Palliative Care Analysis

Part I: Aged Care Services and Interdisciplinary Care

Palliative care is a critical component of nursing and healthcare and aims to enhance the overall quality of life of elderly patients who are terminally ill and possess multiple health complications (Dudley et al., 2019). In the given case scenario, Alexander and Sarah are both elderly individuals who appear physically weak and require care. The interdisciplinary care needed for the patient involves primary care for dementia for Sarah to assist Alexander. Therefore, aged home care services can be used by the couple for the well being of both of them. Financial assistance for aged individuals can also be sought through government policies to promote medical attention and ensure healthcare access for the elderly couple as they are self-funded and can use medical aid. As the children of the couple live interstate, primary care nurses are required to provide constant support and promote well-being and maintenance of the health of Alexander and Sarah to ensure their physical as well as emotional well-being (Wordingham et al., 2017). Alexander has not attended a thorough medical check-up in the last three years and therefore needs a complete assessment of his wellbeing. For medical assistance, collaborative care is required for Alexander, for effective management of hypertension and the management of cardiovascular health as the patient has a history of myocardial infection. Alexander also suffers from GORD requires management through the assistance of a gastroenterologist (Gerhart, 2019). Alexander also has arthritis and thus has difficulty in walking and driving, therefore management and care from orthopedics is also required. Immediate intervention for pain management is also needed as the current pain in the patient is at 6/10 on pain scale and cause of major discomfort in day to day life and is the primary cause of hindrance in the independence of the patient. Further, wound care and management is needed for Alex for the existing wound that is being self cared for from the last three months. This is needed as proper care will prevent the risk of infection development and sepsis. Alexander is a smoker with 10-15 cigarettes every day, this can significantly impact his health and cause deterioration. Therefore, he requires assistance from cessation program as well as suitable counselling that will assist in the management of tobacco and alcohol consumption as well as stress management (Gerhart, 2019). A decreased appetite has been identified that must be mitigated through assistance or nutritionist to ensure that the required nutrients are ensured in the diet of Alexander and Sarah to prevent secondary complications, promote health, and prevent the development of deficiencies (Wordingham et al., 2017).

Part II: Age-Related Changes and Patient Assessments

Body systems for assessments

The five body systems that should be taken into consideration for caring for Alexander include:

Musculoskeletal system: Patient is suffering from arthritis and requires immediate care and management. The excessive pain and difficulty in walking are associated with arthritis (Zegkos et al., 2016). Therefore, assessment of this system will help in the identification stage of disease progression and assist in the application of suitable intervention (Nikiphorou et al., 2016).

Digestive system: Patient has a medical history of GORD (Gastroesophageal reflux disease), that is the stomach leaks the food the gullet and causes difficulty in food consumption and digestion and also causes major discomfort (Savarino et al., 2018). The patient appears weak and underweight. Therefore, assessment of the digestive system should be done to identify the underlying health problems and promote the development of suitable interventions for the health management of the patient (Savarino et al., 2018).

Cardiovascular system: Alexander has a medical history myocardial infarction and angina. Therefore, a cardiovascular assessment should be done for the assessment of his wellbeing and overall health (Gerhart, 2019).

Respiratory system: Patient smokes 10-15 cigarettes every day, this is likely to assert a significant impact on the respiratory health of the patient (Lewis, 2016). Therefore, a pulmonary exam should be conducted and the respiratory system of the patient must be examined.

Circulatory system: Alexander has a medical history of hypertension along with the habit of drinking and smoking. This can exert a significant impact on the circulatory health of the patient. The patient also has several cardiovascular problems. And therefore, it is suggested that the circulatory system of the patient is tested to ensure his wellbeing and overall beneficence (Giddens, 2019).

Assessments to be performed

The medical assessments that should be performed for Alexander include the following:

Head to toe assessment:  A primary head to toe examination should be conducted for Alexander as he has not been taking a proper medical exam for the last three years. Therefore, the patient should be screened through the primary head to examination to identify critical cues associated with a current health condition and medical history identify potential problems and to develop suitable care plan and interventions for health management and beneficence of the patient (Giddens, 2019). This will also assist in the identification of complications with wound with the physical examination of injury and need of focused assessments associated with same (Lewis, 2016).

X-rays: The health of the knee joints of Alexander should be done using the X-rays. This will allow the screening of the knees and assist in the identification of disease progression in the patient (Nikiphorou et al., 2016). X-rays are done in consideration with physical examination and symptoms like pain and swelling patients with arthritis and help in the development of suitable interventions associated with the health of the patient (Zegkos et al., 2016).

Cardiovascular assessment: A cardiovascular assessment should be done due to the health history of angina and myocardial infarction in the patient. The carotid arterial pulse and the auscultation of the carotid bruits of the patient should be identified along with jugular venous pulse and cervical venous hums (Giddens, 2019). The precordial impulses of the patient should be noted with palpations of the heart sound and the murmurs. Auscultation of the heart should be done for cardiac assessment of the patient (Wordingham et al., 2017).

Vitamin profile through blood assessment: Alexander has a medical history of Gastroesophageal reflux disease and also has indicated that his diet has limited food intake. Therefore, assessment vitamins of the patient are suggested to identify the consequences of limited food intake (Savarino et al., 2018). This will also help in the identification of the cause of decreased body weight and any deficiencies if present in the patient due to poor diet. 

Pulmonary examination: The patient has a medical history of smoking every day and, therefore, a pulmonary examination is required to assess the health of lungs of the patient (Wordingham et al., 2017).

Part III: Medication Management

Age-related changes that impact on pharmacokinetics

The pharmacokinetic changes with medication in the elderly are associated with increased sensitivity an absorption of drugs like anticoagulants and the cardiovascular drugs (Thürmann, 2020). The primary age-related pharmacokinetic change associated with the medications is the reduced renal elimination of the medications (Dudley et al., 2019). After 40 years of age, the creatinine clearance of the medication decreases gradually, and thereby, increased concentration of the drugs is present in the blood (Currie, 2018). The effectiveness of the drugs also decreases with age and increased risk of adverse reactions is thus observed in elderly patients (Thürmann, 2020).

Factors associated with increased risk of an adverse drug event in elderly

Factors associated with increased risk of an adverse drug event in the elderly include the presence of multiple medical complications and thereby enhanced drug consumption, polypharmacy, reduced drug elimination, and metabolic changes (Currie, 2018). In the given case, Alexander at increased risk of an adverse drug event as he has multiple health complications and has been prescribed multiple medications for the same. Therefore, Alex is aged with altered pharmacokinetics and dynamics of medications, poor drug elimination, polypharmacy that increases his risk of developing an adverse drug event.

Medication use and side effects

Medication of Alexander

Use of medication

Potential side effects

Aspirin

Medication is generally used as an antipyretic, however, it is also used to alleviate mild pain and swelling in patients with arthritis. The drug belongs to the class of nonsteroidal anti-inflammatory drug (NSAID) (Hajialilo et al., 2019)

The side effects associated with prolonged use of aspirin include increased risk of stroke, gastrointestinal bleeding, and allergic reactions (Hajialilo et al., 2019).

Perindopril

The drug is used to treat patient with hypertension and belongs to the class of angiotensin-converting enzyme inhibitor. (Ancion et al., 2019)

The side effects associated with prolonged use of medication are dry mouth and lightheadedness, headaches, nausea and diarrhea. Blurred vision and skin rashes may also occur with the use of medication (Ancion et al., 2019).

GTN spray

A glycerin trinitrile (GTN) spray is given to relieve pain in the chest in patients that suffer from health conditions like angina. The spray provides rapid relief from the pain (Rees, 2020).

The side effects associated with prolonged use of medication are severe headache, flushing. Vertigo, tachycardia, and hypotension (Rees, 2020).

Omeprazole

The drug is an antacid and used to decrease the amount of acid in the stomach and provide comfort to the patients that have indigestion and problems associated with acid reflux (Zuriaga et al., 2019).

The side effects associated with prolonged use of medication are headaches, diarrhea, and mild stomach pain (Zuriaga et al., 2019).

Panadol

The drug is used as rapid pain relief and discomfort associated with headache and also for patients that have pain due to osteoarthritis (Richards & Edwards, 2020).

The side effects associated with prolonged use of medication are increased perspiration. Headaches, digestive problems, and loss of appetite (Richards & Edwards, 2020).

Ibuprofen

Medication is a painkiller used for inflammation and pain associated with joints (Oliveira et al., 2019).

The side effects associated with the use of medication are stomach pain, nausea, digestive problems, heartburn, and constipation (Oliveira et al., 2019).

Part IV: Personal Reflection

As a part of the assessment, I was asked to critically analyze a case study of a patient that required assistance in a Palliative care setting. I approached this assessment with a critical approach and used evidence-based practice for the compilation of the assessment. Having analyzed the case of Alexander, I realized that patient required critical attention and person-centred care with focused assessments for his well-being. As I was compiling this assessment, I felt highly informed as I read various resources and study material that helped me in compiling the key findings in this assessment. If I were in this situation, I would have ensured comprehensive care for Alexander and would have tried my best to provide comprehensive care and collaborative assistance that was required by the couple. As a developing healthcare professional, I acknowledge the need for empathy and the critical need for person-centred care practices for the well being of the patients. Alexander is the primary carer for his wife, Sarah, who requires constant care and therefore, has not been able to pay attention to his own well being and health. The children of the couple live interstate and there is no economic aid available shifting the entire burden of care and management of the health of self as well as of Sarah on Alexander. The provision of care becomes even more difficult with existing health complications of Alexander himself and the age-related health problems that hinder his mobility and independence. As a care nurse, I would have ensured that I connect the couple to care facilities and ensure financial aid and care from these facilities to improve the quality of life. I would have also ensured that I communicate effectively and understand the needs of the patient and deliver the best quality care. I would have also educated Alexander about the importance of regular assessments at his age and how he should not ignore his health. As a practitioner, in the given case scenario, I would have also ensured that interdisciplinary and collaborative interventions are applied for the care of the patient to ensure his well being and health.

References for Alexander Kumar and Sarah Case Study

Ancion, A., Tridetti, J., Trung, M. L. N., Oury, C., & Lancellotti, P. (2019). A review of the role of bradykinin and nitric oxide in the cardioprotective action of angiotensin-converting enzyme inhibitors: Focus on perindopril. Cardiology and Therapy, 1-13. https://link.springer.com/article/10.1007/s40119-019-00150-w

Carneiro, P., Villarroya, A., Colim, A., Torres, M., & Arezes, P. (2019). Ergonomic study of nursing tasks in surgical hospital services. In International Conference on Healthcare Ergonomics and Patient Safety (pp. 29-36). Springer, Cham. https://doi /10.1007/978-3-030-24067-7_4

Currie, G. M. (2018). Pharmacology, part 2: Introduction to pharmacokinetics. Journal of Nuclear Medicine Technology, 46(3), 221-230. http://tech.snmjournals.org/content/46/3/221.short

Dudley, N., Ritchie, C. S., Rehm, R. S., Chapman, S. A., & Wallhagen, M. I. (2019). Facilitators and barriers to interdisciplinary communication between providers in primary care and palliative care. Journal of Palliative Medicine, 22(3), 243-249. https:// doi/abs/10.1089/jpm.2018.0231

Gerhart, J. (2019). Advantages and challenges of an interdisciplinary palliative care team approach. Practicing Primary Palliative Care, An Issue of Surgical Clinics, Ebook, 99(5), 815. https://books.google.com/books?hl=en&lr=&id=5vWrDwAAQBAJ&oi=fnd&pg=PA815&dq=interdisciplinary+care+in+palliative+care+arthritis&ots=YQcbnQXK7A&sig=G1TB9Ekldm7ZeB9o3xzNv6n7nVs

Giddens, J. F. (2019). Concepts for nursing practice e-book. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=5nTADwAAQBAJ&oi=fnd&pg=PP1&dq=clinical+nursing+book&ots=oYAT88bwgx&sig=Oi91sxhqM68rwjkXIcPPHnml1P8

Hajialilo, M., Ghorbanihaghjo, A., Ghassemi, F., Khabbazi, A., & Mahdavi, A. M. (2019). Effect of low-dose aspirin on platelet aggregation inhibition in patients with rheumatoid arthritis. Journal of Research in Clinical Medicine, 7(4), 110-117. https://jrcm.tbzmed.ac.ir/Article/jarcm-31724

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-surgical nursing-e-book: assessment and management of clinical problems, single volume. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=vGclDwAAQBAJ&oi=fnd&pg=PP1&dq=clinical+nursing+book&ots=9JSuRCCTd4&sig=BKTota-LMT0_O5JI9vxjs_nU8GI

Nikiphorou, E., Radner, H., Chatzidionysiou, K., Desthieux, C., Zabalan, C., van Eijk-Hustings, Y., ... & Gossec, L. (2016). Patient global assessment in measuring disease activity in rheumatoid arthritis: A review of the literature. Arthritis Research & Therapy, 18(1), 251. https://doi: 10.1186/s13075-016-1151-6

Oliveira, I. M., Borges, A., Borges, F., & Simões, M. (2019). Repurposing ibuprofen to control Staphylococcus aureus biofilms. European Journal of Medicinal Chemistry, 166, 197-205. https://www.sciencedirect.com/science/article/pii/S0223523419300613

Rees, S. (2020). Glyceryl trinitrate. Journal of Prescribing Practice, 2(7), 372-373. https:// /doi/abs/10.12968/jprp.2020.2.7.372

Richards, A., & Edwards, S. L. (2020). A nurse's survival guide to drugs in practice e-book. Elsevier. https://books.google.com/books?hl=en&lr=&id=I4X3DwAAQBAJ&oi=fnd&pg=PP1&dq=Panadol+drug+action&ots=CGVyNdIm4D&sig=d5ZKIcSJdFM0PbO5PFrdaZfGUt4

Savarino, E., Bredenoord, A. J., Fox, M., Pandolfino, J. E., Roman, S., & Gyawali, C. P. (2018). Erratum: Advances in the physiological assessment and diagnosis of GORD. Nature Reviews Gastroenterology & Hepatology, 15(5), 323-323. https://www.nature.com/articles/nrgastro.2018.32

Thürmann, P. A. (2020). Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anesthesiology, 33(1), 109-113. https://journals.lww.com/co-anesthesiology/fulltext/2020/02000/pharmacodynamics_and_pharmacokinetics_in_older.15.aspx

Wordingham, S. E., McIlvennan, C. K., Fendler, T. J., Behnken, A. L., Dunlay, S. M., Kirkpatrick, J. N., & Swetz, K. M. (2017). Palliative care clinicians caring for patients before and after continuous flow-left ventricular assist device. Journal of Pain and Symptom Management, 54(4), 601-608. https://doi /S0885392417302701

Zegkos, T., Kitas, G., & Dimitroulas, T. (2016). Cardiovascular risk in rheumatoid arthritis: Assessment, management and next steps. Therapeutic Advances in Musculoskeletal Disease, 8(3), 86-101. https:// /doi/abs/10.1177/1759720X16643340

Zuriaga, E., Lomba, L., German, B., Lanuza, P. M., Aldea, L., Ribate, M. P., ... & Giner, B. (2019). Ecotoxicity in aliivibrio fischeri of ibuprofen, omeprazole and their mixtures. Chemistry and Ecology, 35(2), 102-114. https:/ /doi/abs/10.1080/02757540.2018.1540608

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