Medical Diagnosis, Age Of Individual, And Preparing For Procedures

Medical Diagnosis

Mrs. Natia Euta, has been admitted to the hospital upon being inflicted with a cerebrovascular accident. If left untreated, the stroke can lead to long term negative impacts in the form of loss or difficulty of speech, movement, cognition or swallowing, which can lie undetected from weeks to almost years after the episode (Rashid et al., 2016). The patient also has a medical history of obesity and type 2 diabetes mellitus. If left untreated, obesity as well as diabetes has been associated with long term impacts of an abnormal lipid metabolism, result in adipose and fatty steak deposition in the blood vessels, further increasing the susceptibility of the patient to cardiovascular diseases and myocardial infarction in the future (Furukawa et al., 2017). Lack of treatment of the medical history of hypertension, may result in long term impact of artery hardening and narrowing, blood vessel bulging or aneurysms, enlargement or left ventricular hypertrophy, irregular heartbeat or arrhythmia and further susceptibility blood vessel rupturing, stroke and hemorrhages (Zanchetti, 2017). The patient also has a medical history of a transient ischemic stroke which produces symptoms similar to a stroke. Despite the absence of permanent or severe damages, lack of treatment  leads to long term impacts of increasing the susceptibility of stroke (van Rooji et al., 2016). Mrs. Natia also has a past medical history of osteoarthritis. Lack of treatment can lead to long term impacts of muscles and joints stiffening and losing mobility over time, leading to loss of movement, susceptibilities to fracture and possible joint deformities (Paterson et al., 2015).

Mrs. Natia is of 76 years of age, which increases her susceptibilities of acquiring the physiological changes associated with ageing. Ageing leads to detrimental changes in the muscoskeletal system leading to shrinkage in the size and reduction in flexibility of muscle tissues and difficulty in mobility. Further loss of bone density results in weakening of bones and age associated osteoarthritis as can be observed in Mrs. Natia. Hence, her age will considerable reduce her abilities of locomotion and movement, further making it difficult for her to conduct daily life activities (Curtis et al., 2015). Ageing has also been associated with detrimental neuroendocrinal activities resulting in increased insulin resistance leading to impaired metabolism and associated diabetes as observed in Mrs. Natia, which will affect her daily life by reducing her body’s ability to metabolize and utilize essential nutrients (Das, 2015). Ageing also has been linked to reductions in the cardiac output followed by hardening of blood vessels and increase in hypertension, further increasing one’s susceptibility to strokes, myocardial infarction and atherosclerosis as observed in Mrs. Natia’s risk of stroke acquisition as observer in her medical history (Merz & Cheng, 2016). Ageing also leads to loss of alveolar elasticity and gas exchange abilities which may negatively affect Mrs. Natia’s daily activities through occurrences of breathing difficulties and chest tightening (Haq & McElhaney, 2014). Ageing has been associated with decreased functioning of the central nervous system due to decrease in the number of neuronal dendrites, which can negatively affect the patient’s performance of daily activities through reduced cognition and increased susceptibilities to mental health disorders like anxiety which has already been observed in Mrs. Natia (Rawji et al., 2016).

Age of Individual

In the case of Mrs. Natia, along with the detrimental effects of her ageing, her extensive medical complications further puts her at increased risk of complications. Hence, prior to surgical procedures, a multidisciplinary team must be adopted considering the varied medical conditions of Mrs. Natia (Pearce et al., 2016). The clinical team prior to procedures, must carry out preoperative assessments in the fields of cardiac assessment, pulmonary assessment, abilities to make decisions, dementia and associated impaired cognition, risk of falls, mobility, risk for delirium post operation, medications consumed, availability of adequate support from patient’s family and social networks, counseling, fraility and status of food and nutrient intake (Knittel & Wildes, 2016). Assessments of fraility and risk of falls must be conducted considering the patient’s history of osteoarthritis while cardiac assessment is essential to monitor existing cardiac functioning considering patient’s history of strokes and hypertension (Kim et al., 2016). Surgical procedures often leave elders confused and anxious, hence requiring delirium assessment as Mrs. Nadia has already begun to show signs and symptoms of distress and anxiety (Robinson & Rosenthal, 2015). Obese patients are susceptible to hemorrhages or blood loss prior to surgery due to their associated hypertension, hence along with cardiac assessment, nutritional screening must be performed in Mrs. Natia considering her medical history (Clavellina-Gaytán et al., 2015).

While caring for Mrs. Natia, the nurse or doctor must always ask for permission before entering her room, followed closing of doors and curtains during appropriate times. Considering her gender, the medical team must aim to provide same sex accommodation to Mrs. Natia along with provision of same sex bathrooms which are clean and hygienic (Quinn & Happell, 2015). Mrs. Natia is a Samoan and may have preferences and needs unique to her culture. Hence the medical team must communicate with her to enquire about her cultural beliefs or employ an interpreter for with possessing similar cultures in order to make her feel respected and at ease. The hospital can communicate further with the nearest interpreter, aboriginal or multicultural institute for the purpose of providing culture competent treatment (Betz & Wintemute, 2015).

With age, Mrs. Natia may be at a risk of reduced mobility and increased susceptibility to fractures due to her comprised muscoskeletal and bone health associated with reduced number and flexibility of muscle fibers and reduced bone densities. Age puts her at a risk of cardiovascular ailments due to age associated artery hardening, increased hypertension and reduced cardiac output. Age also puts the patient at a risk of reduced cognition due to reduction in neuronal dendrites and increased metabolic disorders due to age associated insulin sensitivity (Scott-Warren & Maguire, 2017).

Usage of anesthesia prior to surgery in elderly patients has been documented to increase the risk of post operative cognitive dysfunction and delirium (Rajesh, 2015).

Ageing puts Mrs. Natia at a risk for reduced cognition due to age associated loss of neurons. Surgery also puts her at a risk of cognitive loss since surgical procedures in the elderly has been documented to increase the risk of post operative cognitive dysfunction and delirium. Further, occurrence of cerebral stroke as experienced by the patient, increases the risk of cognitive mental disabilities such as Alzheimer’s and dementia (Kubu et al., 2017).

Preparing for Procedures

Deep Vein Thrombosis, Venous Thromboembolism and Pulmonary Embolism increases the risk of strokes and hemorrhages as evident in Mrs. Natia suffering from prolonged headaches, which further puts the patient at a risk of loss of speech, movement and food ingestion behaviors like swallowing. Strokes due to thromboembolism also increase the risk of dementia and Alzheimer’s (Chung et al., 2014).

Loss of movement due to the patient’s arthritic condition increases the risk of pressure ulcers. Immobility also increases the risk of age associated muscle wastage or sarcopenia in elders like Mrs. Natia (Abe et al., 2016).

Identify Problem/Issue	Establish Goals (With Timeframes)	Take Action	Evaluate Outcomes (Has it worked)	Reflect on Process
1.Recurrent pain in the right side of head as evidenced in the progress notes of 20th, 21st and 22md September.	Relieve pain within the next three days and maintain pain-free status throughout remaining hospital stay.	Following interventions can be undertaken (Harrison & Field, 2015): 1. Conductance of CT scan for assessment of presence of cerebral embolism 2. Assess medication status for side effects (blood thinners cause post stroke headaches) 3. Administration of complementary therapies like massage and aromatherapy for relaxation in tension headaches. 4. Initiation of family visit to reduce distress.	Following two days of nursing intervention, goals have been met as evident in patient’s reported reduction of pain.	Mrs. Natia has reported reductions in pain and feels relieved and relaxed upon being visited by her family and as a response to nursing interventions.

2. Recurrent lack of sleep/insomnia as evident in the progress note dated 22nd September.	Improve sleep patterns within one day and maintain healthy sleep levels throughout remaining hospital stay.	Following interventions can be undertaken (Qaseem et al., 2016): 1. Refer to psychologist to assess psychological reasons of stress and anxiety as causative factors for insomnia. 2. Execute action plan for pain relief as mentioned above. 3. Administration of complementary therapies like massage and aromatherapy for relaxation in tension headaches. 4. Initiation of family visit to reduce distress. 5. Administration of benzodiazepines and antidepressants for management of anxiety associated insomnia.	Following one day of nursing interventions, goals have been met as observed in patient receiving regular, restful sleep.	Mrs. Natia has reported sleeping peacefully last night and feels rested and relaxed.
3.Increased susceptibility to falls due to impairment in mobility.	Improve patient safety and increase movement within next three days and maintain regular mobility status throughout hospital stay.	Following interventions can be undertaken (Kemle & Patel, 2018): 1. Administration of mild physical activity like walking for improved mobility, muscle strength and resistance. 2. Administration of protective footwear for falls prevention. 3. Execution of hourly nurse monitoring for assistance and safety. 4. Administration of complementary therapies like massage therapy for inducing joint relaxing, flexibility and distress reduction.	Following 2 days of nursing interventions, goals have been met as evidenced by patient being able engage in free movement within range of motion.	Mrs. Natia has reported to feel no difficulty in movement and can walk reasonably well with assistance from nurses.
4. Increased risk of obesity and cardiovascular complications due to reduced mobility and past medical history of diabetes.	Reduce patient weight within the next seven days and maintain healthy nutritional status throughout remaining hospital stay.	Following interventions can be undertaken (Bischoff et al., 2017): 1. Administration of mild physical activity like walking to reduce weight and improve mobility. 2. Formulation of nutritionally adequate diet plan through nutritionist consultation. 3. Monitoring of diabetes through blood glucose level evaluation.	Following seven days of nursing interventions, goals have been met as evidence by patient displaying minor weight loss and maintenance of healthy blood glucose levels.	Mrs. Natia has reported to feel lighter and energetic. She has displayed a weight loss of 500 grams and fasting blood glucose level of 90 mg/ dl after seven days of nursing interventions.

References

Abe, Y., Nishimura, T., Arima, K., Kanagae, M., Mizukami, S., Tomita, Y., … & Aoyagi, K. (2016). Effect of self-reported walking difficulty on bone mass and bone resorption marker in Japanese people aged 40 years and over. Journal of physiological anthropology, 35(1), 25.

Betz, M. E., & Wintemute, G. J. (2015). Physician counseling on firearm safety: a new kind of cultural competence. Jama, 314(5), 449-450.

Bischoff, S. C., Boirie, Y., Cederholm, T., Chourdakis, M., Cuerda, C., Delzenne, N. M., … & Koletzko, B. (2017). Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clinical nutrition, 36(4), 917-938.

Chung, W. S., Lin, C. L., Ho, F. M., Li, R. Y., Sung, F. C., Kao, C. H., & Yeh, J. J. (2014). Asthma increases pulmonary thromboembolism risk: a nationwide population cohort study. European Respiratory Journal, 43(3), 801-807.

Clavellina-Gaytán, D., Velázquez-Fernández, D., Del-Villar, E., Domínguez-Cherit, G., Sánchez, H., Mosti, M., & Herrera, M. F. (2015). Evaluation of spirometric testing as a routine preoperative assessment in patients undergoing bariatric surgery. Obesity surgery, 25(3), 530-536.

Curtis, E., Litwic, A., Cooper, C., & Dennison, E. (2015). Determinants of muscle and bone aging. Journal of cellular physiology, 230(11), 2618-2625.

Das, U. N. (2015). Ageing, telomere, stem cells biology and inflammation and their relationship to polyunsaturated fatty acids. Agro Food Ind Hi Tech, 26, 38-41.

Furukawa, S., Fujita, T., Shimabukuro, M., Iwaki, M., Yamada, Y., Nakajima, Y., … & Shimomura, I. (2017). Increased oxidative stress in obesity and its impact on metabolic syndrome. The Journal of clinical investigation, 114(12), 1752-1761.

Haq, K., & McElhaney, J. E. (2014). Ageing and respiratory infections: the airway of ageing. Immunology letters, 162(1), 323-328.

Harrison, R. A., & Field, T. S. (2015). Post stroke pain: identification, assessment, and therapy. Cerebrovascular diseases, 39(3-4), 190-201.

Kemle, K., & Patel, D. (2018). Evaluation and Management of Falls. Physician Assistant Clinics, 3(4), 479-486.

Kim, D. H., Kim, C. A., Placide, S., Lipsitz, L. A., & Marcantonio, E. R. (2016). Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures: a systematic review. Annals of internal medicine, 165(9), 650-660.

Knittel, J. G., & Wildes, T. S. (2016). Preoperative assessment of geriatric patients. Anesthesiology clinics, 34(1), 171-183.

Kubu, C. S., Brelje, T., Butters, M. A., Deckersbach, T., Malloy, P., Moberg, P., … & Carpenter, L. L. (2017). Cognitive outcome after ventral capsule/ventral striatum stimulation for treatment-resistant major depression. J Neurol Neurosurg Psychiatry, 88(3), 262-265.

Merz, A. A., & Cheng, S. (2016). Sex differences in cardiovascular ageing. Heart, 102(11), 825-831.

Paterson, K. L., Hinman, R. S., Hunter, D. J., Wrigley, T. V., & Bennell, K. L. (2015). Concurrent foot pain is common in people with knee osteoarthritis and impacts health and functional status: data from the Osteoarthritis Initiative. Arthritis care & research, 67(7), 989.

Pearce, L., Bunni, J., McCarthy, K., & Hewitt, J. (2016). Surgery in the older person: training needs for the provision of multidisciplinary care. The Annals of The Royal College of Surgeons of England, 98(6), 367-370.

Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 165(2), 125-133.

Quinn, C., & Happell, B. (2015). Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views. Journal of clinical nursing, 24(15-16), 2268-2276.

Rajesh, M. C. (2015). Post Operative Cognitive Dysfunction (POCD) in Geriatric Population. BMH Medical Journal-ISSN 2348–392X, 2(4), 110-112.

Rashid, M., Kwok, C. S., Gale, C. P., Doherty, P., Olier, I., Sperrin, M., … & Mamas, M. A. (2016). Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis. European Heart Journal–Quality of Care and Clinical Outcomes, 3(1), 20-36.

Rawji, K. S., Mishra, M. K., Michaels, N. J., Rivest, S., Stys, P. K., & Yong, V. W. (2016). Immunosenescence of microglia and macrophages: impact on the ageing central nervous system. Brain, 139(3), 653-661.

Robinson, T. N., & Rosenthal, R. A. (2015). Optimizing the geriatric preoperative assessment: the use of functional dependence and beyond. Annals of surgery, 261(3), 438-439.

Scott-Warren, V., & Maguire, S. (2017). Physiology of ageing. Anaesthesia & Intensive Care Medicine, 18(1), 52-54.

van Rooij, F. G., Kessels, R. P., Richard, E., De Leeuw, F. E., & van Dijk, E. J. (2016). Cognitive impairment in transient ischemic attack patients: a systematic review. Cerebrovascular Diseases, 42(1-2), 1-9.

Zanchetti, A. (2017). Factors and consequences of hypertension. Journal of hypertension, 35(1), 1-2.