NUR312 Nursing The Adult Client

Background

The current assignment takes into consideration a number of assessments for analysing the condition of the patient. Here, the patient Mary was an 82 years old widow living in Adelaide. She had been living alone after the death of her husband and has two children who stay in Brisbane and Queensland and occasionally visiting her. Mary had been diagnosed with breast cancer 10 years ago and had survived it. However, she had developed a number of health complications very recently. For example, she suffers from hypertension, borderline dementia and has osteoarthritis, which makes daily activities or movement difficult for her. She has also had reportedly showing signs of macular degeneration which makes performing activities like driving difficult for the patient.  Mary stated that she has had an active life and had been visiting her friends in the local community centre where she would drive herself on every Saturdays. However, her present health condition has limited her within the four walls of her home. Therefore, as a community nurse I was assigned with the job role of assessment of the present health condition of the patient.

Experience in completing the assessments 

I had faced a number of difficulties in conducting the health assessments of the older lady over here. This is because the old lady had dementia, which made remembering things or effectively reporting them difficult for her. However, on slight nagging she reported that she had been taking three different medicines for her diabetes, hypertension and osteoarthritis. She also admitted that she had difficulty in remembering the medicine time and doses and ended up missing medication doses quite often.

Therefore,  in order to come  out with an effective diagnosis a number of assessments test were conducted for the lady such as the Katz index independence in activities of daily living, Lawton’s  instrumental activities of daily living, assessment of nutrition in the elderly, immunizations for older adults.

Three findings from the assessment

The kat’s index independence consists of a number of activities of daily living such as – bathing, dressing, toileting, transferring, continence and feeding. The patients are rated on a scale of 0-1 where the patient is given 0 in case he/ she cannot perform the activities without supervision or assistance and 1 in case they can do it alone. Here, the patient received a score of bathing-1, dressing- 1, toileting-1, transferring-0, continence- 1, feeding- 1.  Hence, the patient could only move with the help of walking aide.

The Lawton’s instrumental activities of daily living consist of a range of activities which are complex in nature. As mentioned by Kane, Ouslander, Abrass & Resnick (2017), one losses the capability to perform some of these complex activities such as shopping, cooking, managing and finances much before they lose control over their activities of daily living. These may decline incipient decline in older adults. Here, the patents are rated on a scale of 0-8; where o signifies low functioning whereas 8 signify high functioning (Korc-Grodzicki et al., 2015). The patient received an average score of 4.5, which signifies risk in losing functions.

The patient reported that she had once received varicella vaccination for the treatment of hepatitis infection and has liver issues. The patient reported that she is not very accurate about her diet and most of times would only eat two times   in a day from her   stocked up biscuit cans and jars.

Outcomes developed for the client

Therefore, based upon the above assessment it can be said that the patient had movement difficulties owing to her condition of osteoarthritis and had difficulty in cooking and shopping for her. She also reported that she often neglected effective medications due to dementia. Therefore, as a community nurse I will have to help the patient in regaining autonomy over most of her activities of daily living. For example, I can use telephone to give her reminders on a six hourly basis to take her medications; I can drive her to the shopping centres as well as help her to the clinic to treat the condition of osteoarthritis.

Discussion of the post

Dear friend,

I have read your post on the health condition of your 87 year old African American patient. In think you have rightfully conducted the assessments with her as taking the immunization history is very important before starting a clinical process.

I think   as you have well summed up the total scores of the patient from the Lawton instrumental activities of living and katz index of independence. However, giving a detailed outlook on the individual parameters considered would have been helpful. I think suggesting the patient control exercises would have been effective enough. However, I think you should have also mentioned provision of counselling services to the patient as the patient is an 87 year old lady living alone as the counselling services help in supporting old age crisis to a greater extent (Honda, Ito, Ishikawa, Takebayashi & Tierney, 2016).

References

Honda, M., Ito, M., Ishikawa, S., Takebayashi, Y., & Tierney, L. (2016). Reduction of behavioral psychological symptoms of dementia by multimodal comprehensive care for vulnerable geriatric patients in an acute care hospital: A case series. Case reports in medicine, 2016, 125-136.

Kane, R. L., Ouslander, J. G., Abrass, I. B., & Resnick, B. (2017). Essentials of clinical geriatrics. London: McGraw-Hill Medical Publishing Division, 55-72.

Korc-Grodzicki, B., Sun, S. W., Zhou, Q., Iasonos, A., Lu, B., Root, J. C., … & Tew, W. P. (2015). Geriatric assessment as a predictor of delirium and other outcomes in elderly cancer patients. Annals of surgery, 261(6), 1085.