PROBLEM/ISSUE

GOAL OF CARE

NURSING INTERVENTIONS

EVIDENCE BASED PRACTICE RATIONALE

REFERAL WITH RATIONALE

ISSUE ONE

The risk of falls can be an issue for Mr Teo. He lives alone and has no one to take care of him since 2015. Mr. Jones suffer from OA (Osteoarthritis), which results in cartilage erosion and increases the risk of falls.

The first nursing goal would be to reduce the risk of falls. However according to the healthy habits and personal safety assessment it has been found that patient has moderate healthy habits and little concern about personal safety, but not as much as required. There are various reasons that can affect the safety of an individual and can increase the risk of falls. He has problem in his knees and finds it difficult to use toilet. He also finds difficulty in going up and down the steps. The goal will focus on reducing the risk of falls

Falls are considered as the major safety risk for older adults. The risk of falls can be determined by the use of tool called as Fall Risk Assessment (El Miedany et al, 2011).

Evidences indicate that at least 30% to 40% older adults experience at least one severe fall in one year. Thus it becomes very important to reduce the risk of serious falls. According to the study of El Miedany et al (2011), Fall Risk Assessment Tools can help in predicting the risk of falls and risk of sustaining the fall can also be predicted.

Allied Health Support services of CHSP help patient to receive occupational therapy and physiotherapy. This can help to strengthen his muscles and reduce risk of falls. To reduce falls risk Mr. Jones can also use home maintenance and modification service in his home (Commonwealth Home Support Programme, 2015).

Reducing the chances of falls by considering the internal and external factors of the client’s living environment. Internal factors includes the internal physical condition of patient that can cause falls and external factors include any history of fall, client’s safety measures and any kind of unsafe furniture or tools at home.

Evidence based studies show that 25% of the falls in older patient cause severe injuries. These injuries can include fractures in skull, fracture in limbs, spinal cord injuries and also internal bleeding. Ensuring safe environment for the older people reduce chances of severe fall injuries.

Educating the client about reducing the risk of falls is very important. Thus, this intervention would be educating Mr. Toe about avoiding incidence of falls. Education will include importance of exercise and how to cope with falls (Burton et al, 2015).

Educating the patient, will help him to be aware of the situation that can result in falls and to avoid such situations (Burton et al, 2015).

Encouraging client for more physical activities and social interactions.

Physical activities help in strengthening the muscles, and also improve coordination and balance (Haines et al, 2011).

ISSUE TWO

Imbalanced nutrition intake can be a major issue for the client. Mr. Jones has recently lost weight. Imbalance nutrition intake can increase the risk of falls, muscle weakness, loss of muscle mass, deficiency of proteins and calories and hampered daily activities.

The goal of care will focus on balancing nutrition intake by Mr. Jones by evaluating his daily diet and balancing the daily intake of nutrients to maintain mobility, reduce fall risks, increased intake of vitamins and proteins and balance fluid intake.

Mr. Jones will be informed about importance of nutritional diet and regular intake of appropriate amount of proteins and calories.

According to evidence based study of Ahmed, & Haboubi (2010), nutrition serves as the very essential element of good health in older adults.

Food services are offered by CHSP. This helps people, who are unable to make appropriate food for them and do shopping for food. Through this service, Mr. Jones can have nutritional food prepared for him and get stored (Commonwealth Home Support Programme, 2015).

Recording the dietary intake for over the period of seven days. According to the study og Murad et al, (2011) increased vitamin D intake can reduce the risk of falls.

Dietary intake over the period of 7 days can inform about the patient’s consumption of nutrients. It is because unintentional weight loss is a serious problem for older adults and can also result in significant morbidities and mortality (Ahmed, & Haboubi, 2010).

Implementing comprehensive nutritional plan with continuous monitoring.

This is very important for providing high quality care to the client and improving the quality of life.

Taking assistance from the dietician, to prepare and apply nutritional plan for client and will also encourage client to adhere to nutritional plan.

Client’s adherence to nutritional plan is very important for balanced intake of nutrients. Since Mr. Jones is living alone and cooks for himself only, so encouraging him to take healthier food will be helpful.

ISSUE THREE

Acute pain can be another issue for Mr. Jones. Due to bilateral writs and Total knee replacement he may suffer from pain and sleeplessness.

The goal of care will focus on relieved and controlled pain. Patient must be able to relax and take rest. Goal is also to ensure Mr. Jones must be able to take appropriate sleep. Client must be able to use relaxation skills, diversional activities and must be able to cope with pain.  Mr. Jones do not use CPM devices in home and is only dependent on furniture for support.

The intervention will include accessing the information about pain. It will include identifying the location of pain, duration of pain as well as intensity of pain.

Reducing muscle spam and applying appropriate nursing care plan can only be effectively applied by monitoring the pain and condition of patient.

Nursing care of CHSP service can be utilized to manage acute pain (Commonwealth Home Support Programme, 2015).

Encouraging client to use comfort measures, and stress management techniques. Encourage client to involve in physical therapies to relieve pain.

Comfort measures and stress management techniques help in promoting self control. It will also help client in enhancing coping skills. Comfort measures will help in reducing pain and intensity of pain.

Investigating the patient’s condition for severe joint and muscle spams. Any other problems associated with mobility and sudden pains will be evaluated (Makris et al, 2014).

Evaluating and identifying the forms and places of pain is very important for the early recognition of any other developing physical problem or co-morbidities.  This will also allow the healthcare professionals to prevent serious health issues (Makris et al, 2014).

Encouraging client for physical exercise, walks, and physical therapy and CPM devices.

This will help client to increase mobility. It will also enhance blood circulation in the body. Exercise will also reduce joint stiffness and relieves muscle spams (Makris et al, 2014).

ISSUE FOUR

Lack of social and family support is a very big issue for the healthcare of Mr. Jones. He does not have any family member to take care and lives an independent life. Lack of support also results in cognitive and behavioural issues and emotional distress.

The goal of care is to encourage client for working towards receiving social support and work well with coping strategies. For the holistic care and well-being of the client, social and emotional support is very essential.  Patient suffers from OA and TKR, which requires social and psychological support. Goal will include identification and mobilization of the social support resources, modifying cognitive impediments and developing supportive relationships.

First intervention would be to encourage client to participate in social activities, treatment sessions and becoming active in social networks.

Participating in social activities and becoming active in social networks encourages confidence in individuals. They build a sense of support and emotional support as well.

The patient can be benefitted with Social Support services provided by CHSP. This programme includes home based services to the patients and provides required support (Commonwealth Home Support Programme, 2015).

Establishing therapeutic relationships with client. Maintaining rapport and forming therapeutic relationships with Mr. Jones is important.

The empathetic and supportive way of the nursing professionals develops a strong sense of emotional support in older patients, who live alone. The mental health issues are found in older patient, who have lack of emotional support. Thus, nurse can provide support to patient and encourage level of functioning (Wills & Ainette, 2012).

Mr. Jones complained that he often gets bored due to loneliness, and also state about memory problems. Thus, intervention would be to assist Mr. Jones in joining different communities.

Mr. Jones must be encouraged to understand the importance of social support and community services for older people. Such services will allow him to find new friends and supportive environment (Wills & Ainette, 2012).

Nurse would counsel patient to develop self-therapy of support and gaining confidence.

Self-therapy is very important factor for an individual as it allows enhancing coping skills and communication skills with others (Wills & Ainette, 2012).

ISSUE FIVE

Impaired physical mobility is also an issue for Mr. Jone, as he suffers from OA, due to which he is not able to move his knee and make frequent movements. Impaired physical mobility is characterized by pain, discomfort, and decreased muscle strength and activity intolerance.

The goal of care is to improve physical mobility in patient.  It also aims towards improving strength and function of whole body and encouraging behaviour that allow more physical activities.

The first intervention would be evaluating and monitoring the pain and inflammation in the knee and bilateral wrists. Mr. Jones suffers from OA, due to which mobility has been reduced.

Accessing the level of inflammation and pain would allow the nurse to understand the level of physical mobility of the patient and will help in preparing appropriate nursing interventions.

Physical mobility of Mr. Jones is limited, thus CHSP service of transport can help him in going out and do shopping and managing healthcare appointments (Commonwealth Home Support Programme, 2015).

Encouraging the use of walkers, and canes. Modifying the home according to the older people living.  Encouraging independence is also important.

Mr. Jones do not use appropriate mobility support machines or CPM machines. Mr. Jones must be encouraged to use machines as it helps in easy knee bending.

Home support programs will be offered to Mr. Jones for increasing physical mobility by reducing various environmental factors.

Home based program will have regular visits of nurse and physician. It will help patient to understand importance of physical mobility, and self assisting manuals (Bhatia, Bejarano, & Novo, 2013).

Patient should be educated about physical positions, change in position frequently, and use of pillows and sand bags.

Regular change in physical position will help in increasing blood circulation, and will reduce pressure on tissues. It also facilitates self-care in patient and also reduces risk of spine injuries (Bhatia, Bejarano, & Novo, 2013).

ISSUE SIX

Self care deficit could be another issue for Mr. Jones. Due to his limited mobility and pain he may not be able to take care of personal hygiene.  Self care deficit is the problem where a patient is unable to complete hygiene activities.

The goal of the nursing care plan will be encouraging hygiene and self care in patient to prevent any kind of physical complications and infections.

Patient will be encouraged to understand the importance of self care and hygiene.

It will help to avoid any kind of skin infections and diseases. Nurse would evaluate the patient’s ability to carry out important activities for maintaining their own health.

CHSP services provide personal care to the elderly patients. This service includes assistance in bathing showering, hair care and going to toilet. Mr. Jones find difficulty in going to toilet, thus he can be benefited by this services of CHSP (Commonwealth Home Support Programme, 2015).

Nurse would monitor the patient’s capability to be able to demonstrate moderate self care abilities. Nurse would monitor physical ability of the patient.

Monitoring the patient’s ability is important to understand the level up to which patient can be responsible for self care and keeping hygiene.

Identifying the needs of the patient by direct communication and interaction with patient.

According to the needs of the patient, nurse would be able identify the required care plan, such as wholly compensatory, partly compensatory or supportive and educative system. The care to the patient would be provided according to the degree or level of deficit.

Identifying the exact reasons behind patient being self care deficit.

Mr. Jones is alone and patient of OA. He does not have any social or emotional support. Thus, being self care deficit may involve pain and discomfort, thus, appropriate measure will be taken.