillespie, Robertson, Gillespie, Sherrington, Gates, Clemson Lamb, 2012). The risk factors of falls include demographics such as age more than 75 years, status of household, living alone and history of previous falls (Hunter, 2016). Acute and chronic illnesses, physical deficits, medical prescriptions, cognitive impairment, foot and vision problems. Environmental hazards such as poor lighting and stairs can also lead to falls to the elderly. Medications that are associated with high risk of falls include corticosteroids, non-steroidal anti-inflammatory drugs, ant-depressants and ant-hypertensives (Huang, Mallet, Rochefort, Eguale, Buckeridge Tamblyn, 2012). When performing a physical assessment on Amalie, the nurses should ask about deformities or problems of joints such as inflammation, visual problems, illnesses, gait disturbance, nutrition and weigh loss (Ward Reuben, 2016). Other things they should ask about are lighting conditions of the home compound and stairs at her home that might lead to her falls. Appropriate measures such as physiotherapy, education on impacts of medications regarding falls and other factors which can lead to falls, proper lighting at home and avoidance of stairs at her home. Medical management is also useful for the illnesses which cause risk of falls. Prevention of falls should be multidisciplinary and multidimensional for positive patent outcome (Carolan Jorgensen, 2013). The third priority is pain management. Amalie is aged 89 years and she has swollen and painful joints especially the hip, knee, back and fingers as stated in the referral letter from her GP in the case scenario. From the scenario, Amalie has rheumatoid and osteoarthritis and a positive medical history of arthritis which have largely contributed to her mobility issues making her unable to move out of her house. Due to these mobility problems, Amalie consequently lost physical contact with the community, friends and members of the association she was in. Osteoarthritis is a bone disorder associated with continuous wearing and tearing of specific body joints while rheumatoid is an autoimmune disorder characterized by inflammation of joints (Hunter, 2016). This priority will include the last four steps of the Clinical Reasoning Cycle which include: goal setting, taking action, evaluation of care and a reflection of the entire scenario. The fifth step on setting goals, the main goals of pain management in Amalies scenario is that she should report reduced pain after nursing intervention, she should demonstrate restored emotional, physical and social function after implementation of nursing care interventions and improved adherence to prescribed medications which she seems to skip when she is on intense pain (Levett-Jones, 2013). Pain is among the commonest complaints among old people due to increased chronic diseases and frailty which are associated with increased pain (Hunter, 2016). According to Millers Functional Consequences Model, old people are likely to develop joint and bone disorders, arthritis and other chronic illnesses that are associated with pain (Horgas, Yoon Grall, 2012). If the pain remains untreated, it can lead to negative consequences such as reduced quality of life and health leading to anxiety, depression, social isolation, sleep disturbances, immobility and cognitive impairment (Horgas, 2017). Based on Amalies scenario, it is evident that she has poor quality of life associated with continued isolation behaviors, inability to leave the house due to problems of mobility which are caused by rheumatoid and osteoarthritis bone and joint disorders (Carolan Jorgensen, 2013). On the sixth step-taking action- (Levett-Jones, 2013). The best action is provision of analgesics such as paracetamol for relieving pain and anti-inflammatory drugs such as ibuprofen which relieves fever, pain and inflammation since she has swollen joints. The second action is the non-pharmacological approach of managing pain (Horgas, 2017). This approach should involve educating the patient on nature of pain, instruments used in pain assessment, use of medications, involvement in group programs and strategies of coping with pain to enhance pain tolerance and sooth the pain. Cognitive Behavioral Therapy can also be used to promote coping mechanisms (Horgas, 2017). Some of the risk factors associated with rheumatoid arthritis include female gender, age 60 years and above and a medical history of arthritis. Based on these risk factors, it was possible for Amalie to develop rheumatoid and osteoarthritis. Both rheumatoid and osteoarthritis are associated with joint pain especially the fingers, hips, knee, hands and elbow. At the onset, rheumatoid is associated with fever, weight loss, loss of appetite and fatigue which indicate development of the disease (Singh, Saag, Bridges, Akl, Bannuru, Sullivan Curtis, 2016). Some other symptoms of rheumatoid include joint stiffness, multiple joint swelling and general malaise (Carolan Jorgensen, 2013). The seventh step of the Clinical Reasoning Cycle about evaluation of care should states the outcome of the nursing care. Amalies pain should be reduced and she should be adhering to medications properly. She should also be physically, emotionally and socially active without having to isolate herself from others. Nurses should adequately assess pain in Amalie based on onset, location, frequency, duration, causative factors, aggravating factors, relieving factors of pain and any medications that she has used for pain management. For instance, from the scenario, the referral letter from Amalies GP states that she is on slow release paracetamol and ibuprofen which are important in relieving pain, inflammation and fever (Horgas, Yoon Grall, 2012). As a reflection of the entire scenario, it is my clear understanding that pain, risk of falls and ADLs can largely impact on the general functioning of the elderly. I now understand that patient-centered and holistic care approaches are very useful in the care of the elderly. The clinical Reasoning Model is very critical in nursing care for prioritization of patient needs. Conclusion This essay was meant to purposely analyze the scenario of Amalie and plan for care based on Millers Functional Consequences theory and Levette-Jones Model of Clinical Reasoning. Based on these two models, it was realized that nurses need to be knowledgeable and critically think in order to implement appropriate care. Ageing is an irreversible developmental process that impacts on the functioning of most of the body systems including the musculoskeletal. Ageing is a risk factor to various health conditions such as age-related macular degeneration, rheumatoid arthritis and depression especially in a female gender. Nursing priorities such as pain management, risk of falls and Activities of Daily Living were fully addressed in this essay. Both multidimensional and multidisciplinary approaches were discussed on management of these priorities of care. 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