Nursing Care Plan For Violet: Postural Hypotension And Malnutrition

Identified Patient Problem

Goals

Interventions

Evaluation Date

Problem1:

Postural hypotension and risk of falls

Reduction of postural hypotension

Falls are one of the most common issues among older adults. It is notable that 30% of the people over 65 and 50% of the people over 80 are more prone to be in a high risk of falls (Nilsagård et al., 2015). One of the most common causes of falls among older adults is postural hypotension (van der Wardt et al., 2014).  It is a feeling of a migraine due to low blood pressure while getting up from any static condition. Violet has been suffering from postural hypotension over the years and is having Amlodipine 5m for the hypotension. However, the medicine is not the suitable treatment of postural hypotension as the medicine is incapable to prevent falls (van Strien, 2017).  Necessary treatments and care plans are essential to reduce the risks associated with postural hypotension. On the contrary, the postural hypotension can lead to severe falls if it is remained untreated for a long time. As mentioned in the case study, it is seen that Violet has experienced several falls in spite of having medicines for hypotension. The cost of falling includes severe pain, distress, injury, loss of confidence and reduction in mortality (Yau et al., 2013). An every time quality care, necessary mental support and proper treatment and medication are required to reduce the possibilities of fall injuries. Thus, the change of medication and treatment process can be suitable for Violet to reduce the risks associated with the hypotension. On the contrary, if Violet remains untreated she can face symptoms like blurry vision, dizziness, weakness, fainting, confusion and nausea. The blurry vision and weakness can lead to the acute stage of a migraine that leads to fall (Gooch, Pracht and Borenstein, 2017). Moreover, fainting and confusion can lead to the permanent mental problem having no control over the physical activities that can also lead to falling. It is assumed that around UK£15 million is annually spent on fall-related issues for the older adults in the UK (Chen and Chantala, 2014).

The alone older adults are also at the high risk of hypothermia. The low blood pressure and unusual weight loss reduce the average body temperature (Azzopardi et al., 2014). Thus, the reduction of body temperature weakens the pulse rate, reduces the normal range of breathing and weakens the mental condition that can lead to the hypothermia (Azzopardi et al., 2014). It is generally the final stage of postural hypotension. It is found that Violet is not properly traded for her postural hypotension as she experienced several falls. Thus, she is at the high risk of facing hypothermia. The risks related to hypothermia can be more fatal for Violet due to her staying alone in her home. She had no one in her home to provide quality care to her in case of an emergency. In the case of hypothermia breathing becomes painful and body temperature deteriorates constantly. The deterioration can lead to body shivering and freezing that results in brain death (Azzopardi et al., 2014). Thus, it is necessary to avail sufficient treatment while facing any symptoms of postural hypotension that reduces the blood pressure. As per the case scenario, violet genuinely requires a caregiver who can provide support to her daily livings and provide assistance during falls (Andrews et al., 2015). Moreover, a change in the medication process can also work for the betterment of Violet in reducing the symptoms of postural hypotension (Azzopardi et al., 2014).

Problem 2: Malnutrition and weight loss

Ensuring Violet to weight gain

MUST tool is a universal guideline to reduce the risks associated with malnutrition and provide sufficient nutrition to the patients suffering from malnutrition and unusual weight loss (Garnett et al., 2014). M signifies nutrition, U signifies universal, S signifies Screening and T signifies tool. This screening tool can be suitable to control the unusual weight loss for Violet by providing a proper diet. Proper diet is an essential element for MUST that provides guidance regarding that provides guideline regarding BMI chart, weight loss techniques and a flow chart on food screening management (Garnett et al., 2014). Five steps can be taken as per the guideline of MUST to reduce the risks associated with the weight loss of Violet.

Step 1: Measurement of the BMI score

Height and weight should be regularly measured as per the BMI chart. The score as per the height and weight of Violet must be measured. The significance of below per average weight of Violet can be symbolised as low body weight (Notman et al., 2013). The low body weight can be controlled through proper vitamins and proteins intake. Additionally, proper dietary timing can also be a necessary aspect to control the unusual weight loss (Notman et al., 2013).  

Step 2: Recoding weight loss score

The BMI chart is also helpful here. This helps to measure the consistency in weight loss (Notman et al., 2013). A consistent measurement in the weight loss helps to figure out the reasons for the weight loss. As per the case scenario, Violet is not interested in having too much that leads her to the acute level of malnutrition. The record of the weight loss score is helpful to find out the ingredients that are lacking in her diet chart which lead to unusual weight loss (Notman et al., 2013).  

Step 3: Identification of the effect of the disease due to weight loss

The identification of the effect of the disease is helpful to understand the factors that are promoting to the disease due to weight loss (Notman et al., 2013). This can be a lack of vitamins, proteins and fat ingredients. The lack of vitamin, protein and fat ingredients promotes the consistency in weight loss (Notman et al., 2013). The records of these factors lie proper dietary plan (Lean et al., 2013). However, it is also notable that Violet does not consume sufficient foods for her healthcare development. This results in a continuation of weight loss and malnutrition (Slee, Birch and Stokoe, 2015). She needs to consume fruits, vegetables, milk, fishes and meat in order to gain her body weight. On the contrary, the lack of proper nutrition can lead to diseases like postural hypotension, hyperthermia and sever falls.  Thus, it is significant to record the diseases to promote further care plans (Mullick, Martin and Sallnow, 2013).

Step 4; Score addition

The recorded scores for all three steps must be added in order to figure out the risks associated with the malnutrition (Slee, Birch and Stokoe, 2015). It is found that Violet has lost 4 kgs of weight from her average weight in the last three months. Thus, it is necessary to add all the scores to get a detail of the factors that are promoting weight reduction in each stage (Slee, Birch and Stokoe, 2015). The loss of weight promotes malnutrition and physical and mental weakness (Slee, Birch and Stokoe, 2015). Moreover, it also invokes the symptoms of low blood pressure. Thus, the assessment of the score of all there stages is helpful to measure the type of malnutrition to Violet.

Step 5: Development of a care plan

The accumulation of the scoring of all the four stages is helpful to develop care plans in the final stages. The care plan must focus on increasing body weight (Fildes et al., 2015). The healthy development of Violet’s body weight can be done with the effective use of protein intakes. This is helpful to warm the body and increase the body weight (Fildes et al., 2015). Consumption of meat, fish, milk, eggs, fresh foods and fresh vegetables must be in the daily food chart in order to develop the body weight (Fildes et al., 2015).

Problem 3: Mobility issue

Safety assurance

A referral to occupational therapist and physiotherapist is essentially required for the healthcare betterment of Violet. The loss of mobility due to illness can be developed with the effective implementation of proper care plans for older adults (Adam et al., 2013). Violet is suffering from syndromes of hypertension and she uses to consume amlodipine 5m for her hypotension. This can often lead to muscle strain and muscle pain that leads to immobility. Thus, the effective care from occupational therapists can reduce the muscle pain through several physical exercises (Adam et al., 2013). Apart from that, they also assist to conduct the exercises that reduce muscle and bone complexity.

It is also notable that arthritis and low bone density are the common obstacles for the old ages that use to promote the immobility (Adam et al., 2013). As mentioned in the case study, Violet is an old aged patient who uses to suffer from the immobility. Moreover, she had no assistance in her home that can provide her care during her movement. Thus, a referral to the occupational therapists and physiotherapists can promote her mobility, can assist her to commit movement and can advise her exercises for her healthcare betterment (Adam et al., 2013).

Patients safety

The holistic approach of the occupational therapists and physiotherapists is to provide acute care to the old aged patients that can provide patients safety (Lunt et al., 2013).  The occupational therapists and physiotherapists can help Violet to promote the rehabilitation process to promote her acute interventions. They are determined by the personalised motivators that can help the old aged patients to maintain their healthy diet, having medicines and assisting in physical activities (Adam et al., 2013). 

The occupational therapists have profound knowledge regarding normal healthcare development, surgical and medical interventions and using their clinical skills to develop the mobility of old aged patients (Adam et al., 2013). On the other hand, the physiotherapists have profound knowledge regarding the exercises that help to promote mobility to the old aged patients. The physiotherapists can help violet by providing her assistance in developing her mobility through physical exercises (Adam et al., 2013). This includes walking, stretching and bending. The development of mobility can help Violet in reducing her immobility. Moreover, they can prevent from certain falls that she is facing presently.

The occupational therapists and the psychotherapists can provide support in critical care, surgical care and development of the behavioural health.

Critical care

The occupational therapists and the psychotherapists can provide critical care support to Violet  by

Ø Evaluating the requirements of the devices that are necessary to maintain joint integrity

Ø Performing the processes of the evaluation by determining the safety issues regarding eating and swallowing

Ø Providing training to the old aged patients regarding the possible exercises to promote mobility

Surgical care

The occupational therapists and the psychotherapists can provide surgical care support to Violet  by

§ Providing training on self-care activities

§ Developing self-mobility with the use of neuromuscular re-education and truck stabilization.

§ Developing muscle balance with the effective utilisation of occupation based care activities

§ Developing mobility by providing wheelchair assistance

§ Providing training regarding the orthopaedic protocols and appropriate weight balance.

§ Developing home programs to instruct healthcare development process

§ Teaching functional mobility

Development of behavioural health

The occupational therapists and the psychotherapists can provide support regarding the development of behavioural health  to Violet  by

· Assisting in conducting daily activities  acute mobility

· Teaching stress management system

· Addressing the cognitive requirement to develop self-care

· Developing protocols to ensure therapists regarding the healthcare goals setting and re-entry strategies

· 

Nurses Name

Signature

Date