Issue Key Words
PHCNursing Intervention
Evidence Based Practice Rationale
Effect Of Issue On Lola’s Comorbidities Or Other Issues
Referral with Rationale and Links to Other Issues.
Issue One
Presbycusis (bilateral)
Presbycusis can be considered as a complex and multifactorial hearing loss that is also symmetrically progressive loss of hearing. The first intervention for this disease will be to help patient to understand the importance of the hearing aid (Li-Korotky, 2012).
Hearing aids can improve the sensory function hearing in the patient suffering with presbycusis (Mondelli, & de Souza, 2012). The progression of the disease rarely becomes very severe that hearing aids are not effective. Hearing aids can effectively restore the ability to communicate with others and it can also reduce the symptoms of withdrawal and emotional problems (Li-Korotky, 2012). Appropriately fit hearing aids can also help in improving quality of life of the patient (Ciorba et al, 2012).
Hearing loss or Presbycusis is a very significant age related problem. The health related quality of life of patients can be reduced over the time. Lola is a very positive and active woman, but she may face significant decline in her cognitive and mental abilities. Since the population of the baby boomers is significantly aging, the likelihood of the chronic health problems increases (Li-Korotky, 2012). Since, hearing is an important sensory function; Lola may find difficulty in effectively communication, understanding health related instructions and progressive problems can lead her to depression. The co-morbidities may include, cognitive problems, psychological distress, depression and many more issues that Lola can face in future.
Lola will be referred to the auditory rehabilitation and counselling for have better perception of speech and for gaining the better ability to communicate.
Lola will also be referred to the community based health literacy programs for older people with hearing disabilities to increase health literacy that will help to self manage herself in future.
The community based service was contacted through phone and written referral was provided to Lola. Lola has been displaying improvement in her condition and feeling more confident and independent.
Patient will be provided with auditory rehabilitation. Auditory rehabilitation is considered as the counselling, training or management for the hearing impairments (Lu, Tio & Le, 2012).
Auditory rehabilitation helps the patients with age related hearing loss, to perceive speech even in the noisy environment (Beier, Pedroso & Costa-Ferreira, 2015). This also helps patient, as it reduces the difficulties of understanding speech (Karawani et al, 2015). Hearing loss is also considered as the social loss. Therefore, maintaining hearing abilities is important for social functioning (Ciorba et al, 2012).
Patient will be provided with education to maintain continuity of care. Health literacy of the patient will be improved by providing education about the hearing impairments. Lola will also be encouraged to use the information about taking care of hearing aids and importance of timely medication.
Health literacy in the adult or older patients is very important., Health literacy is important to increase “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Chesser et al, 2016)
Patient will also be assessed for the psychological problems, as the studies have associated the hearing loss problem with impaired cognitive difficulties.
Hearing loss can progressively decline the functioning of the brain (Lin et al. 2015). The chances of cognitive decline are higher in the older patients, which may further reduce their quality of life (Gurgel et al, 2014).
Issue Two
Disturbed Sleep
Nurse will assess the sleeping patter of the patient and will help to develop the sleeping plan.
Sleeping plan will help the patient to understand the importance of effective sleeping environment and for understanding the importance of proper sleep.
The current information about the patient displays that she is able to carry out her daily activities and have not displayed any cognitive decline, but he suffers from disturbed sleep and ineffective sleeping pattern. The interventions for sleeping will help Lola to have better sleep and that would make her feel refreshed in the morning. Lifestyle modifications, sleep hygiene and physical exercise will help Lola to get better sleep at night.
Lola will be referred to community based leisure activity and physical exercise programs. Community or group based Physical exercise sessions can help Lola to strengthen her muscles and improve her sleeping pattern. After the physical exercise sessions, Lola is feeling more physically fit and sleeping pattern has also improved. She is feeling more independent and do not feel tired while shopping. She is now able to take long sleep at night without disturbance.
Patient will be encouraged to make lifestyle modifications. Patient will ask to take light food before sleep, avoiding caffeine, avoiding alcohol and soda.
Taking balanced diet and light food before sleep helps in taking un-disruptive sleep and maintaining stable sleeping pattern (Rodriguez, Dzierzewski, & Alessi, 2015).
Patient will be educated about and will be encouraged to maintain sleep hygiene practices.
Sleep hygiene consists of various interventions that help to promote un-disruptive environment and stable sleeping pattern. These include, maintaining sleeping and wake up time, refrain from taking napes in day time, keeping dark bedroom with stable temperature and promoting relaxation techniques before sleeping (like listening to mild music) (Gooneratne & Vitiello, 2014).
Patient will be encouraged to take part in physical exercise. This is because Physical exercise is considered as an important intervention for treating sleep problems in older people.
Exercise is a non-pharmacological intervention for eliminating sleep problems, such as insomnia, disturbed sleep. Physical exercise, such as brisk walking and moderate resistance training will improve sleeping pattern (Kredlow et al, 2015).
Issue Three
Nutrition Imbalance
Nutrition history of the patient has been received according to that history, level of nutrition will be analysed. Physical signs of the poor nutrition intake will be assessed.
Nutrition imbalance is very complex situation for the older adults. Nutrition imbalance can lead to cognitive decline; reduce mobility, physical functioning and significant impact on sensory and motor functions. Older people are vulnerable to malnutrition that also increases the risk of morbidities and mortality.
Nutritional imbalance is also associated with social factors, as in the case of Lola, where the cooking meal for one can be a burdensome task for the patient and patient may limit the meal to snacks (Leslie & Hankey, 2015). Since, Lola does not have any physical issues that restrict her nutritional intake. Therefore, the main reason is her loneliness and isolation that impacts her dietary practices. Fluid, protein and nutrition intake in case of Lola are below the requirement that can hamper her mobility and cognitive functioning in future (Godfrey et al, 2012).
Lack of protein, fluid, fibre and other nutrition can reduce her functional outcomes, and reduced functionality can significantly affect her quality of life. Fluid intake is important for preventing the problem of constipation and helps in regulating the body temperature (Godfrey et al, 2012).
Lola is not taking a balanced diet. The health records of Lola displays that she also lacks proper fluid balance and intake of protein. This problem can deteriorate her mobility and activities of daily life. Therefore, she will be referred to the dietician and dietary educational sessions. Imbalanced diet can increase the risk of falls and falls related injuries that can further reduce patient’s mobility, and well-being (Leslie, & Hankey, 2015). Nutritional problems are also associated with psychological problems, hopelessness and perceived loneliness (Jyväkorpi, 2016).
Patient will be referred to the dietician for complete nutrition assessment and for learning the methods of nutrition support.
The role of registered dietician is very significant for the older adults. It is because various conditions are associated with nutrition imbalance and dietician can determine the nitrogen balance and level of proteins in the patient, which are significantly required for proper health and functionality for maintaining future well-being (Bernstein & Munoz, 2012).
Patient will be encouraged to take more fluids, fibre, and more protein in her daily diet. For preventing muscle weakness and risk of falls and fractures.
Skeletal muscle mass, muscle strength, and bone mass can reduce in the older people. Lack of nutritional diet and lack of protein, fibre and other nutrients can result in loss of muscle mass and increases the risk of reduce mobility (Nowson & O’Connell, 2015). Fibre helps in appropriate motion and maintaining digestive system. Adequate amount of dietary protein influences functional outcomes of patients. Dietary balance and protein intake also increases leg strength (Bauer et al, 2013).
Patient will be encouraged to increase fluid intake.
Fluid plays an essential role in body and helps in increasing the capacity to the cells to carry nutrients and regulating body temperature (Godfrey et al, 2012).
Issue Four
Social Isolation
Patient will be assessed for explaining her feelings about her living condition to analyse the rate of hopelessness. This is because her husband is admitted in the nursing home.
Age related hearing loss or Presbycusis can affect the quality of life of the patient and can also increase the likelihood of psychological disorders like depression and anxiety. Patient assessment can effectively help in determining the risk (Ciorba et al, 2012).
Age related hearing loss can be associated with many negative consequences on the patient’s life. Hearing loss can also be associated with social withdrawal, social isolation, helplessness and depression.
Hearing loss can impact the social as well as emotional well-being of the patient. Walking and exercise sessions can be beneficial in encouraging social interaction and improves psychological problems Lambert et al (2017).
Social isolation in the case of Lola can also increase, as she lives alone and have no specific social or emotional support. However, studies have shown that social contact and social relationships are important for the lifespan for mental and physical well being (Hemingway & Jack, 2013). Therefore, addressing the future consequences of social isolation are required to be addressed in case of Lola.
According to the study of Hemingway & Jack, (2013), “participation in leisure, social, cultural and spiritual activities in the community, not only facilitates older people to maintain self-esteem, but also creates or enhances supportive and caring relationships by fostering social integration”. Therefore, patient will be referred to community support services. Through community programs related to social, cultural and leisure activities, patient can promote social relationships, have better mental health and chances of depression and hopelessness in future are also reduced. Involvement of family will increase sense of connectedness and self-esteem in patient (Mick, Kawachi & Lin, 2014). Lola was little uncomfortable about this schedule. However, she took and positively and provided her consent.
Lola has decreased taking part in social activities due to the changes in her lifestyle and physical condition. This can further increase her process of isolation. Therefore, patient will be encouraged to take part in social and cultural community based programs.
According to Lambert eta l (2017), community based social and cultural programs can encourage social inclusion in people suffering from age related hearing loss.
Family of the patient will be involved in providing care and support.
Patient centred care encourages the involvement of the family members in improving psychological and social problems. The people with hearing loss, living alone conditions and separation from partner can lead to progressive depression. Support of family will increase emotional support for patient will reduce the chances of psychological problems and hopelessness in future (Mick, Kawachi & Lin, 2014).
Patient will be encouraged to stay in contact with social network and try to visit her friends or relatives. Patient will also be encouraged to make social ties through community programs and interventions.
The psychological effect of social involvement and social ties has found to be positive on mental health and immune function (Hemingway & Jack, 2013).
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