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Part 1: Interdisciplinary and Aged Care Services

For the patients who are terminally ill especially the ones who are older in age and may have comorbidities of health palliative care help in improving the quality of life (Warraich, Hernandez & Allen, 2017). This kind of care is required for the patients who are suffering from terminal or life-limiting disease but it is also applicable for older people as they have multiple diseases with limited support. The present case is given of Mr. Alexander Kumar and his wife Sarah who are elderly and in the recent visit, they appear to be dishevelled, weak and are in need of care. It is seen that Alex is limping and Sarah seems underweight and Alex says that he has not visited a doctor for his leg because he is not able to drive anymore and public transport is not easy in the area where they live as his wife gets agitated at times. He has been taking care of the wound but it has not been getting better. For the management of both Alexander and Sarah, it is required that interdisciplinary care is provided which can assist Alex so that he is effectively able to manage the condition of his wife. One of the services that can be provided to the patients is aged home care services which can be effective for both of them. Before the aged care services can be assigned there is a requirement of assessment that is aged care service assessment such that the level of care can be decided for the patients (Visvanathan et al., 2020). This care is suggested because it is a government-funded policy which can help in healthcare as well as assist with activities of daily living. Home and community care can be provided for Alexander and Sarah where the care can be provided in the home care setting of the patient or even in a residential care setting (Rahman, Efird, Kendig & Byles, 2019). For the last three years, Alexander has not undergone any medical check-up and a complete assessment is required so that all the systems that be checked. Care for Alexander requires collaboration between different aspects of medical problem that is hypertension with the history of cardiovascular health as he has a history of myocardial infarction. There is a requirement of a gastroenterologist as Alexander suffers from gastric oesophageal reflux disorder (Bosman, 2019). The other care that is required is of orthopedics because Alexander suffers from arthritis which has caused the difficulty in driving and walking. He also suffers from pain which is 6 on a 10 point pain scale which requires to be taken care of so that it can be reduced and the quality of life can be improved. There is also a requirement of referral to a general physician and psychiatric for the dementia of Sarah. She has also lost weight which requires her to be referred to the nutritionist and dietitian so the nutritional state of the patient can be returned back to normal (Wallace, Campbell & Brech, 2020). This is not only required for Sarah but even for Alexander as he has an injury which can heal faster if proper nutrition is provided.

Part 2: Age-Related Changes and Patient Assessment

Assessments of Body Systems

Musculoskeletal system: Alexander suffers from arthritis which requires care and appropriate management which is the cause of pain and difficulty in doing the activities of daily living. The assessment is required so that the stage at which the disease is can be recognised so that suitable intervention can be provided (Aas et al., 2020).

Gastro-intestinal system: Alexander has a history of Gastro-oesophageal reflux disease (GORD) where the gastric acid is refluxed outside the stomach which into the oesophagus which causes difficulty in food consumption and may cause discomfort to the patient (Healthy, 2016). While Sarah is underweight and nutritional assessment needs to be done so that underlying health problems so that suitable intervention can be given to Alexander and Sarah.

Cardiovascular and circulatory system: Alex has a history of myocardial infarction and cardiovascular assessment so that appropriate work can be done and overall health can be assessed and underlying risk factors can be managed appropriately (Şimşek, 2017). He is hypertensive and circulatory system needs to be assessed which involve peripheral pulse and capillary refill time.

Respiratory system: Alexander is a smoker and being a smoker affects the health of the person as it reduces the working of the lungs. The oxygen saturation can be reduced which affects the main organs of the body like kidneys, brain and so on. Oxygen saturation can be assessed by the use of Doppler (Hazar & Gundogus, 2020).

Ocular system: Alex requires an ocular assessment as it has been long since he has got himself checked. He has other comorbidities like hypertension which can affect the eyes as well as age is one of the factors which can cause impairment of vision (Whitson et al., 2020).

Assessments to Be Done

Head to toe assessment: Alexander has not got his assessment done for a long time and it is required that all the body systems are checked and head to toe assessment is one of them. When the patient is screened in this assessment it can give various clues as to what can be the underlying cause of current health problems can be identified so that suitable nursing and medical care plan can be made (Bryant, 2017). This will also help in the identification of any complications which can help in the deducing the delay in wound healing.

Radiographs: the patient Alex has difficulty in driving the car as he has developed arthritis this can be assessed by the use of radiographs of his joints. The assessment can help in the identification of the level of destruction that has occurred and the treatment plan can be formulated (de Miguel et al., 2017).

Cardiovascular assessment: Given the history of the patient it is seen that he has myocardial infarction and angina. The assessments that need to be conducted are auscultation for carotid bruits and atrial pulse of the carotid along with jugular venous pulse and cervical venous humus. As a part of the cardiac assessment of the patient's heart auscultation needs to be done along with precordial impulses as well as palpitations of heart and murmurs (Şimşek, 2017).

Nutritional assessment: There is a history of GORD (gastro-oesophageal reflux disorder) which can cause malnutrition for these vitamin levels can be assessed by conducting blood analysis (Healthy, 2016). This assessment can help in the identification of deficiencies so that replenishment can be done.

Pulmonary assessment: the patient is a smoker and this assessment is required to know the health of the lungs as well as the oxygen saturation. This is required as chronic smoking can lead to chronic obstructive pulmonary disorder.

Part 3: Medication Management

Impact of Age-Related Changes on The Pharmacokinetics of The Drugs Administered

There are many age-related changes which can have an effect on the pharmacokinetics of the drugs which might be administered to the patient. There is a reduction in the elimination by the renal and hepatic systems which would increase the plasma concentration of the drug. Metabolism of drugs occurs in the liver while the elimination of the metabolites and the unreacted drug is by kidneys and with an increase in age the functioning of the body (van den Anker, Reed, Allegaert & Kearns, 2018). The gastrointestinal system gets affected and the absorption of the drug by the system is reduced making the bioavailability to be reduced. These changes alter the drug that is available for the action and the dosage of the drugs need to be altered accordingly.

Factors Responsible for Adverse Drug Reaction in An Elderly Patient

In case of geriatric patients, adverse drug reactions can occur as there are multiple conditions for which medications can be given to the patients for their comorbidities and it is called polypharmacy (Ridge, Macintyre, Kitsos, Murray & Bereznicki, 2019). These drugs have the ability to interact with each other and cause a reaction. The alterations in the pharmacokinetics can affect the action of the drug causing an adverse reaction. Geriatric patients can also have a problem with their memories which can either lead the patients to skip their medications or overdose which can cause adverse drug reaction.

Use of Various Medications and Their Side Effects

Medications

Uses

Side effects possible

Aspirin

Aspirin is a non-steroidal anti-inflammatory drug.

It is essentially an antipyretic drug which is also known to reduce mild to moderate pain and swelling in case of arthritis (Veronese et al., 2017).

Prolonged use of aspirin can include the risk of bleeding of the gut, stroke and even allergic reactions which can be either mild like pruritis or anaphylactic like reaction (Veronese et al., 2017).

Perindopril

It is an angiotensin-converting enzyme inhibitor which is given to the patient who suffers from hypertension (Brugts et al., 2017).

Use of perindopril for a long time can cause xerostomia, lightheadedness, diarrhea and nausea. It can cause an allergic reaction like skin rashes and blurred vision (Brugts et al., 2017).

Glycerin trinitrate spray

The patient suffers from angina which is essentially chest pain and Glycerin trinitrate spray can help in relieving the pain and the action is rapid in nature (Rees, 2020).

Prolonged use cause flushing and severe headache, vertigo, reduction in blood pressure and tachycardia (Rees, 2020).

Omeprazole

The patient has a history of GORD and administration of drug reduces the acid production such that reflux is reduced and indigestion can be reduced (Forgerini, Mieli & Mastroianni, 2018).

Potential adverse effects can be stomachache, headaches, diarrhea due to prolonged medications (Forgerini et al., 2018).

Panadol

The patient is suffering from pain due to arthritis and angina. This is a rapid pain-relieving medication which is given to the patient (Raja, Al-Shammari, Al-Otaibi & Amjad, 2020).

Potential adverse effects due to prolonged use can be is perspiration, gastrointestinal disturbances and loss of appetite (Raja et al., 2020).

Ibuprofen 

It is also a non-steroidal anti-inflammatory drug which is used for reduction in pain and associated inflammation of the joints (Wongrakpanich, Wongrakpanich Melhado & Rangaswami, 2018).

Potential adverse effects due to prolonged use can be is perspiration, gastrointestinal disturbances and loss of appetite (Wongrakpanich et al., 2018).

Part 4: Reflection

In this assessment, I have done a critical analysis of the provided case study which is related to two patients Alexander and Sarah who required assistance in palliative care. For the completion of this assessment, I undertook critical thinking and evidence-based practice to explore the various aspects of the case study. From the case study, I saw that the patients are old and have various systems that have been affected and for the assessment, I felt that interdisciplinary approach with person-centred care is the most appropriate for the wellbeing and appropriate recovery. For this assessment's completion, I have analysed the case the information used for the rationale has been extracted from high academic resources. As a healthcare professional, in this particular situation if I would have been there I would have compiled comprehensive care for the patient and the geriatric rehabilitation for both Alexander and Sarah. In the present case, I empathize with both of them as they live alone and Alex is the primary caregiver for the Sarah and has been taking care alone but because of this, he has ignored his own health. This is evident by the fact that he has a wound on his leg which has not health in the last few months and it can have underlying causes for the same which are required to be taken care of so that appropriate care plan can be made. As a healthcare professional it is required that there is effective communication with the patient, family members and within the healthcare team so that effective treatment can be provided to the patient. For effective care, interdisciplinary and collaborative interventions are required which I have understood as a part of developing the assessment.

References for Alexander Case Study

Aas, S. N., Breit, M., Karsrud, S., Aase, O. J., Rognlien, S. H., Cumming, K. T., ... & Raastad, T. (2020). Musculoskeletal adaptations to strength training in frail elderly: A matter of quantity or quality?. Journal of Cachexia, Sarcopenia and Muscle. https://doi.org/10.1002/jcsm.12543.

Bosman, R. (2019). When GOR becomes GORD: gastroenterology. In The Specialist Forum, 19 (11), 15-16. New Media. https://hdl.handle.net/10520/EJC-1d389ec8c5.

Brugts, J. J., Bertrand, M., Remme, W., Ferrari, R., Fox, K., MacMahon, S., ... & Boersma, E. (2017). The treatment effect of an ACE-inhibitor based regimen with perindopril in relation to beta-blocker use in 29,463 patients with vascular disease: a combined analysis of individual data of ADVANCE, EUROPA and PROGRESS trials. Cardiovascular Drugs and Therapy31(4), 391-400. https://doi.org/10.1007/s10557-017-6747-9.

Bryant, S. G. (2017). Keeping it in the program: Second year nursing students as stand-in patients for first year head-to-toe assessment check-offs. Nurse Educator42(2), 60-61. https://doi.org/10.1097/NNE.0000000000000323.

de Miguel, E., Pecondón-Español, A., Castaño-Sánchez, M., Corrales, A., Gutierrez-Polo, R., Rodriguez-Gomez, M., ... & Ivorra-Cortés, J. (2017). A reduced 12-joint ultrasound examination predicts lack of X-ray progression better than clinical remission criteria in patients with rheumatoid arthritis. Rheumatology International37(8), 1347-1356. https://doi.org/10.1007/s00296-017-3714-5

Forgerini, M., Mieli, S., & Mastroianni, P. D. C. (2018). Safety assessment of omeprazole use: a review. Sao Paulo Medical Journal136(6), 557-570. https://doi.org/10.1590/1516-3180.2018.0019220318.

Hazar, A., & Gundogus, B. (2020). Assessment of inflammatory markers, disease severity and comorbidities in very elderly patients with acute respiratory diseases. Archives of Medical Science16(1). https://doi.org/10.5114/aoms.2020.94495

Healthy, G. O. R. D. (2016) GORD and the elderly. The Specialist Forum, 16 (4), 22 – 24. https://hdl.handle.net/10520/EJC189164.

Rahman, M., Efird, J. T., Kendig, H., & Byles, J. E. (2019). Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women’s Health. European Journal of Ageing16(3), 293-303. https://doi.org/10.1007/s10433-018-0495-y

Raja, M. A. G., Al-Shammari, S. S., Al-Otaibi, N., & Amjad, M. W. (2020). Public attitude and perception about analgesic and their side effects. Journal of Pharmaceutical Research International, 35-52. https://doi.org/10.9734/jpri/2020/v32i330412

Rees, S. (2020). Glyceryl trinitrate. Journal of Prescribing Practice2(7), 372-373. https://doi.org/10.12968/jprp.2020.2.7.372.

Ridge, A., Macintyre, K., Kitsos, A., Murray, L., & Bereznicki, L. (2019). Assessing risk of adverse drug reactions in the elderly: a feasibility study. International Journal of Clinical Pharmacy41(6), 1483-1490. https://doi.org/10.1007/s11096-019-00908-1.

Şimşek, E. (2017). Perioperative assessment of elderly patient with cardiovascular disease. Turk Kardiyoloji Dernegi Arsivi: Turk Kardiyoloji Derneginin Yayin Organidir45(Suppl 5), 128-133. https://doi.org/10.5543/tkda.2017.26037.

van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology58, S10-S25. https://doi.org/10.1002/jcph.1284.

Veronese, N., Stubbs, B., Maggi, S., Thompson, T., Schofield, P., Muller, C., ... & Solmi, M. (2017). Low‐dose aspirin use and cognitive function in older age: A systematic review and meta‐analysis. Journal of the American Geriatrics Society65(8), 1763-1768. https://doi.org/10.1111/jgs.14883.

Visvanathan, R., Amare, A. T., Lang, C., Khadka, J., Yu, S., Beilby, J., ... & Inacio, M. C. (2020). Utilisation of general practice health assessments around an aged care assessment is associated with lower mortality risk in older Australians. Age and Ageing. https://doi.org/10.1093/ageing/afaa091.

Wallace, M., Campbell, M., & Brech, D. (2020). Role of Nutrition Focused Physical Exam in the Identification of Malnutrition in the Elderly. https://obu.edu/virtualscholarsday.php

Warraich, H. J., Hernandez, A. F., & Allen, L. A. (2017). How medicine has changed the end of life for patients with cardiovascular disease. Journal of the American College of Cardiology70(10), 1276-1289. https://doi.org/10.1016/j.jacc.2017.07.735

Whitson, H. E., Hajduk, A. M., Song, X., Geda, M., Tsang, S., Brush, J., & Chaudhry, S. I. (2020). Comorbid vision and cognitive impairments in older adults hospitalized for acute myocardial infarction. Journal of Comorbidity10, 2235042X20940493. https://doi.org/10.1177/2235042X20940493.

Wongrakpanich, S., Wongrakpanich, A., Melhado, K., & Rangaswami, J. (2018). A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging and disease9(1), 143. https://doi.org/10.14336/AD.2017.0306.

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