Implement and Monitor Care of the Older Person

Medical Diagnosis

The past medical history of the patient is associated with many complications and one of the issues is a myocardial infarction. It is considered to be one of the major cardiac issues that are directly associated with decreased blood flow to the heart that directly leads to necrosis of the muscle associated with the heart. Many complications are directly associated with the myocardial infraction include misbalanced heart rate, heart failure, increased blood pressure and increased mortality rate (Saleh, & Ambrose, 2018). Hypertension is also considered to be one of the major public health burdens that have directly increased burden over the health sector. The hypertension is directly associated with many issues that include cardiac system, renal system, metabolic issue and seizures (Singh et al., 2017).

There some more issue apart from hypertension in the patient history that has directly increased complication of the patient and one of them is osteoarthritis. Osteoarthritis is one of the major joint issues that directly increase the impairment in the individual and it can lead to the breakdown of cartilage, bone death or stress fracture (Chen et al., 2017). The accumulation of the monosodium crystals in the tissue directly leads to gout that is directly associated with joint damage, kidney stone or psychological issue (Ragab et al. 2017). Gout is also one of the complications faced by Mr Woods that has directly increased the complication. Anxiety and depression are a major concern for the health care sector as they directly increase the behavioural complication in the individual that deteriorate the health status of the patient (Sinnema et al., 2018).

Theory of Ageing

Ageing is the progressive deterioration in the physical and mental wellbeing of the individual that is justified by many theories. One of the theories that are related to ageing includes the programmed theory that state that ageing is the genetic programming of the human body that directly decreased the body functioning. The theory states that a living organism has the set biological call that directly controls the metabolic process which is also involved in the ageing process. The phenomena justify that the ageing process is related to the length of the telomerase and decreased length up to a limit leads to ageing. The direct relation of decreased metabolic functioning with ageing is also discussed in the theory (Pathath, 2017). The programmed theory indicates that body renews and repair to sustain the healthy body but decreased rate lead to ageing that is directly associated with the deteriorated metabolism. The normal physiology directly experiences the predictable changes that result in the ageing that is related to the internal biological clock. The programmed theory suggests that the ageing process can be active or adaptive depend upon the personal experience of the individual (da Costa et al., 2016). The increased age is directly associated with genetic programming and increased age of the Mr Wood with deteriorated health status is directly justified by the programmed theory of ageing. The decrease in body functioning is directly associated with increased age and it has increased complication for the patient. 

Physiology of Ageing

Ageing is one of the interesting topics that are divided into many sections that include prenatal, birth, postnatal and death. The ageing is directly associated with physiological changes in the body that can lead to deteriorating health and increased complication which lead to death. Homeostatic reserves are considered to be the hallmark for ageing and it leads to a physiological reduction in the function of the different system. Different systems are directly changed with ageing that includes the cardiovascular system, nervous system, renal system, respiratory system, endocrine and immune system. The ageing is directly lead to deteriorated functioning of the body which directly reduces the health status of the individual by increasing complication (Navaratnarajah & Jackson, 2017). Ageing leads to changes in skin that include decreased wound healing, wrinkling, decreased thermal regulation and easily damage. Vision associated changes are also viable with ageing like dark adaption, increased visual impairment and increased vision sensitivity. The cardiovascular changes associated with ageing include increased vascular stiffness, decreased cardiac muscle strength, decreased blood-pumping ability and increased load (van Beek et al., 2016). The increased complication of Mr Wood is directly associated with increased age. The myocardial infarction is due to the reduced capacity fi the cardiovascular system and hypertension is also one of the complications. Anxiety and depression directly increase with age and loneliness that increased complication for the patient.

Primary Health Services

One of the primary health services that can be provided to the dementia patient includes the multidisciplinary care approach that includes neurological examination with GSC. The mental status examination is one of the key components with the dementia patient as it helps to evaluate the progression of the disease that can be addressed by the medicines. The mental status examination helps to identify the cognitive and behavioural pattern of the individual that include memory, language, visual-perceptual, executive functioning. Mental status history is important to continuously monitor the patient condition and the effect of the intervention over the health status of the patient. The mental status examination helps the patient and the healthcare-associated to understand the current health status of the patient which can be utilized tailor the care process accordingly to improve the quality of life of the patient (Grossman & Irwin, 2016).

One of the health services that can be utilized to improve the health status of the dementia patient includes Cognitive Dementia and Memory Service. It is one of the health services programs that is specially designed for the dementia patient to support them is the multidisciplinary approach. The multidisciplinary approach includes diagnostic, referrals and educational program that aim to improve the memory loss and cognitive behaviour of the dementia patient (Victoria State Government, 2020). Theses both approach can help to improve the health status of the Mr Wood as there is need for the neurological assessment that helps to understand her current health status. The Cognitive Dementia and Memory Service can help Mr Wood to improve the memoir and cognitive functioning.

Strategies and Interventions for Dementia/challenging Behaviours

Cognitive stimulation therapy is one of the methods that help Mr Wood to improve his cognitive functioning that is necessary to improve the health status of the patient. The cognitive stimulation therapy is one of the non-pharmacological methods that help the patient to improve quality of life by reducing behavioural issue in the patient. The therapy includes different aspects that are collectively utilized to improve the health status of the patient that include reality orientation, reminiscence therapy and validation therapy (Berg-Weger & Stewart, 2017). Multisensory Stimulation is another method that can be used to help the patient encountered dementia. The therapy includes a pleasant and relaxing room that is utilized to improve the cognitive functioning of the individual. The stimulation helps to improve the visual, auditory, tactical and olfactory functioning that help to improve the cognitive function of the individual (Sánchez et al., 2015). The lifestyle intervention is another method that can be utilized to improve the health status of the patient. The intervention will include physical activity program followed by nutritional therapy that aims to improve the physical activity and nutrition intake in the patient. These help to support the recovery and improve the cognitive functioning of the patient having dementia (Toman et al., 2018). The last intervention that can help to reduce the loneliness and isolation of the dementia patient include dog therapy that is considered to improve the mental status of the patient. The dog assisted therapy is considered to be the one method that can help to cheer the dementia patient and improve their mental status (Zafra-Tanaka et al., 2019).

Oral Hygiene

The dementia patient face issue that can include reduced self-care and decrease motor skill that directly increases the risk to encounter poor oral hygiene. The dementia patients are at increased risk to encounter the dental issue that can increase their complication. The decreased capability of the dementia patient to perform the accurate oral hygiene process directly increased the complication of the patient thus increase the need to provide accurate intervention to improve oral-hygiene. The decreased oral hygiene directly lead to the dental cavity, gum disease and dental carries that can lead to the deteriorated health status of the patient (Delwel et al., 2018). Acceptance and commitment therapy is one of the methods that can be utilized to improve the oral hygiene of the individual. It is considered to the cognitive behavioural therapy that directly helps the patient to understand different aspect that can be utilized to improve oral hygiene. The psychological flexibility helps to improve the behaviour of the individual concerning the self-oral care practice. The intervention will try to reduce the chances of oral complication that can help to improve the health status of the patient (Wide et al., 2019). The incapability of Mr Wood to perform the oral care practice directly increases the chances to encounter the oral issue. The intervention can help to improve the oral hygiene practise which will help to reduce the chances of complication that occur due to decreased oral hygiene.

Pain

The pain assessment tools are considered to be one of the methods that can help to identify the intensity of the pain in the patient. The pain assessment tool can utilize the self-reporting of the patient and another tool that is utilized for the patient who is not able to self-report the pain. The tool assessment tool should be utilized according to the patient current condition and Numerical rating scale is utilized for the patient able to self-report the pain on the scale of 0 to 10. Some other tool that is utilized with the patient who is not able to self-report include Behavioural Pain Scale (BPS) and Critical Care Observation Tool (Suzuki, 2017). One of the primary symptoms of the Osteoarthritis includes joint pain that directly increases the complication of the patient. The pain experienced by the osteoarthritis patient can be constant background pain that directly increases the complication of the patient or intermittent pain that is severe and arise inconsistently.

The patient observes pain on movement of joints that include knee, elbow which directly hamper the routine of the individual (Fu et al., 2018). The method that is used to manage the pain of the patient depends upon the current intensity of the pain and preference of the patient. Two methods can be utilized to reduce the pain that includes pharmacological and non-pharmacological interventions. The pharmacological method uses the medication for reducing the pain of the individual that are utilized to reach the short-term goal. The non-pharmacological method is considered to be another method that includes nutritional intervention or exercise that help to address the long term goal of the patient (Yusuf, 2016).

Complementary Therapies

Yoga is considered to be one of the complementary therapies for the dementia patient as it helps to improve the physical as well as mental wellbeing of the individual. The yoga helps to purify the body and mind that help to generate positive thoughts which help in the healing process. Yoga helps to unite the body and mind for harmonizing health and efficiency of the patient. The yoga includes a different set of practices that aim to improve the overall wellbeing of the patient that include practising postures, sequencing movement uniting with breathing and meditation practice. The yoga helps to improve the sleeping pattern of the patient that directly help to relax the body and improve the health status (Ghaffari, 2019). Yoga is considered to strengthen the body system that helps to promote immunity and reduce the chances of infection that can deteriorate the health status. The cognitive impairment is one of the major issues faced by the dementia patient that can be addressed by practising yoga as it helps to improve the cognitive functioning of the individual which decrease the dementia patient complication. Complementary therapy is considered to be one of the best non-pharmacological treatment options that can help to improve the health status of the patient (Brenes et al., 2018).

Nursing Care Plan

The nursing care plan is considered to be one of the methods that can be used to plan the intervention technique for the patient by evaluating the patient current health status (Leoni-Scheiber et al., 2019). Clinical reasoning cycle is one of the keys practises that is utilized in the clinical setting to improve the evaluation process concerning the patient health status. The cycle consists of eight-steps that can be utilized to improve the patient analysis process (Gummesson et al., 2018).

  • Consider the patient situation:

The patient is an 85-year-old Mr John Wood he lives in a residential aged care facility in metro victoria. The handover indicates that Mr Wood has been awake overnights and staff continuously checked her to continuously monitor the patient. He was found to be awake at 1 hrs and he was getting ready for lunch that was followed by nursing helping him to reduce pain and help to maintain incontinent of urine. The next time when the staff found him confused at 3hrs that increase the need of the staff to help him to reach the bed. The staff also analysed that he was missing his sister and they try to reassure him.

  • Collect cues/ information:

His medical history indicates the deteriorating health status of the Mr Wood that has started 8 years ago when he encountered with the myocardial infarction. The myocardial infarction is one of the major cardiovascular issues that increase the complication of the patient as it occurs due to blockage in the coronary artery that leads to decrease in the blood flow which leads to the formation of thrombus which increases chances of heart failure (Lüscher, 2015). He was also diagnosed with hypertension somewhere about 1 3year ago and he also has osteoarthritis with gout in the left knee. Persistent increase blood pressure is one of the major health issues that directly increase the complication for the patient like increased risk for stroke, myocardial infarction and eventually heart failure (Zhou et al., 2018).

One of the tissue degenerative disorders directly increases the joint complication for the patient which lead to increase pain (Charlesworth et al., 2015). 2 years ago he has also diagnosed with anxiety and depression that has directly the complication for the patient. The anxiety and depression in the patient directly increase the mental complication of the patient and it leads to behavioural complication (Gerontoukou et al., 2015). The main issue with the patient recently diagnosed is dementia and urinary incontinence that is the major issue for the patient. According to the World Health Organization (2019), dementia is considered to be one of the syndromes that directly increase the behavioural and cognitive complication of the patient. Urine incontinence is also one of the major complications as it leads to decrease control over the urine passage that lead to leakage to the urine (Biswas et al., 2017). 

  • Process information:

Many risk factors are directly associated with increased risk for the urinary incontinence that includes increased age, history of stroke, cognitive impairment and medication. These factors directly lead to increase chances to encounter the urinary incontinence that increase the complication of the patient (Demir et al., 2017). The increased age and cognitive impairment due to dementia are some of the factors that directly lead to urinary inconsistency in Mr Wood. There are the different factor that directly increases the risk for the patient to encounter dementia that includes persistent blood pressure, loneliness, increased stress and sedentary lifestyle. These factors increase the risk for the patient to encounter dementia which leads to cognitive dysfunction (Sibbett et al., 2017).

Dementia leads too much complication for the patient due to impaired cognitive functioning in the individual. One of the major consequences associated with dementia patient includes memory loss that directly increases the complication of the patient as he/she will be not able to remember anything that can cause the patient to get lost. Problem-solving skill is one of the major complications that is associated with dementia that directly deteriorates the accurate judging power of the patient which can lead to relevant behaviour of the patient. Confusion concerning time and place is also one of the complications faced by the patient that leads to disturbance in the biological clock of the individual (Grover & Somani, 2016). The disturbance of the biological clock of the Mr Wood and getting ready for lunch at night directly increased complication associated with dementia. Mr Wood was found lost at 3hrs that directly lead to decreased memory of the patient which also indicate complication associated with dementia.

  • Identify problem

The actual problems associated with the patient current health status are his knee pain that has directly increased his complication in walking that requires urgent attention. Another actual problem associated with the patient includes complication associated with dementia faced by the patient that has directly increased complication of the patient.

The potential problem that can in future increase complication for the patient includes urinary tract infection that occurs due to persistent urinary incontinence that can increase complication for the patient. Another potential complication associated with an increased rate of weight loss due to inconsistency in the diet.

  • Establish goals

The goal is to improve the health status of the patient by reducing knee pain and the nurse can also assist the patient during daily activities. The intervention aims to reduce complication associated with dementia that helps to improve the cognitive functioning of the individual. The long term goal of the intervention is to reduce the chances of further complication that can further increase the complication of the patient.

  • Take action

The multidisciplinary team approach will be used to improve the health status of the patient by providing accurate non-pharmacological treatment that aims to support the patient health status. Cognitive behavioural therapy can be utilized to reduce the complication associated with dementia and improve the cognitive functioning of the patient. Dietary and physical activity intervention will help to reduce the complication associated with weight loss and osteoarthritis that directly reduce pain.

  • Evaluate

The intervention can be evaluated by the health status of the patient as it helps to improve the cognitive and physical health of the patient that can be evaluated to analyse to understand the efficiency of the intervention.

  • Reflect on the process and new learning

The incident helps me to improve my clinical skill that can be utilized to improve future practice and it will also help to improve the quality of care.

References for Mr John Woods Case Study

 Berg-Weger, M. & Stewart, D. B. (2017). Non-pharmacologic interventions for persons with dementia. Missouri medicine, 114(2), 116–119.

Biswas, B., Bhattacharyya, A., Dasgupta, A., Karmakar, A., Mallick, N. & Sembiah, S. (2017). Urinary incontinence, its risk factors, and quality of life: a study among women aged 50 years and above in a rural health facility of west Bengal. Journal of mid-life health, 8(3), 130–136. https://doi.org/10.4103/jmh.JMH_62_17

Brenes, G., Sohl, S., Wells, R., Befus, D., Campos, C. & Danhauer, S. (2018). The effects of yoga on patients with mild cognitive impairment and dementia: a scoping review. The American Journal of Geriatric Psychiatry, 27, 1-10. 10.1016/j.jagp.2018.10.013

Charlesworth, J., Fitzpatrick, J., Perera, N. K. P. (2015). Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee. BMC Musculoskeletal Disorder, 20(151), 1-12. https://doi.org/10.1186/s12891-019-2525-0

Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L. & Im, H. J. (2017). Osteoarthritis: toward a comprehensive understanding of the pathological mechanism. Bone Research, 5(16044), 1-13. https://doi.org/10.1038/boneres.2016.44

da Costa, J. P., Vitorino, R., Silva, G. M., Vogel, C., Duarte, A. C. & Rocha-Santos, T. (2016). A synopsis on aging-Theories, mechanisms and prospects. Ageing research reviews, 29, 90–112. https://doi.org/10.1016/j.arr.2016.06.005

Delwel, S., Binnekade, T. T., Perez, R., Hertogh, C., Scherder, E. & Lobbezoo, F. (2018). Oral hygiene and oral health in older people with dementia: a comprehensive review with a focus on oral soft tissues. Clinical oral investigations, 22(1), 93–108. https://doi.org/10.1007/s00784-017-2264-2

Demir, O., Sen, V., Irer, B., Bozkurt, O. & Esen, A. (2017). Prevalence and possible risk factors for urinary incontinence: a cohort study in the city of Izmir. Urologia Internationalis, 99(1), 84–90. DOI:10.1159/000466705

 Fu, K., Robbins, S. R. & McDougall, J. J (2018). Osteoarthritis: the genesis of pain. Rheumatology, 57(4), 43–50, https://doi.org/10.1093/rheumatology/kex419

Gerontoukou, E. I., Michaelidoy, S., Rekleiti, M., Saridi, M. & Souliotis, K. (2015). Investigation of anxiety and depression in patients with chronic diseases. Health psychology research, 3(2), 2123. https://doi.org/10.4081/hpr.2015.2123

 Ghaffari, M. (2019). Yoga as a complementary therapeutic modality for people with Alzheimer’s disease: a review. Journal of Yoga & Physiotherapy, 8(2), 40-46.

Grossman, M., & Irwin, D. J. (2016). The mental status examination in patients with suspected dementia. Continuum, 22(2), 385–403. https://doi.org/10.1212/CON.0000000000000298

Grover, S. & Somani, A. (2016). Etiologist and risk factors for dementia. Journal of geriatric mental health, 3, 100-107.

 Gummesson, C., Sundén, A. & Fex, A. (2018) Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews, 23(1), 29-34, DOI: 10.1080/10833196.2018.1450327

Leoni-Scheiber, C., Mayer, H. & Müller-Staub, M. (2019). Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses' knowledge and attitude: Study protocol. Nursing Open, 6(3), 1269–1280. https://doi.org/10.1002/nop2.299

Lüscher, T. F. (2015). Myocardial infarction: mechanisms, diagnosis, and complications, European Heart Journal, 36(16), 947–949, https://doi.org/10.1093/eurheartj/ehv071

Navaratnarajah, A. & Jackson, S. H. D. (2017). The physiology of ageing. Medicine, 45(1), 6–10. DOI:10.1016/j.mpmed.2016.10.008

Pathath, A. W. (2017). Theories of Aging. International Journal of Indian Psychology, 4, 15-22. 10.25215/0403.142.

Ragab, G., Elshahaly, M. & Bardin, T. (2017). Gout: An old disease in a new perspective - A review. Journal of advanced research, 8(5), 495–511. https://doi.org/10.1016/j.jare.2017.04.008

Saleh, M. & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7, 1-8. https://doi.org/10.12688/f1000research.15096.1

Sánchez, A., Marante-Moar, M. P., Sarabia, C., de Labra, C., Lorenzo, T., Maseda, A. & Millán-Calenti, J. C. (2015). Multisensory stimulation as an intervention strategy for elderly patients with severe dementia. American Journal of Alzheimer’s Disease & Other Dementias, 31(4), 341–350.

Sibbett, R. A., Russ, T. C., Deary, I. J. & Starr, J. M. (2017). Risk factors for dementia in the ninth decade of life and beyond: a study of the Lothian birth cohort 1921. BMC psychiatry, 17(205), 1-10. https://doi.org/10.1186/s12888-017-1366-3

Singh, S., Shankar, R. & Singh, G. P. (2017). Prevalence and associated risk factors of hypertension: a cross-sectional study in urban Varanasi. International journal of hypertension,2017, 1-10. https://doi.org/10.1155/2017/5491838

Sinnema, H., Terluin, B. & Volker, D. (2018). Factors contributing to the recognition of anxiety and depression in general practice. BMC Fam Pract, 19(99), 1-10. https://doi.org/10.1186/s12875-018-0784-8

Suzuki, T. (2017). Does the combination use of two pain assessment tools have a synergistic effect? Journal of intensive care, 5(1), 1-3. https://doi.org/10.1186/s40560-016-0195-7

Toman, J., Klímová, B. & Vališ, M. (2018). Multidomain lifestyle intervention strategies for the delay of cognitive impairment in healthy aging. Nutrients, 10(1560), 1-10. https://doi.org/10.3390/nu10101560

van Beek, J. H., Kirkwood, T. B. & Bassingthwaighte, J. B. (2016). Understanding the physiology of the ageing individual: computational modelling of changes in metabolism and endurance. Interface Focus, 6(2), 1-17. https://doi.org/10.1098/rsfs.2015.0079

Victoria State Government. (2020). Cognitive, Dementia and Memory Service (CDAMS). Retrieved from: https://www.betterhealth.vic.gov.au/health/ServiceProfiles/cognitive-dementia-and-memory-service-CDAMS-service

Wide, U., Hagman, J. & Werner, H. (2019). Can a brief psychological intervention improve oral health behaviour? A randomised controlled trial. BMC Oral Health 18(163), 1-8. https://doi.org/10.1186/s12903-018-0627-y

World Health Organization. (2019). Dementia. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/dementia

Yusuf, E. (2016). Pharmacologic and non-pharmacologic treatment of osteoarthritis. Current Treat Options in Rheum, 2, 111–125. https://doi.org/10.1007/s40674-016-0042-y

Zafra-Tanaka, J. H., Pacheco-Barrios, K., Tellez, W. A. & Taype-Rondan, A. (2019). Effects of dog-assisted therapy in adults with dementia: a systematic review and meta-analysis. BMC psychiatry,19(1), 41. https://doi.org/10.1186/s12888-018-2009-z

Zhou, D., Xi, B., Zhao, M., Wang, L. & Veeranki, S. P. (2018). Uncontrolled hypertension increases the risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Scientific reports, 8(9418), 1-7. https://doi.org/10.1038/s41598-018-27377-2

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