Identify Contributing Factors And Strategies To Prevent And Manage Skin Breakdown

Medical Diagnosis and Care Related Needs of Mr. Nigel Wheeler

The past medical history that Miss Alice had include myocardial infarct diagnosed for ten years ago, hypertension diagnosed for ten years ago, osteoarthritis especially in her right knee, and depression and anxiety diagnosed for two years ago. The impact of her medical history includes;

Myocardial infarct (MI). A myocardial infarct is a condition that arises when there is a decrease in blood flow or the blood stops flowing in a part of the heart; it causes damage to the muscle of the heart. Myocardial infarct condition that is present in Miss Alice may/will have health-related complications like irregular heartbeat, heart failure, cardiac arrest and cardiogenic shock (Shah et al, 2015). As presented in the case scenario Miss Alice had experienced two falls this may be as a result of the effects of MI.

Hypertension. Hypertension is a condition that occurs when there is a high force of blood that flows in the artery walls. Hypertension gives rise to health-related conditions like narrowed and damaged arteries, aneurysm-causing a damage to the heart that includes heart failure, enlarging the left heart and causing coronary artery disease, causing brain-related problems like transient ischemic attack, dementia, stroke and mild cognitive impairment, and damaging the kidney which can result to kidney artery aneurysm, kidney failure and kidney scarring (Gabb et al, 2016). It is evident from the case study that hypertension had influenced Miss Alice conditions by causing health conditions like dementia, causing a transient ischemic attack and mild cognitive impairment as she seemed confused since she cannot even remember her room.

Osteoarthritis. Osteoarthritis is a condition that affects the normal functioning of body joints. The impacts that osteoarthritis has on the wellbeing of a person include causing stiffness, pain and tenderness in body joints. As in the case scenario, Alice had been affected by osteoarthritis since she had been complaining of experiencing pain in her right knee.

Depression and anxiety. These conditions are mainly caused by stress. Some of the health conditions that may arise to Alice due to depression and anxiety include; insomnia, trouble with decisions or memory, weight fluctuations, fatigue and feeling of emptiness or sadness. In the case scenario, Alice had started portraying some effects of depression and anxiety like trouble with memory since she had forgotten that her sister died, lack of sleep and loss of weight (Prince et al, 2015).

1. Theory of aging

The Immunological Theory of Aging

The Autoimmune Theory of Ageing ascertains that as people grow old, their immune system tends to be less effective, start experiencing dysfunction and start reducing the capacity to fight an infection. The theory holds that as people age their immune system decreases and hence one becomes more prone to chronic conditions (Fulop, Witkowski, Pawelec, Alan & Larbi, 2014). Older people mainly experience changes in the immunological level which alters their immune system and hence causing alterations and disruptions in the interaction of the immune system with the other body systems. As in the case scenario, considering the past medical history of Alice she was first diagnosed with Myocardial Infarct, osteoarthritis particularly in her right knee and hypertension at the age of 79 years. Her immune system continued to be weak since at the age of 87 she was diagnosed with depression and anxiety. It is evident from the case scenario that immune decreases as one grow older since the more Alice gets older, the more she is experiencing more health-related complications like urinary incontinence, Alzheimer’s dementia, insomnia and inadequate eating (Walford, 2016).

1. Physiology of aging

Effects of Medical History on Miss Alice’s Wellbeing

As people grow old, the functioning of their organs is affected by the physiological process and diseases associated with aging start occurring. The normal aging process influences the physiological process of a person especially in the third and fourth decades of life resulting to deterioration of the functioning of the organ systems as someone grows old (Flaatten, Skaar & Joynt, 2018). Aging influences all the body’s organs, tissues, and cells and hence it influences the way all the body systems function normally. Some of the common physiological changes that occur with age include the increase in blood pressure, a decrease in cardiac output and the development of arteriosclerosis. The lungs also start portraying lower expiratory rates of flow, the decline in the vital capacity and compromised gas exchange. The physiological changes that occur in a person are necessary since they form the basis for effective clinical management of the older people (Willott, Cegielski, Smith, Gordon, Atherton & Phillips, 2018). As evident in the case scenario, Miss Alice started experiencing changes in the body functioning at the age of 75 years. It is at the age of 75 years that she was diagnosed with health-related complications like hypertension, osteoarthritis and myocardial infarct. As Miss Alice continued growing old, more age-related conditions were prevalence since at the age of 87 years she was diagnosed with anxiety and depression, and at the age of 88 years, she was diagnosed with urinary incontinence and Alzheimer’s Dementia.

1. Primary health services

Some of the appropriate primary health services that are essential for Miss Alice include;

The health care providers should be continually reviewing the patient. Continually reviewing Miss Alice is essential since it assists in the reduction of falls that she is experiencing. Continually reviewing the patient especially those experiencing falls is essential since it helps to reduce chances of a fall and in case a fall occurs the health care provider will be aware and hence can provide the necessary interventions practices. Prevention of falls is important since it improves the quality of life and prevents unintentional injuries of patients especially the old patients.

Collaborative provision of health carse services. Studies show that services that are provided collaboratively by health care providers are more effective especially to a patient with dementia and depression. The collaborative way of working is important since it helps in ensuring early care and shared decision making in the treatment of the patient (Bujnowska-Fedak & Pirogowicz, 2014). Collaborative with health specialist is essential when treating Miss Alice since she had been diagnosed with Alzheimer dementia and depression and hence can support in improving the quality of her life through the provision of quality health care services.

Moderation of fluid uptake is another primary health service that is appropriate for Miss Alice. Moderation of fluid uptake is vital especially in maintaining urine incontinence. Reduction of drinks rich in caffeine is one of the methods that are useful in the treatment of urine incontinence. Miss Alice has been suffering from urine incontinence and hence reducing fluid uptake is essential in order to manage it (Banerjee, 2015).

1. Strategies and interventions for dementia/challenging behaviors

The Immunological Theory of Aging

Strategies that are important for a person with dementia patient include;

Communication.  Good communication is essential to a person who has dementia. Good communication involves the use of sentence structure and language that is matching to the patient level of understanding, culture, sensory activities, and sensory abilities. Communication also involves the caregiver to undertake some tasks for the person. As the caregiver, one is expected to perform some tasks for Alice like caring for her dental.

Activity planning. The patients and the caregivers should take plan in finding out the activities that the patient can undertake. They should work collaboratively to ensure that they establish activities that capture the patient strength, interest, preferences and life histories to enhance the patient performance in group or individual based activities. For instance, Alice seems not to be interested in attending social activities, and hence caregivers should opt for another mean like participating in exercise (Nakanishi et al, 2018).

Assistive technology. Assistive technology involves any equipment, system, item or product that can be used for improving, maintaining or increasing the functional abilities of a person with physical, communication and cognitive disabilities. As the caregiver of Alice maximizes the use of the available technology, it is vital, for instance, to increase her usage of the wheeled frame.

Exercise. Conducting various exercise activities is important for dementia patients. Exercise helps in slowing the loss of mobility, improving continence and reducing the loss in strength. In the case scenario, exercise can support Alice in reducing the urine incontinence and also reduce the loss of weight.

Rehabilitation programs.  Rehabilitation services are of benefit to people with dementia. Through rehabilitation, the dementia patient needs can be easily identified hence promoting and maintaining cognitive skills and enhancing independence activities of daily living (Moniz-Cook et al, 2017).

1. Oral hygiene

Alice may be at risk of not having daily oral hygiene because, at her age, it is rare for one to remember such personal care. The fact that Alice has been diagnosed with depression and anxiety at over eighty years, this may lead to her confusion which may lead her not being able to take care of herself. Alice requires nurse’s assistance to make her recall, guide and assist her with the whole dental care; this indicates that she cannot do such personal care all alone. Thus, when the assisting nurse is not available, or he/she forgets, then Alice may skip her dental cleanliness (Jennings, 2015).

Strategies

The older people like Alice who uses dentures are at dangers of developing fungal diseases. Oral hygiene for the old requires brushing at least twice a day especially in the morning and at night. To maintain oral hygiene for the old, dentures are supposed to be cleaned with mild soap using the denture brush so that to remove plaques from the surfaces and rinsing them under the running water. Ensuring that Alice removes the dentures overnight. Helping Alice to brush the tongue and the gum using soft toothpaste. Storing dentures in cold water in a denture container overnight which is well labeled by her name. Proper follow up of her brushing, rinsing the toothbrush under running water and tap to remove excess water and store the brush in a clean, dry place is essential daily practice for oral hygiene (Aung, Ueno, Zaitsu, Furukawa & Kawaguchi, 2015).

1. Pain

Physiological Changes that Occur with Age

The pain signs that indicates that Miss Alice is in pain include; difficulties in falling asleep, being upset, loss of appetite, increase in confusion and restlessness. Also, the use of pain assessment scales for identifying pain is appropriate especially to older people with dementia as in the case with Alice (Bihlet et al, 2018). The pain that Alice was experiencing might have been caused by;

Unfamiliar environment- since the environment of Alice had been changed it can initiate behaviors like agitation, aggression, and restlessness which can cause pain.

Lack of personal space- Alice seems to have lived alone since she had no husband or child. Alice might be upset with the hospital settings because of distractions from the caregivers which may trigger her to be upset.

Urine incontinence. Urine incontinence is another factor that can cause pain in Alice.

The management approaches that can be used to manage pain include;

Use of analgesic. These are drugs that can be initiated to Alice to help in managing the pain that she is experiencing. The drugs include aspirin, paracetamol, ibuprofen, and opioids.

Guided imagery and biofeedback. Guided imagery involves focusing the attention of the patient on music, sounds, words, and sights to create a feeling of relaxation and empowerment. In the case scenario, guided imagery and biofeedback can be helpful to Alice to feel relaxed easily and hence reduce her confusion and help her to avoid wandering around the hospital hence reducing pain.

Physical activity and exercise. Maintaining and increasing physical activity is essential especially to older people in order to aid in reducing the pain. Programs that comprises maintaining flexibility, endurance and strengthening support in increasing physical activity (Anitescu, 2018).

1. Complementary therapies

Acupuncture.  Acupuncture involves triggering using needles the specific points on the skin. It is a complementary therapy that can be used to aid the body in responding. It assists in the stimulation of the immune system, pain modulation and wound healing (Chung et al, 2015). In the case scenario, it can help Alice to help reduce anxiety, depression, and osteoarthritis since it assists patients to achieve balance hence providing relief for some ailments.

Massage. Massage support in the reduction of chronic pain. Massage helps in increasing the dopamine and serotonin level and hence enhancing the normal flow of blood which results in the reduction of pain. Massage also assist individuals to sleep better and relax. Applying massage to Alice can be helpful since she has difficulties in falling asleep.

Reflexology. Reflexology, especially in the foot, has supports in harmonizing the way the body functions and hence producing a relaxing and healing effect. Reflexology also helps in relieving tension and stress. Reflexology conducted on foot for thirty minutes can help in reducing anxiety (McVicar, Greenwood, Ellis & LeForis, 2016). Foot reflexology can be helpful to Alice since she had been diagnosed with anxiety and hence reducing the anxiety condition.

PART B

Nursing Care Plan as per the clinical reasoning cycle

The Problem/Issue	Goals established	Action	Outcome Evaluation	Reflection
1. Pain (osteoarthritis in the right knee). Miss Alice complains of increasing pain in her right knee which she is unable to explain well to the staff.	Identification of the level of pain Miss Alice is experiencing so that to determine the appropriate control intervention. Improving the pain through performing relevant daily practices to the clients	1. Completing the pain assessment. 2. Encouraging Miss Alice to use the four-wheeled frames, especially when the nurse is not around for assistance to avoid falls. 3. Supporting the client to get into the frame and when she wants to leave the frame comfortably. Providing 4. Encourage and support Miss Alice to walk on her feet’s while supporting her so that to strengthen her body joints through physical exercises.	Apart from physical pain due to knee complications, Miss Alice also experiences other mental distress that causes pain due to discomfort, confusion and restless. Some of the recommended drugs to relieve such pains include the use of analgesics like opioids, ibuprofen and paracetamol.	The patient has been fully assessed according to the level and the intensity of the pain. The patient responded well to the medication, and she responded well to the walking exercises for she shown some improvement by moving faster than before thus an indication of reduced pain in her right knee.
2. Cognitive and sleep impairment. The patient has been experiencing impaired sleep as she has been seen by some of the staff wandering at night which causes her to spent most of her daytime asleep. Cognitive problems occur whereby she sometimes forgets her meals when there is no one to remind her, and her meals are returned when completely uneaten. Also, the is reports of anxiety and depression. Miss Alice has been food confused several time where she forgets her room, and she is found wandering around the facility.	Ensuring that the client gets enough sleep at night. Encouraging the clients and participating to motivate her in engaging in social activities with the other clients.	1. Give the patient medication to reduce sleep during the day. 2. Minimize fluid intake to the client to reduce frequent toileting. 3. Ensuring that there are few naps during the daytime. 4. Providing Miss Alice with a comfortable environment which should be quiet and dark to ensure enough sleep. 5. Ensuring and assisting the client to have her food at the right time. 6. This participation with the client to field activities motivates her and can help her keep her mindset to reduce the distress of anxiety and depression as well as improving the body fitness.	Miss Alice after adhering to the sleep medication and the schedule recommended to her by the assistant nurse she has reduced the more naps during the daytime, and mostly she currently sleeps at night. The client can eat with little or no supervision.	The client has reported that she has been able to sleep at the right time and is taking her food on herself at the right time when it is provided to her. The patient has been trained to follow the normal sleeping routine. The has been advised to take little fluids, have some painkillers to reduce pain and she now sleeps comfortably since she reduced daytime sleeps.
3. Personal care deficit. These personal cares include bathing, toileting, oral hygiene and dressing properly due to the clients’ interests of walking outside by herself.	Assisting to improve on the client’s self-care abilities. To enhance to the patient to safely wash her face trunk, arms the other perineal area with little assistance.	1. Helping her to brush her dentures at least twice a day. Ensuring that the client removes her dentures overnight and ensure safe storage for the brush and the dentures. 2. Help Alice to perform daily bathing and provides privacy and independence while bathing her body parts within her ability and reach. 3. Encourage her to use the shower chair in the bathroom to prevent falling. 4. Provide privacy and allow much time as she takes a long time to bath and to improve indigence about safe bounds.	Miss Alice can bathe herself with minimal assistance. She can walk to the bathroom and go back to her bed alone although she is worried and quite nervous that she may fall.	The client maintains her balance using the shower chair thus there is a reduction of falling chances. Her privacy is always maintained and proper supervision all the time to ensure safety as she performs her daily activities.
4. Incomplete communication. The client’s impaired communication is evidenced by the fact that Miss Alice is unable to give clear information concerning her increasing pain when asked by the staff after her pain complains.	Ensure that the client understands and can explain her body feelings clearly.	1. Using gestures or demonstrating to her by using your body as an example so that she can understand better. 2. Gather her total attention especially when she is experiencing the pain and use of clear, slow and loud voice. 3. Give the client time and tell her to repeat her explanation twice or thrice even in her language is the foreign language is the problem. 4. Use of “yes” or “no” to demonstrate to the patients so that she may get you well.	Miss Alice understands the staffs well and can explain herself and also participates fully to the conversation to help her.	Miss Alice can understand, demonstrate and explain her feeling especially where she is experiencing pain in an easy and clear way. She can rephrase her sentences well but requires a bit of some time to respond. The client can answer most of the “yes” or “no” questions when asked while demonstrating to her.

References

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Primary Health Services Essential for Miss Alice

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