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Introduction

The case study includes a 72-year-old Leonie and she was recently administered to the emergency department because Leonie was confused and agitated in the market. The initial assessment of the reveal that she is febrile and increase blood pressure also observed after that she was diagnosed with UTI then prescribed with antibiotics. The medical history of the patient reveals that she had a pressure ulcer on her left leg, urinary urgency, arthritis in her knees and hypertension. The family background of the Leonie indicates that the reason for deteriorated health is her husband’s death and she does not have a child but have 2 sisters. There are certain issues raised by her sister regarding the lifestyle of the Leonie that has increased her complication which include increasing consumption of microwave meal, increased weight and decreased personal care. The report is going to discuss a different issue and possible intervention for Leonie.

Behavioural Health Risk Factors

The three behavioural risk factor that has deteriorated health status of the Leonie include a sedentary lifestyle, poor dietary routine and unhygienic condition.

The change in the lifestyle after Leonie’s husband death leads to a decrease in physical activity which ultimately leads to a sedentary lifestyle. A sedentary lifestyle is considered to be a decrease in physical activity that directly increases the complication of the individual. The decrease in physical activity increased the risk as it directly increases the burden over different body functioning unit. The increase sedentary lifestyle has increased the risk for non-communicable disease the directly increase the risk for deteriorated health and mortality of individual (González et al., 2017).

The poor dietary routine is one of the behavioural risk factors faced by Leonie that increase the prevalence of the different disorders. The microwave meal is preferred by Leonie’s since the past 6 months that directly affected her weight and deteriorated health status. The body requires the proper amount of nutrition on a daily bases to sustain properly and maintain health status. The nutrition’s are required in fixed amount decrease or increase nutrition intake can lead to issue for the individual. Poor nutrition intake which includes insufficient intake or high intake leads to many complications like obesity, hypertension, hypercholesterolemia and heart disease (Khan et al., 2018).

The unhygienic condition of the Leonie is also one of the major risk factors for urinary tract infection. The unhygienic condition directly increases the chances of infection which lead to increased risk for the urinary tract infection. The major reason behind the urinary tract infection is the bacterial infection that arises due to the decrease shower, dirty clothes or hygienic habit that act as a reservoir for the microorganism which causes infection (Vyas, 2015).

Best-Practice Assessment Tools

The first method that can be utilized to evaluate the patient condition is the mini mental assessment method. It is considered to be the psychometric screening tool that helps to analyse the cognitive function of the individual. It is involved to assess the memory, attention and language of the individual that can help to understand the patient condition. It includes the 30-point questioner that is framed to understand the cognitive impairment of the patient that can be utilized to provide accurate care to the patient.it is considered to be one of the good tools as it does not require any equipment or expertise of the health care professional (Arevalo-Rodriguez et al., 2015).

The fall assessment is also one of the important methods that can be utilized to identify the risk of fall in individual. One of the fall assessment tools is proposed by the Johns Hopkins medicine that include set questioner to be utilized to identify the fall risk of the patient. The question includes different aspect like fall history, bowel and urine, medication and equipment utilized. The different factor then collaborates counter to calculate the fall score and if the falls score is greater than 13 it indicates higher fall risk (Johns Hopkins Medicine, 2019). One of the assessment tools that can be utilized to identify the nutrition status of the patient includes the mini nutritional assessment.

It is considered one of the easy and less time-consuming method that can be performed in 10 min by a brief questionnaire that can help in the evaluation of the nutrition status of the individual. The questions are divide into two part that includes screening and assessment and the total score of all the questions are used to evaluate the nutrition habit. It is considered to be more sensitive and specific to analyse the nutrition status in the patient when compared to other nutritional assessment tools. It includes a total of 18 questions that divided into four main categories like dietary assessment, subjective assessment, global assessment and anthropometric (Hailemariam et al., 2016).

Interventions

The deteriorated health status of the Leonie urgently requires lifestyle changes to improve the health status as it works to improve the all-round betterment of the patient. The lifestyle intervention utilized different aspect that will be utilized to uplift the health of the patient. The first aspect that will address by the intervention is the diet and it helps to maintain the proper nutrition intake that will reduce burden over the body functioning while improving nutrition intake. The second aspect includes physical activity that helps to reduce the sedentary lifestyle by incorporating supervise exercise in the daily routine that can help to improve endurance and strength of the individual. The third aspect includes a socializing aspect that includes increasing social presence that helps to improve the social circle that leads to improved mental and physical wellbeing (Mountain et al., 2017). The lifestyle intervention will help to maintain the blood pressure, poor dietary habit and sedentary lifestyle of the Leonie that help to maintain health status.

Cognitive therapy is also one of the methods that can be utilized to improve the mental distress of the Leonie to improve the mental wellbeing of the individual. Cognitive-behavioural therapy includes the behavioral and cognitive therapy to improve the emotional or behaviour of the individual. The cognitive-behavioral therapy helps to improve the self-skill of the individual to control over the thought, behavior and feeling of the individual. Cognitive therapy aims to change the distorted thinking of the individual and behavioral therapy includes skill modification to improve mental wellbeing.

The nurses can help the patient by identity in the negative thought followed by the challenging thought process and least step is to replacement of the though proves to more realistic form. The main objective of the therapy is to improve the mental wellbeing by teaching, coaching and reinforcing positive behavior in mentally low individual to improve the mental wellbeing. Many aspects are addressed by the therapy which includes mood disorder, anxiety, personality disorder, eating disorder and confusion to improve mental wellbeing (Lorenzo-Luaces et al., 2016).

Registered Nurse Obligation

The intervention that is utilized to help Leonie to increase the health wellbeing is framed as per the patient current health status to provide person-centred care. Nursing and Midwifery Board (2017a) code of conduct state that nurses should provide the person-centred care to improve the wellbeing of the patient. Nurses should work in a manner that encourages the patient to indulge in the decision that will tailor the treatment process as per the patient requirement. The patient should be informed about the treatment process to increase the awareness of the individual.

The interventions are tailored to improve the patient health status by utilizing an accurate assessment that helps provide proper care to the patient. The Registered Nurse standard includes seven principles that are needed to be followed during the patient to promote quality of care. The 4 standard states that nurses are expected to conduct a timely assessment by utilizing a holistic approach that is culturally safe. The nurse should work in partnership during the treatment process to improve the wellbeing of the patient by providing cultural and patient appropriate care. The nurses should utilize the clinical skill during the assessment to predict the accurate treatment that aims to improve the patient health status (Nursing and Midwifery Board, 2017).

The interventions that are utilized to increase the health status of the patient are accurate as they are planned after patient assessment to increase the quality of care. Nursing and Midwifery Board have proposed code of ethics that help the nurse to work according to the ethical and legal framework to improve the care process. The first code of ethics states that nurses are expected to provide accurate care that aims to decrease recovery time. Health care associates utilize decision making skill during patient care to ensure accurate care. The nurse should value quality nursing care ability with collaboration to patient preference to deliver the quality of care (Nursing and Midwifery Board, 2017b).

The report discusses the case study related to Leonie as she was recently admitted to the emergency department as she was confused and agitated. After the case analysis, it was revealed some behavioural factor associated with the patient are obesity, sedentary lifestyle and the poor dietary that lead to the deteriorated health of the Leonie. The assessments that were can be conducted for the patient includes mini mental assessment, fall assessment and mini nutrient assessment to understand the issue with individual health status. Two interventions were suggested to improve the health status that includes lifestyle modification and cognitive behavioural therapy to reduce health-associated complication. The interventions that are suggested by utilizing professional skill to increase the patient wellbeing that includes code of ethics, professional standards and code of conduct. 

References

Arevalo-Rodriguez, I., Smailagic, N., Roqué I Figuls, M., Ciapponi, A., Sanchez-Perez, E., Giannakou, A., Pedraza, O. L., Bonfill Cosp, X., & Cullum, S. (2015). Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI). The Cochrane database of systematic reviews, (3), 1-74. https://doi.org/10.1002/14651858.CD010783.pub2

González, K., Fuentes, J., & Márquez, J. L. 2017. Physical inactivity, sedentary behaviour and chronic diseases. Korean Journal of family medicine, vol. 38, no. 3, pp. 111–115. https://doi.org/10.4082/kjfm.2017.38.3.111

Johns Hopkins medicine. (2019). Fall Risk Assessment. Available at: https://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html

Hailemariam, H., Singh, P. & Fekadu, T. (2016). Evaluation of mini nutrition assessment (MNA) tool among community dwelling elderly in urban community of Hawassa city, Southern Ethiopia. BMC Nutr 2(11), 1-6. https://doi.org/10.1186/s40795-016-0050-1

Khan, A., Khan, S. U., Khan, S. Zia-ul-islam, S., Baber, N. K. & Khan M. 2018. Nutritional complications and its effects on human health. Journal of Food Science and Nutrition, vol. 1, no. 1, pp. 17-20.

Lorenzo-Luaces, L., Keefe, J. & DeRubeis, R. 2016. Cognitive-behavioural therapy: nature and relation to non-cognitive behavioral therapy. Behaviour Therapy, vol. 47, pp.1-19. 10.1016/j.beth.2016.02.012.

Mountain, G., Windle, G., Hind, D., Walters, S., Keertharuth, A., Chatters, R., Sprange, K., Craig, C., Cook, S., Lee, E., Chater, T., Woods, R., Newbould, L., Powell, L., Shortland, K.,

& Roberts, J. 2017. A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial. Age and Ageing, vol. 46, no. 4, pp. 627–634. https://doi.org/10.1093/ageing/afx021

Nursing and Midwifery Board. 2017. Registered nurse standards for practice. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Nursing and Midwifery Board. 2017a. Professional Standards. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursing and Midwifery Board. 2017b. Professional Standards. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx.

Vyas, S., Varshney, D., Sharma, P., Juyal, R., Nautiyal, V., & Shrotriya, V. (2015). An overview of the predictors of symptomatic urinary tract infection among nursing students. Annals of medical and health sciences research, 5(1), 54–58. https://doi.org/10.4103/2141-9248.149790

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