Healthy Aging

Executive Summary of Mr. Jungala Case Study

Mr. Jungala is a 71 years old man who is appointed in hospital because of sudden fall in his home. He has additional diseases such as hypertension, angina and type 2 diabetes and for this reason high dose medicines such as Aspirin, GTN are consumed by him to get relief. On the other hand, he is alcoholic in nature in this is really harmful for him due to age and lack of physical and mental stability. Urinary test report as well as respiratory test report is not good for this man and it is required to go through different nursing assessments to solve such problems. This study provides clear inspection of Mr. Jungaal and various types of medical interventions are proposed to him to reduce vulnerability of physical and mental health.

Table of Contents

PART 1- Assessment

PART 2- Plan and implementation.

PART 3 - A biopsychosocial approach.

References.

Part 1-Assessment

  • Alcohol withdrawal risk assessment -

Alcohol drinking has been a regular habit for all ages, especially among the aboriginals as a trait of custom or practice. Alcohol drinking can cause liver injury and stomach problems are a regular negative impact for this reason. Alcohol withdrawal symptoms are also serious causing alcohol withdrawal symptoms (AWS) including - anxiety, irritability, frequent tremors, confusion, agitation, fever, a cardio-pulmonary arrest which can increase the risk of heart-attack, and life-threatening conditions such as coma (Benedict et al. 2018). Therefore, this assessment is necessary for the proper evaluation of alcoholic patients before commencing treatment because just after 6-24 hours of alcohol consumption discontinuation the patient suffers from mild to severe symptoms including hallucinations and autonomic dysreflexia.

Mr. Jungala is known to have 2-3 beers of mid-strength for 2-3 times per week. At this age, carrying out alcohol withdrawal assessment can push him into the above syndromes because he has reported that sometimes to ease out tension, to relieve him from stressing out his daughter’s illness he drinks beer along with his family (Jesse et al. 2017). So, the doctors and nurses need to openly discuss the issues with Mr. Jungala and his family to limit his alcohol intake without risking him from the alcohol withdrawal syndromes because he has been taking high doses of drugs.

  • Cognitive assessment

Cognitive assessment is a great practice offered by medical professionals to understand brain function and memory loss of a patient. A cognitive test measures main brain activity region and for old patients it is effective to understand reasons of different functionalities of body. This include memory, focus, rhythm, language and the capacity to think (Cross, 2018). There was an error. In the event of symptoms or issues (including severe disease or brain injury), a diagnostic test provides the basis for the calculation of cognitive difficulties. The cognitive assessment is used to evaluate the general thought and reasoning skills of a person, also known as IQ. Skill testing can determine different cognitive skill domains of your children. The MMSE is the best recognised and most commonly used standard of sensitivity of clinical practise in all areas of the world.

Mr. Jungala is old in age and there is a high probability of dementia for him that has to be detected before starting any medication or therapeutic process for him. On the other hand, from the case study, it is detected that he is anxious in nature and further medical assessments such as respiration level study, UTI and position of urinary information has shown that the person has some mental trauma (Pérez-Ros & Martínez-Arnau, 2020). Therefore, hospital authority has suggested this assessment for him to understand reasons behind mental illness. In addition, this assessment can also help to understand his current health condition in a proper manner.

  • Falls assessment

Falling is a type of accident that can happen anywhere and at any time. But falling in old age can lead to various other consequences which can be temporary and permanent. Old age people can fall due to weakness, poor nutritional diet, impaired bones and muscles which causes balance disorders, vertigo, impaired vision, mental unhappiness, etc. falls can lead to mild bruises, broken bones, head wounds, or even death. fall assessment tests are done with assessment tools (Baran, 2018). This can help to detect the probable reasons for falls and correct nursing interventions can be suggested by the hospitals in near future for this purpose.

Fall assessment screening is recommended to all adults aged more than 65 years. The primary screening will include questions from the doctor about the health and stability of the patient, any fall history, and if one faces problems while standing or walking due to old age. If the screening states one is at risk then an assessment is required. During the assessment, the following tools are used - Timed Up-and-Go (TUG), 30-Second Chair Stand Test, and 4-Stage Balance Test (Patton & Henry, 2019). Mr. Jungala is also recommended such screening because people with symptoms such as- dizziness, light-headedness, and irregular or rapid heartbeats are at high risk.

  • Functional assessment

A multidimensional and often interdisciplinary diagnostic method that determine and measure the medical, psychosocial and cognitive status of older people is a cognitive evaluation. Functional appraisal incorporates observation, queries, background experience and analyses of particular children's abilities and attitudes across a variety of diverse circumstances and environments of regular habits and activities (Junge et al. 2020). The assessment of a person's capacity to perform duties and behaviours that typically are essential for everyday living is a practical examination of medicine and gerontology. There was an error. A practical evaluation before discharge can also be used by certain individuals, and can help planners facilitate a healthy transition home.

Functional assessment is prescribed for Mr. Jungala to understand different side effects of medicines for his body. It is clear from the case study that the person has consumed high dose medicine because of hypertension, diabetes and angina (Vetrano et al. 2016). However, medicines such as Aspirin, GTN etc. have number of side effects for older people and this has to monitored through proper assessment. Henceforth, functional assessment can help to determine negative impact of medicines for Mr. Jungala and reduction of doses can also be possible in a greater manner. In addition, this assessment can also help nurse professionals to take proper action for this patient in case of viability reduction.

  • Nutritional assessment

A nutritional assessment can be defined as a multidisciplinary framework done in an organized way to design the nutritional status and energy required by a patient by assessing his/her health condition by aligning the patient’s health condition (Poveda et al. 2019).

 Determination of the nutrition uptake rate of the patient before being admitted in the hospital. Time-to-time identification of the health condition of the patient so that the treatment is not hampered. Collecting the data for scientific assessment and research purposes and then preparing a diet chart for the patient so that the patient does not suffer from malnutrition (Reuter et al. 2019). Regular blood test is recommended for Mr. Jungala for proper assessment of his nutritional requirement.

Part 2- Plan and Implementation

Mr. Jungala is a 71-year-old man with old-age diseases like hypertension, type II diabetes, chronic renal failure, and unstable angina. He is also suffering from comorbidity like the decreased vision which may be due to diabetic retinopathy. He is also developing cataracts. Mr. Jungala have had the following medications for the above diseases -

  • Aspirin 100mg mane
  • Perindopril 2mg mane
  • Metformin 100mg TDS
  • GTN 600mcg tablets S/L prn.

From the case study, it can be estimated that Mr. Jungala used to have GTN of such a high dose which can be responsible for his tripping down and fall.

Glyceryl trinitrate (GTN) has the following side effects-

  • Headache is a potential side effect of this drug and for older patients, this is harmful.
  • Redness of the skin which can be a result of drug rashes.
  • Feeling dizzy means, he is tired due to the high dose of GTN and this may be another reason for his fall.
  • Having weakness and an increased rate of fainting. If used simultaneously with alcohol, the drug maximizes its action which is critical for aged patients like him.
  • A rapid increase in the rate of the heartbeat which can increase palpitation (Akselbo, I., Killingberg & Aune, 2020).
  • Feeling nauseatic or vomiting.

Nursing actions

Mr. Jungala can be treated under the nursing actions given below to improve his health condition and future development of him can be possible.

ACTIONS

IMPORTANCE

Nutritional supplements (Nitrogen-rich food products)

Nitrogen-rich foods such as meat, green leafy vegetables, soya beans, etc. contribute to building up the muscles of our body and maintains cell growth by synthesizing proteins. Proteins provide us with the same amount of energy as do carbohydrates (Lenjani, 2020). 

Effective communication skills

The nurse-in-charge should be soft-spoken with good communication skills and maintain good behaviour with Mr. Jungala because he is aged and needs proper attention. Moreover, his family has a friendly atmosphere which has accustomed him to be tender. Rude behaviour will not cure him soon and neither will return him to his supportive family soon.

Routine check-up and tests

Mr. Jungala is suffering from hypertension and diabetes. So, his blood pressure and sugar level need to be checked twice a day to keep a proper update. He is also having unstable angina so to lessen the chances of a heart attack his everyday routine must be restricted as per prescribed by the doctor. He also had a history of urine infection so he must look after the proper sanitizing condition of the area where he is urinating.

Table 1: Action of nurses

(Source: Shiells et al. 2020)

Execution

Strategy

Importance

A premier consultation with the family members of Mr. Jungala with the doctors and nurses in charge of curing him.

Exchange of views and information is important between the family members and the hospital staff because any kind of complication can be easily met and the treatment process also goes smoothly (Andersson et al. 2020).

Exploration of the hobbies of the patient

 Family members can also give an idea about the habits of Mr. Jungala to the doctors for easy treatment.

Medical equipment

Medical equipment used for treatment needs proper checking before use (Al-Dweik & Ahmad, 2020).

Table 2: strategic execution

(Source: Karkhah et al. 2020)

Part 3 - A Biopsychosocial Approach

The psychological and social environment around Mr. Jungala’s day-to-day life is well and good. He is surrounded by his extended family of wife, daughters with their children, and son with his children. The positive side is his family is supportive and takes care of him. Although he is retired, he is not that depressed or bored at home. He only visits church during the funerals. His strength and mental well-being are centred around his family and country (From case study). Most of his nights are spent sitting by the campfire listening to music or chatting with his family members. Some nights are spent relaxing by the campfire with few beers of mid-strength.

Being 71 years old, Mr. Jungala is suffering from age-related issues such as diabetes and chronic renal failure. Every few months Mr. Jungala attains regular check-ups with his diabetic doctors and thus takes care of his health. He is also suffering from unstable angina since last year but due to appropriate medications, he is doing well in his daily life. Most of his time is spent in sitting and relaxing and he admits that he does not stress himself at all. When he feels bored, he just goes to his house bush (From case study).

The only thing presently stressing Mr. Jungala and have had a negative impact on his psychosocial health is of the accident which he met. He has hurt his right hip by tripping over his grandchild’s Tonka truck. He had tumbled on the floor by his right side and after that, he is feeling pain while moving or lifting heavyweights. This has increased his level of anxiety from low to medium and he has forbidden to himself to stay alarmed so that he does not trip over the Tonka truck again. He is also worried about his urine infection and is displeased with the circumstances he had to face during his illness (From case study). He urges to call his family friends When Mr. Jungala fell, his teenage grandchildren came to help him but they were unable because every wrong movement badly pained him. So, they took the help of an ambulance and associated medical staff to take him to the doctor.

Coming from a supportive family background Mr. Jungala is certainly not stressed about him but is worried about his younger daughter who is suffering from cancer and he does not want to concern her much because she is already preoccupied with her diseaseand other relatives if he needs something incapable of his family. Mr. Jungala has stopped driving so if he wants to go to the town for shopping, Centrelink, banking, or medical check-ups he wants to ask his neighbouring friends or relatives to give him a lift so that he does not have to take the pain to involve his family member in every aspect (From case study). Mr. Jungala’s family has a healthy atmosphere despite having a serious disease like cancer- they gather near the campfire with drinks and yarn to relieve out stress which has helped Mr. Jungala defeat various health problems.

References for Mr. Jungala Case Study

Akselbo, I., Killingberg, H., & Aune, I. (2020). Simulation as a pedagogical learning method for critical paediatric nursing in Bachelor of Nursing programmes: a qualitative study. Advances in Simulation, 5(1), 1-9. .: https://link.springer.com/article/10.1186/s41077-020-00140-2

Al-Dweik, G., & Ahmad, M. (2020). The Effectiveness of Patient Acuity Tool on Nursing and Patients Outcomes: A Literature Review. ISSN: 13412051, 25(1), 329-346. .: https://www.researchgate.net/profile/Ghadeer_Dweik/publication/338804218_The_Effectiveness_of_Patient_Acuity_Tool_on_Nursing_and_Patients_Outcomes_A_Literature_Review/links/5e328662a6fdccd965768f57/The-Effectiveness-of-Patient-Acuity-Tool-on-Nursing-and-Patients-Outcomes-A-Literature-Review.pdf

Andersson, R. B., Al-Namaeh, M., Monaco, W. A., & Meng, H. (2020). Vision Loss Among Delaware Nursing Home Residents. Gerontology and Geriatric Medicine, 6, 2333721420934245. .: https://journals.sagepub.com/doi/pdf/10.1177/2333721420934245

Baran, L. (2018). Predictive validity of three fall risk assessment tools in nursing home residents in Turkey: a comparison of the psychometric properties. International Journal of Caring Sciences, 11(1), 36-44. .: http://www.internationaljournalofcaringsciences.org/docs/5_baran_original_11_1.pdf

Benedict, N. J., Wong, A., Cassidy, E., Lohr, B. R., Pizon, A. F., Smithburger, P. L., ... & Kane-Gill, S. L. (2018). Predictors of resistant alcohol withdrawal (RAW): a retrospective case-control study. Drug and alcohol dependence, 192, 303-308. .: https://dl.uswr.ac.ir/bitstream/Hannan/50091/1/2018%20DAD%20Volume%20192%20November%20%2846%29.pdf

Cross, J. (2018). Nursing the patient with altered cognitive function. In Fragility Fracture Nursing (pp. 109-123). Springer, Cham. .: https://library.oapen.org/bitstream/handle/20.500.12657/23127/1007029.pdf?sequence=1#page=122

Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben‐Menachem, E., Tanasescu, R., ... & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4-16. .: https://onlinelibrary.wiley.com/doi/pdf/10.1111/ane.12671

Junge, S., Gellert, P., O’Sullivan, J. L., Möller, S., Voigt-Antons, J. N., Kuhlmey, A., & Nordheim, J. (2020). Quality of life in people with dementia living in nursing homes: validation of an eight-item version of the QUALIDEM for intensive longitudinal assessment. Quality of Life Research, 1-10. .: https://link.springer.com/content/pdf/10.1007/s11136-020-02418-4.pdf

Karkhah, S., Ghazanfari, M. J., Norouzi, M., Khaleghdoust, T., Dahka, S. M., & Taheri, Z. (2020). Designing a nursing care plan based on Johnson's behavioral model in patients with wrist joint hematoma: A case study. .: https://www.researchsquare.com/article/rs-34306/latest.pdf

Lenjani, B. (2020). Nursing Care and Health Care Plan with Chest Pain. International Journal of Open Medicine and Surgery, 1(1), 9. .: https://www.ijomasr.com/uploads/189/8192_pdf.pdf

Patton, S. K., & Henry, L. J. (2019). Nursing students’ experience with fall risk assessment in older adults. Nursing & health sciences, 21(1), 21-27. .: https://onlinelibrary.wiley.com/doi/pdf/10.1111/nhs.12427

Pérez-Ros, P., & Martínez-Arnau, F. M. (2020). EQ-5D-3L for assessing quality of life in older nursing home residents with cognitive impairment. Life, 10(7), 100. .: https://www.mdpi.com/2075-1729/10/7/100/pdf

Poveda, K. F., Jiménez, M. H., Salazar, G. R., & Ojeda, M. G. (2019). Nutritional assessment of Nursing in pregnant adolescents. Espirales Revista Multidisciplinaria de investigación, 3(29), 48-69. .:http://revistaespirales.com/index.php/es/article/download/590/488

Reuter, B., Shaw, J., Hanson, J., Tate, V., Acharya, C., & Bajaj, J. S. (2019). Nutritional assessment in inpatients with cirrhosis can be improved after training and is associated with lower readmissions. Liver Transplantation, 25(12), 1790-1799. .: https://www.aasld.org/sites/default/files/2020-03/NutritionalAssessmentinInpatientsWithCirrhosis.pdf

Shiells, K., Baquero, A. A. D., Štěpánková, O., & Holmerová, I. (2020). Staff perspectives on the usability of electronic patient records for planning and delivering dementia care in nursing homes: a multiple case study. BMC medical informatics and decision making, 20(1), 1-14. .: https://link.springer.com/article/10.1186/s12911-020-01160-8

Vetrano, D. L., La Carpia, D., Grande, G., Casucci, P., Bacelli, T., Bernabei, R., ... & Bonassi, S. (2016). Anticholinergic medication burden and 5-year risk of hospitalization and death in nursing home elderly residents with coronary artery disease. Journal of the American Medical Directors Association, 17(11), 1056-1059. .: http://www.academia.edu/download/52689564/9_I-GrADE_group_Vetrano_DL_et_al__2016.pdf

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