Medical Diagnosis

Mrs. Natia Euta, has been admitted to the hospital upon being inflicted with a cerebrovascular accident. If left untreated, the stroke can lead to long term negative impacts in the form of loss or difficulty of speech, movement, cognition or swallowing, which can lie undetected from weeks to almost years after the episode (Rashid et al., 2016). The patient also has a medical history of obesity and type 2 diabetes mellitus. If left untreated, obesity as well as diabetes has been associated with long term impacts of an abnormal lipid metabolism, result in adipose and fatty steak deposition in the blood vessels, further increasing the susceptibility of the patient to cardiovascular diseases and myocardial infarction in the future (Furukawa et al., 2017). Lack of treatment of the medical history of hypertension, may result in long term impact of artery hardening and narrowing, blood vessel bulging or aneurysms, enlargement or left ventricular hypertrophy, irregular heartbeat or arrhythmia and further susceptibility blood vessel rupturing, stroke and hemorrhages (Zanchetti, 2017). The patient also has a medical history of a transient ischemic stroke which produces symptoms similar to a stroke. Despite the absence of permanent or severe damages, lack of treatment  leads to long term impacts of increasing the susceptibility of stroke (van Rooji et al., 2016). Mrs. Natia also has a past medical history of osteoarthritis. Lack of treatment can lead to long term impacts of muscles and joints stiffening and losing mobility over time, leading to loss of movement, susceptibilities to fracture and possible joint deformities (Paterson et al., 2015).

Mrs. Natia is of 76 years of age, which increases her susceptibilities of acquiring the physiological changes associated with ageing. Ageing leads to detrimental changes in the muscoskeletal system leading to shrinkage in the size and reduction in flexibility of muscle tissues and difficulty in mobility. Further loss of bone density results in weakening of bones and age associated osteoarthritis as can be observed in Mrs. Natia. Hence, her age will considerable reduce her abilities of locomotion and movement, further making it difficult for her to conduct daily life activities (Curtis et al., 2015). Ageing has also been associated with detrimental neuroendocrinal activities resulting in increased insulin resistance leading to impaired metabolism and associated diabetes as observed in Mrs. Natia, which will affect her daily life by reducing her body’s ability to metabolize and utilize essential nutrients (Das, 2015). Ageing also has been linked to reductions in the cardiac output followed by hardening of blood vessels and increase in hypertension, further increasing one’s susceptibility to strokes, myocardial infarction and atherosclerosis as observed in Mrs. Natia’s risk of stroke acquisition as observer in her medical history (Merz & Cheng, 2016). Ageing also leads to loss of alveolar elasticity and gas exchange abilities which may negatively affect Mrs. Natia’s daily activities through occurrences of breathing difficulties and chest tightening (Haq & McElhaney, 2014). Ageing has been associated with decreased functioning of the central nervous system due to decrease in the number of neuronal dendrites, which can negatively affect the patient’s performance of daily activities through reduced cognition and increased susceptibilities to mental health disorders like anxiety which has already been observed in Mrs. Natia (Rawji et al., 2016).

Age of Individual

In the case of Mrs. Natia, along with the detrimental effects of her ageing, her extensive medical complications further puts her at increased risk of complications. Hence, prior to surgical procedures, a multidisciplinary team must be adopted considering the varied medical conditions of Mrs. Natia (Pearce et al., 2016). The clinical team prior to procedures, must carry out preoperative assessments in the fields of cardiac assessment, pulmonary assessment, abilities to make decisions, dementia and associated impaired cognition, risk of falls, mobility, risk for delirium post operation, medications consumed, availability of adequate support from patient’s family and social networks, counseling, fraility and status of food and nutrient intake (Knittel & Wildes, 2016). Assessments of fraility and risk of falls must be conducted considering the patient’s history of osteoarthritis while cardiac assessment is essential to monitor existing cardiac functioning considering patient’s history of strokes and hypertension (Kim et al., 2016). Surgical procedures often leave elders confused and anxious, hence requiring delirium assessment as Mrs. Nadia has already begun to show signs and symptoms of distress and anxiety (Robinson & Rosenthal, 2015). Obese patients are susceptible to hemorrhages or blood loss prior to surgery due to their associated hypertension, hence along with cardiac assessment, nutritional screening must be performed in Mrs. Natia considering her medical history (Clavellina-Gaytán et al., 2015).

While caring for Mrs. Natia, the nurse or doctor must always ask for permission before entering her room, followed closing of doors and curtains during appropriate times. Considering her gender, the medical team must aim to provide same sex accommodation to Mrs. Natia along with provision of same sex bathrooms which are clean and hygienic (Quinn & Happell, 2015). Mrs. Natia is a Samoan and may have preferences and needs unique to her culture. Hence the medical team must communicate with her to enquire about her cultural beliefs or employ an interpreter for with possessing similar cultures in order to make her feel respected and at ease. The hospital can communicate further with the nearest interpreter, aboriginal or multicultural institute for the purpose of providing culture competent treatment (Betz & Wintemute, 2015).

With age, Mrs. Natia may be at a risk of reduced mobility and increased susceptibility to fractures due to her comprised muscoskeletal and bone health associated with reduced number and flexibility of muscle fibers and reduced bone densities. Age puts her at a risk of cardiovascular ailments due to age associated artery hardening, increased hypertension and reduced cardiac output. Age also puts the patient at a risk of reduced cognition due to reduction in neuronal dendrites and increased metabolic disorders due to age associated insulin sensitivity (Scott-Warren & Maguire, 2017).

Usage of anesthesia prior to surgery in elderly patients has been documented to increase the risk of post operative cognitive dysfunction and delirium (Rajesh, 2015).

Ageing puts Mrs. Natia at a risk for reduced cognition due to age associated loss of neurons. Surgery also puts her at a risk of cognitive loss since surgical procedures in the elderly has been documented to increase the risk of post operative cognitive dysfunction and delirium. Further, occurrence of cerebral stroke as experienced by the patient, increases the risk of cognitive mental disabilities such as Alzheimer’s and dementia (Kubu et al., 2017).

Preparing for Procedures

Deep Vein Thrombosis, Venous Thromboembolism and Pulmonary Embolism increases the risk of strokes and hemorrhages as evident in Mrs. Natia suffering from prolonged headaches, which further puts the patient at a risk of loss of speech, movement and food ingestion behaviors like swallowing. Strokes due to thromboembolism also increase the risk of dementia and Alzheimer’s (Chung et al., 2014).

Loss of movement due to the patient’s arthritic condition increases the risk of pressure ulcers. Immobility also increases the risk of age associated muscle wastage or sarcopenia in elders like Mrs. Natia (Abe et al., 2016).

References

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