Symptoms and Impact on Patient and Environment
Disucss about the Ageing and Related Complications in your chosen case study.
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Mrs. Patel is a 72-year-old female patient who is currently been taken care of at the aged-care centre. She has been at the facility for the past one month receiving holistic care from the medical practitioners. Issues being addressed majorly are nutrition, comfort and preserving quality of life. During my clinical placement, I have been assisting the team in the collaborative care of Mrs. Patel. She was diagnosed with dementia, incontinence of both stool and urine and osteoporosis.
Mrs Patel has been presenting with memory loss. She has short term memory and cannot remember where she left her belongings or even the meal she took in the morning. Mrs. Patel forgets even to eat her food and must be reminded over and over again (Kales, Gitlin & Lyketsos, 2015). She keeps repeating statements the t is due to the memory loss. She has difficulty in expressing herself since she takes time finding appropriate words for a scenario. She has reduced ability to concentrate on tasks given and gets easily distracted and rarely completes tasks. Mrs. Patel has a difficulty in identifying people, even the family members and keeps on asking them over and over again. These are clear symptoms of dementia. Mrs Patel has a constant complaint of back pains. From the assessment, she has lost weight and has a hunched gait. From the history, Mrs Patel has been admitted severally due to bone fractures that result from minor falls (Sotelo & Acevedo-Vasquez, 2016). These symptoms point out to osteoporosis. Due to urine incontinence, she experiences a strong and uncontrolled urge to void (Jones, 2015). She voids on herself by a mere cough or sneeze. She cannot control stool elimination.
The conditions have impacted greatly on Mrs. Patel and the environment. They have affected the quality of life, caused a social, emotional impact and affected physical state of Mrs Patel and the surrounding people in general. She has incontinence of both urine and stool. This conditions have affected her quality of life and her self-esteem is very low. She has to walk in diapers to avoid soaking herself. Due to the incontinence, she has to stay in the facility and this has added a financial cost to the family. This has led to strain on resources to enable cater for the medical attention she needs. The emotional state of Mrs. Patel has been affected and she feels withdrawn and neglected. She keeps forgetting things and gets frustrated looking for them and she feels more of a burden. The family and the care practitioners need to monitor her closely in terms of nutrition. Physically, she has osteoporosis and this has impaired her ability to move around. She is prone to falls and gets fractures easily. Due to this, she needs assistance in moving around by the care practitioners and family members.
Theory of Ageing and Related Complications
The appropriate theory of aging that explains Mrs. Patel’s condition is the theory of wear and tear. This theory explains that ageing is due wearing out of cells and tissues with time. It explains that body parts are like machine parts and the more they are in use, they wear out with time. It explains that the wearing out is contributed due to the environmental factors e.g. toxic substances, radiations and the ultraviolet rays or intrinsic body metabolic processes (De & Ghosh, 2017). Metabolic processes using oxygen leads to eliciting of free radicals that are not friendly to the cells and tissues and cause damage. Damaged cells tend to regenerate and remodel to replace the damaged ones, with time, the DNA strands dividing become very short and cannot remodel anymore this leads to increased rate of damage than remodelling. This is the cause of osteoporosis where the rate of bone resorption is more than remodelling. Some tissues tend to get weakened and function is lost according to the theory. In due time the tissues get overwhelmed due to years of functioning they strain and weaken such like machine parts. To control elimination of urine or stool, one ought to have strong sphincters. The bladder and anal sphincters contract and relax voluntarily normally and one voids on urge and can hold, in cases where they are weakened, one loses the ability to control them and urine and stool leaks out. This is presented by Mrs Patel in the case where the anal sphincters and bladder sphincters are weakened and resulting into incontinence. Cells of the central nervous system do not regenerate hence the damage is progressive. Mrs. Patel has dementia and the symptoms are deteriorating since nerve cells are gradually getting damaged and remodelling does not take place.
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Ageing is the process of becoming older. It involves decaying process where the cells, tissues and organs are gradually damaged due to release of intrinsic and extrinsic toxins or by just wearing out (Zimmerman, Anderson, Mattu, Grossman & Rosen, 2016). In the central nervous system, ageing leads to short term memory loss and loss of ability to learn new materials and tasks. This is due to the damage of nerve cells responsible for memory, reasoning and creative thinking. It leads to loose of communication abilities and one may lack words to describe a situation or the right vocabulary. This is due to the loose of function to the sensory speech area of the brain. Ageing leads to lose of function to the frontal lobe leading to slow task handling and lose of intellectual ability (Fjell, Sneve, Storsve, Grydeland, Yendiki & Walhovd, 2015). There is reduced blood flow to the central nervous system, diminished number of nerve cells and hardening of vertebrae. In the genitourinary system, the bladder sphincters are weakened, the capacity of the bladder is reduced and the nerve cells loose sensation. This leads to stress incontinence (Hutchinson-Colas & Segal, 2015). There is reduced functions of renal tubules and the rate of glucose reabsorption is reduced. There is reduced number of glomeruli hence reduced kidney function. In the gastrointestinal system, there is decreased rate of motility and food tends to spent more time in the tract (Saber & Bayumi, 2016). Water is reabsorbed and the food gets dehydrated hence one suffers from constipation. The internal and external anal sphincters loose the tone and become weakened. One is not able to control the contraction and relaxation of sphincter muscles hence leading to stool incontinence. Concerning the musculoskeletal system, there is decrease in muscle bulk, this is due to damage and loss of cells (Briggs, Cross, Hoy, Sànchez-Riera, Blyth, Woolf & March, 2016). Ageing contributes to disease of the joints, degeneration of cartilages, bone pains limiting daily activities and increases the rate of bone resorption compared to remodellin
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Nursing diagnosis
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Goals
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Interventions
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Rationale
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Evaluation
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Disturbed thought process related to impaired memory due to dementia as evidenced by patient unable to reason, has memory loss, disoriented and is easily distracted.
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Patient should be able to demonstrate improved thought processing.
Patient will demonstrate orientation to time place and person.
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Examine the patient often on the thought process. Assess levels of memory loss, communication patterns and orientation.
Orient patient to the surrounding.
Label drawers and use reminders for the patient
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Assessing the memory change, communication patterns and orientation enables identify whether patient is improving or worsening (Maillet & Schacter, 2016).
Labelling assists the patients memory to avoid looking for things
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After the interventions, the patient was able to demonstrate orientation in time place and person and improved thought process.
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Self-care deficit related to dementia as evidenced by patient unable to brush teeth, don clothing and patient being unable to obtain or pick clothing.
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Patient will be able to demonstrate ability to appropriately dress well with minimal or no assistance after one week.
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Allow patient to perform tasks on her own.
Provide oral care including cleaning of dentures after meals.
Educating family on the adaptive measures of helping the patient cope.
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This will boost confidence and self-esteem.
Oral care promotes dental hygiene and prevents tooth decay (Wallace, Mohammadi, Wallace & Taylor, 2016).
Helps in collaborative care of the patient.
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After the interventions, the patient was able to groom appropriately without assistance.
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Impaired physical mobility related to the disease process leading to pain, bone loss and inability to bear weights as evidenced by history of fractures with mere falls.
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Patient will be able to mobilise with minimal assistance and be free of complications due to motion by the end of facility stay.
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Encourage range of motion exercises.
Assist patient to walk around and provide walkers where necessary.
Turn patient often and assess cough reflexes.
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Enables regaining of function and prevents contractures and death of muscle due to disuse.
Helps patient gain independence and self-esteem.
Turning patient prevents developing of bed sores preventing skin integrity(Pickham, Ballew, Ebong, Shinn, Lough & Mayer, 2016)
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Patient demonstrated ability to move with minimal complications.
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Imbalanced nutrition less than body requirement related to low levels of calcium and vitamin D as evidenced by loss of weight and history of fractures
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Patient should be able to demonstrate normal levels of calcium and vitamin D in the body by the end of 72 hours.
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Advice and administer 1500mg of calcium daily.
Advice patient on the benefits of sunlight and assist her to bask.
Limit intake of coffee or any foods with caffeine.
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Intake of calcium replenishes the body with calcium for normal bone remodelling.
Sunlight is the main source of vitamin D which helps in bone remodelling.
Caffeine inhibits the absorption of calcium in the gastrointestinal tract (Areco, Rivoira, Rodriguez, Marchionatti, Carpentieri & Talamoni, 2015).
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After the interventions, the patient was able to demonstrate normal levels of calcium and vitamin D.
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Bowel incontinence related to inability to voluntarily control anal sphinters due to nerve damage as evidenced by patient unable to dictate passage of stool.
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Patient will be able to verbalise ability to control stool passage by the end of 5 days.
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Assist patient come up with an elimination plan.
Assess the frequency of passing stool.
Educate patient on coping mechanisms including use of diapers.
Educate patient on foods to eat to keep stool regular and of good consistency.
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This stimulates patient’s confidence and cooperation.
It helps monitor the progress whether patient is gaining control.
(Scerri, Innes & Scerri, 2015).
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Following 5 days of nursing interventions, patient was able to control elimination of stool.
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Risk for falls related to weakening of bones secondary to osteoporosis.
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Patient will demonstrate ability to maintain balance and support body weight.
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Provide support and assistance during motion.
Provide walkers or a wheelchair to the patient.
Educate patient and family on the importance of preventing falls.
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Assisting patient to walk prevents falls since some of the body weight is held by the care giver.
To enable easy movement through the facility.
Falls even the mere ones can lead to extensive fractures.
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After the interventions the patient was able to maintain body balance.
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Risk for dehydration related to the increased urinary loss secondary to incontinence.
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Patient will demonstrate adequate hydration status throughout the period of stay in the facility.
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Assess the mucous membranes.
Encourage intake of fluid.
Monitor vital signs.
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Mucous membranes are indicators of dehydration. They should be moist at all times.
Fluid intake rehydrates the body cells.
A rising pulse and a falling blood pressure points to low fluid volumes in the body.
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After the intervention, the patient demonstrated adequate hydration status.
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References
Areco, V., Rivoira, M. A., Rodriguez, V., Marchionatti, A. M., Carpentieri, A., & de Talamoni, N. T. (2015). Dietary and pharmacological compounds altering intestinal calcium absorption in humans and animals. Nutrition research reviews, 28(2), 83-99.
Briggs, A. M., Cross, M. J., Hoy, D. G., Sànchez-Riera, L., Blyth, F. M., Woolf, A. D., & March, L. (2016). Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization world report on ageing and health. The Gerontologist, 56(Suppl_2), S243-S255.
De, A., & Ghosh, C. (2017). Basics of aging theories and disease related aging-an overview. PharmaTutor, 5(2), 16-23.
Fjell, A. M., Sneve, M. H., Storsve, A. B., Grydeland, H., Yendiki, A., & Walhovd, K. B. (2015). Brain events underlying episodic memory changes in aging: a longitudinal investigation of structural and functional connectivity. Cerebral cortex, 26(3), 1272-1286.
Hutchinson-Colas, J., & Segal, S. (2015). Genitourinary syndrome of menopause and the use of laser therapy. Maturitas, 82(4), 342-345.
Jones, M. L. (2015). Series 5.4: Elimination of urine and incontinence of urine. British Journal of Healthcare Assistants, 9(8), 375-379.
Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. bmj, 350(7), h369.
Maillet, D., & Schacter, D. L. (2016). From mind wandering to involuntary retrieval: Age-related differences in spontaneous cognitive processes. Neuropsychologia, 80, 142-156.
Pickham, D., Ballew, B., Ebong, K., Shinn, J., Lough, M. E., & Mayer, B. (2016). Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): study protocol for a randomized controlled trial. Trials, 17(1), 190.
Saber, A., & Bayumi, E. K. (2016). Age-Related Gastric Changes. Journal of Surgery, 4(2-1), 20-26.
Scerri, A., Innes, A., & Scerri, C. (2015). Discovering what works well: exploring quality dementia care in hospital wards using an appreciative inquiry approach. Journal of clinical nursing, 24(13-14), 1916-1925.
Sotelo, W., & Acevedo-Vasquez, E. (2016). Controversies in clinical management of postmenopausal osteoporosis. REVISTA PERUANA DE GINECOLOGIA Y OBSTETRICIA, 62(2), 257-266.
Wallace, J. P., Mohammadi, J., Wallace, L. G., & Taylor, J. A. (2016). Senior Smiles: preliminary results for a new model of oral health care utilizing the dental hygienist in residential aged care facilities. International journal of dental hygiene, 14(4), 284-288.
Zimmerman, K. D., Anderson Jr, R. S., Mattu, A., Grossman, S. A., & Rosen, P. L. (2016). Physiologic changes with aging. Geriatric Emergencies: A Discussion-based Review.
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