NSG1NMA Nursing Management And Assessment
Question:
Scenario
Mrs. Barbara Green is an 89-year-old woman who migrated to Australia from Germany 40 years ago. Barbara is a retired primary-school teacher and lives alone in a single-storey house. Barbara was married to Henry who was in the Royal Australian Navy; however he died of lung cancer two years ago. Barbara has a son Dominik from a previous marriage. He lives in Germany with his family and visits Barbara regularly. Henry‘s daughter from previous marriage, Tracy and his extended family live throughout Australia but keep in contact and visit regularly.
Barbara retired twenty four years ago, at the same time Henry retired from the Navy. The couple spent their time together traveling around the world and volunteering at the local St Vincent de Paul shop. They participated actively in their local Catholic Church, organising fundraising activities. They were also very active members of the German Association. Barbara is fluent in both written and spoken English and German. She speaks with a strong German accent and sometimes people ask her to repeat herself.
Barbara’s health has been slowly deteriorating over the last two years, forcing her to limit her level of activities. Last year, Dominik and his family visited Barbara. They wanted her to return to Germany with them so he and his family could be close to her, but Barbara decided not to leave her home. She was grateful to her son and family for the offer though. Henry’s daughter Tracy has kept in touch with Barbara since Henry died and visits every three months with daily phone calls.
Barbara’s medical history is as follows:
- Dry macular degeneration
- Hypothyroidism
- Rheumatoid arthritis
- Osteoarthritis.
Recently, Barbara has stopped driving due to her diagnosis of macular degeneration. She rarely leaves the house due to altered mobility and has lost physical contact with both friends and members of the German Association. Barbara’s house is unusually unkempt and the cupboards have minimal amounts of food consisting of some tins of soup and baked beans.
Barbara feels very connected to her community and wants to stay in her own home. She realises that in order to do this, she may need help. Barbara feels she is already too much of a burden on Tracy and her family. Barbara’s local doctor is concerned that she is not eating properly, is losing weight and becoming too isolated.
Barbara has been referred by her GP to the local community health centre for assessment and review. The referral letter from her GP states the following symptoms:
- Joint stiffness.
- Swollen feet and enlarged joints.
- Painful joints particularly, her knee, hip, fingers and back.
- Limited joint movement.
- Constipation
- Occasional dizziness
- Vision deficit
- Non-significant recent weight loss
- Patient states adherence to medications but it is suspected she may forget or skip doses when she is in pain
Medications:
- Slow release Paracetamol 665 mg tab ii 3 times a day
- Ibuprofen 400 mg three times a day
- Thyroxine 150 mcg daily
- Hydroxychloroquine 200mg daily
You work at the local community health centre as a Registered Nurse and are assigned to manage Barbara’s assessment and care in her home.
Intructions:
Introduction:
-General Ideas about aged related disease such as macular degeneration, rheumatoid arthritis and osteoarthritis
-Indicate purpose of the essay
-Describe overall parts of essay
Body:
Barbara is at risk of fall related to her macular degeneration as evidenced by subjective claims of vision deficit and occasional dizziness.
- What is dry macular degeneration?
- How does it affect an older people ( relate to Barbara) (google the pathophysiology of macular degeneration and explain how does it affect barbara with her age)
- what are the risk factors of macular degeneration?
- some information about macular degeneration but not solutions
Barbara is also at risk of decreased mobility ( means limited movements )related to her rheumatoid arthritis and osteoarthritis as evidenced by joint stiffness, painful joints particularly at her knee, hip, fingers and back and limited joint movements.
- What is rheumatoid arthritis
- How does it affect older people like Barbara? ( if you type in google the pathophysiology of rheumatoid arthritis, you will read how does it affect barbara considering her age).
- what are the risk factors of rheumatoid arthritis? (relate too to barbara’s case)
- what is osteoarthritis? and how does it affect barbara considering her age.
- pathophysiology of osteoarthritis
Barbara at risk of imbalanced nutrition less than the body requirements related to her hypothyroidism as evidenced by non-significant recent weight loss.
- What is hypothyroidism
- Discuss the signs and symptoms
- Risk factors of hypothyroidism
- how does it relate to Barbara’s case?
Answer:
There are various types of aged related diseases such as rheumatoid arthritis, osteoarthritis and macular degeneration. Macular degeneration refers to the gradual vision loss that affects more than 10 million people. On the other hand, rheumatoid arthritis refers to the autoimmune disease that affects the body immune system those which, protects the body from foreign particles (Finger et al., 2014). Osteoarthritis refers to the degenerative joint disease that is a common chronic disease of joints.
The main purpose of the assignment is to discuss the risks factors, signs and symptoms of various diseases like rheumatoid arthritis, osteoarthritis and macular degeneration. The problems are needed to relate with the case of Barbara.
In the first part of the assignment, the issues of Barbara are discussed that she is facing. She is at the risk of macular degeneration. Therefore, the risks of the macular degeneration and effects on the aged people are discussed. In the second part of the assignment, the discussion focuses on the risks of the rheumatoid arthritis. The effects of the problem on the Barbara are also discussed. The assignment stated that Barbara has the risk of hypothyroidism. The discussion states about the signs and symptoms of the hypothyroidism and risk factors are analyzed.
Dry macular degeneration refers to the general type of macular degeneration that affects most of the people. However, this is the dry form of macular degeneration. This causes due to the breakdown of retinal pigment epithelial cells in macular degeneration.
The pathophysiology of macular degeneration is of two types that is clinical pathophysiology and molecular pathophysiology. Clinical definition of macular degeneration can vary with the source. In case of Barbara, the useful clinical guideline is that when the drusen are greater than five in number is in posterior pole and 63 µm in the size. Gradually the drusen becomes large and shallow elevation of RPE overlies Brush membrane. AREDS evaluation results clinically helpful process to determine the risk of MD. Some of simple criteria are presence of the large drusen and pigment abnormalities. Dry MD may be considered as the autosomal disease, which is affected by the environmental and nutritional factors.
The factors of dry macular degeneration that can affect aged people:
Artificial fats:
Barbara needs to take low fat foods, which can reduce the risks of dry macular degeneration. Artificial fats influence the chance of dry macular degeneration.
Sunlight:
Sunlight has blue wavelength that damage macula. This can damage the retina permanently.
Diet:
According to the case study, Barbara does not take sufficient amount of food. As a result, the disease affects her. However, she needs to avoid the oil and oily foods rather she need to take more green leafy vegetable. The green leafy vegetables help to reduce the signs and symptoms of dry macular degeneration (McCusker et al., 2016).
Obesity:
Obesity is another factor that influences the dry macular degeneration. However, in the case study, it is not mentioned that whether Barbara is obese or not. However, this risk factor can be controlled.
Age:
People above 60 years age are at high risk of dry macular degeneration. Therefore, Barbara needs to be more careful about her health.
Race:
The disease mostly affects the whitish people than the Black people. This happens due to heredity. It affects the older people mainly. The severity of the disease has three types such as early, intermediate and late.
Macular degeneration affects the retina directly. The person may loss the eyesight permanently.
Rheumatoid arthritis is the autoimmune disease that affects the body’s immune system. The immune system helps to protect the body from the foreign particles like bacteria and virus. These foreign particles attack the joints and as a result, rheumatoid arthritis occurs (Nineham et al., 2014). Inflammation occurs and it can damage the cartilage bones.
The pathophysiology of the rheumatoid arthritis is discussed. Rheumatoid arthritis is a systemic inflammatory disease that is caused by the joint destruction and synovitis in Barbara. However, Harman et al. (2014) mentioned that the etiology of the rheumatoid arthritis is still unknown. This may happen due to genetic disorder. Finger et al. (2014) mentioned that the immune response is controlled by the HLA genetic site. The STAT4 gene plays significant role in regulation of immune system as well as helps in the regulation. The synovial membrane in the rheumatoid arthritis is hyperplastic. The number of synoviocytes increases with the inflammation including macrophages, T lymphocytes and B-lymphocytes. The chronic inflammatory response may be persistent in the conjunction with the joint destruction. The main reason of the inflammation of the joints is the presence of the cytokinin and increase of cytokinin increases the risks of rheumatoid arthritis.
Rheumatoid arthritis can happen due to excess production of cytokines, inflammatory mediation and chemokines. This can include the interleukin, IL-6, IL-8, transforming growth factor beta, tumor necrosis factor alpha, fibroblast growth factor and platelet derived growth factors (Harman et al., 2014). It can affect the joints, cartilages as well as the bone, soft tissues, ligaments, blood vessels and tendons.
The affecting factors refer to the something that influences the development of the disease. The rheumatoid arthritis may influence the chance of decreasing working ability. Some factors that influence the rheumatoid arthritis are as follows:
Gender:
Rheumatoid is most common in female in comparison to male. This is the effects if estrogen, which produces in the female body. Estrogen influences the chances of rheumatoid arthritis.
Age:
Age is another factor that influences the signs and symptoms of rheumatoid arthritis. With the increasing age the risks of rheumatoid arthritis increases. In case of Barbara, age is the vital factor.
Genetics:
Barbara has no family history of rheumatoid arthritis therefore, it is not an inherited disease in case of Barbara.
Smoking:
It can be assumed that Barbara has no smoking habit, which may influence the rheumatoid arthritis. del Rincón et al. (2015) stated that smoking worse the situation of rheumatoid arthritis.
Osteoarthritis is the degeneration of underlying bones and joint cartilage. This happens mainly in the mid age or old age. It affects the cartilage bones and tissues.
Hypothyroidism refers to the abnormality of the thyroid gland. The activity if thyroid gland becomes low and the mental power is affected. It mainly affects the children and old age people.
The signs and symptoms of hypothyroidism are as follows:
- Constipation
- Depression
- Fatigue
- Dry skin
- Swelling of thyroid gland
- Reduced heart rate
- Constipation
- Hair loss
- Weight loss
- Carpel tunnel syndrome
Various factors of hypothyroidism are age, sex, family history and rheumatoid arthritis. In case of Barbara the age, sex and rheumatoid arthritis plays vital role that influence the hypothyroidism. On the other hand, Cerbone et al. (2014) mentioned that hypothyroidism is the inflammation of thyroid gland that is caused by poor metabolism rate.
The main reasons of hypothyroidism are radioactive iodine treatment, use of particular medication, thyroid surgery, radiation therapy and intake of low sodium foods.
The risks of hypothyroidism increase with age. Barbara is 89 years old. As a result, hypothyroidism can affect Barbara highly. She needs to modify her lifestyle. For example, she can change the eating habit. It is seen that hypothyroidism mostly attacks females more than male. Moreover, Barbara has rheumatoid arthritis, which influences the hypothyroidism (Enomoto et al., 2014).
References
Cerbone, M., Capalbo, D., Wasniewska, M., Mattace Raso, G., Alfano, S., Meli, R., … & Salerno, M. (2014). Cardiovascular risk factors in children with long-standing untreated idiopathic subclinical hypothyroidism. The Journal of Clinical Endocrinology & Metabolism, 99(8), 2697-2703.
del Rincón, I., Polak, J. F., O’leary, D. H., Battafarano, D. F., Erikson, J. M., Restrepo, J. F., … & Escalante, A. (2015). Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis. Annals of the rheumatic diseases, 74(6), 1118-1123.
Enomoto, K., Uchino, S., Watanabe, S., Enomoto, Y., & Noguchi, S. (2014). Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery, 155(3), 522-528.
Finger, R. P., Wickremasinghe, S. S., Baird, P. N., & Guymer, R. H. (2014). Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration. Survey of ophthalmology, 59(1), 1-18.
Harman, S. M., Black, D. M., Naftolin, F., Brinton, E. A., Budoff, M. J., Cedars, M. I., … & Miller, V. M. (2014). Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Annals of internal medicine, 161(4), 249-260.
McCusker, M. M., Durrani, K., Payette, M. J., & Suchecki, J. (2016). An eye on nutrition: The role of vitamins, essential fatty acids, and antioxidants in age-related macular degeneration, dry eye syndrome, and cataract. Clinics in dermatology, 34(2), 276-285.
Nineham, L. J., Hay, F. C., Male, D. K., Roitt, I. M., & Young, A. (2014). IMMUNE COMPLEXES IN RHEUMA TOID ARTHRITIS: CORRELATIONS WITH CLINICAL FEATURES AND EFFECTS OF GOLD. Protides of the Biological Fluids: Proceedings of the Twenty-Sixth Colloquim, 1978, 179.
Schwartz, S. D., Regillo, C. D., Lam, B. L., Eliott, D., Rosenfeld, P. J., Gregori, N. Z., … & Maguire, J. (2015). Human embryonic stem cell-derived retinal pigment epithelium in patients with age-related macular degeneration and Stargardt’s macular dystrophy: follow-up of two open-label phase 1/2 studies. The Lancet, 385(9967), 509-516.
Use the following coupon code :
SAVE10