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  • Subject Name : Nursing

Care in Old Age

  • The management and support for Mrs. Djokic presents with unique challenges and requires nursing interventions. Primarily, the acute conditions related to the chronic illnesses need to be resolved. As it has been mentioned in the case history that there is a discrepancy between the dosage of insulin prescribed and administered to her at the aged care, symptoms of hyperglycemia and ketoacidosis can be observed in the patient. It is essential to maintain and administer the dosage prescribed to help improve her condition. Increased confusion, urinary incontinence, psychosis, delirium and depressed state can be attributed to prolonged hyperglycemia due to discrepancy between the dosage of insulin administered (Institute for Quality and Efficiency in Health Care, 2017). It needs to be managed by alerting the healthcare team.

It can also be established from the case history that the patient is depressed, confused and drowsy which suggests that the patient needs immediate care with respect to her mental health and a suicide risk assessment should also be performed. Apart from this, it is essential for the nursing staff to treat her with patience, look after her meals and medication and to maintain a silent environment around her. Urinary incontinence seems to be harmless in the shorter duration and can be give less importance due to other critical conditions, however, it is potentially life-threatening (Foreman, 2009). It is vital to look after urinary incontinence and prevent the soiling of the patient’s bed. The patient is also at an increased risk of cross-infection as Mrs. Djokic was residing at an aged care home. Hence, the hygiene of the patient should be scrutinized, wounds and skin tears to be looked for and a wash and change clothes should be provided to the patient.

General management of the chronic conditions is also of great significance and needs attention. For type-1 diabetes the management may include monitoring the blood glucose levels, monitoring closely for the signs of hypoglycemia, monitoring the anion gap, monitoring the fluid balance, administration of a prescribed dosage of insulin and medications (Wood, 2012). For dementia the management may include provision of a quiet environment with minimal stimuli, assisting the patient in daily activities, talking and dealing with the patient calmly and patiently, using simple and short sentences, assisting the patient in taking medications, meals and hygiene care, maintaining a schedule for toileting and avoiding mechanical restraints (Cruz et al., 2012).

  • To make the management of Mrs. Djokic’s condition less traumatic for her and her family as well as to prevent the worsening of her condition a few steps can be taken. These steps include counselling the patient and her family about the patient’s condition, informing them about the cause and discussing the treatment plan as well as sharing information about how her condition could have been prevented. It is essential to closely monitor the patient’s condition such as blood glucose levels and symptoms as well as to keep a close eye on her behavior as the patient is in a confused and depressed state. It is essential to maintain a calm environment around her and to communicate with her as calmly as possible.

The nursing staff should try to maintain a sleeping schedule, a diet chart and a toileting schedule. Medication administration of the patient should be strictly maintained and followed. There are increased chances of fall as the patient has dementia hence adequate lighting should be maintained and the patient should be assisted while walking and in daily activities such as changing clothes, washing etc. As the patient is prone to violent outbursts because of mental health status it is essential to keep any dangerous or harmful items and medicines out of the patient’s reach. Since the patient is diabetic there are increased chances of infections and ulcers. To prevent infections, the patient should be examined for any wounds or signs of infection and to prevent ulcers such as pressure ulcers, the patient should be made to get up from the bed at frequent intervals and made to change the posture of lying on the bed after some intervals.

References for Mrs Evanka Djokic Case Study

Cruz, C., Fisher, A.S., Lussier-Cushing, M. & Repper-DeLisi, J. (2012). Dementia. In Buttaro, T.M. Nursing Care of the Hospitalized Older Patient. Wiley: Hoboken.

Foreman, M.D. (2009). Critical Care Nursing of Older Adults Best Practices (3rd ed). Springer Publishing Company: New York.

Institute for Quality and Efficiency in Health Care. (2017). Hyperglycemia and hypoglycemia in type 1 diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK279340/

Wood, S.L. (2012). Diabetes. In Buttaro, T.M. Nursing Care of the Hospitalized Older Patient. Wiley: Hoboken.

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