Question:

1- He is at high risk of falling from visual impairment, hearing loss or confusion.

2- wandering out of the venue and/or getting lost.

3- Requires behavioral management to prevent wandering from other residents.

These three aspects are symptoms and signs of the condition. Could you please discuss them with him and tie them to his patho?4- Diet management due to his T2DB and hypercholesterolemia( he is not on any meds for high cholesterol), which might impact on his BGL and cholesterol level if they haven’t been managed.

5- Pain management because of his Chronic lower-back pain. It might have an impact on his ADLs.

Do you think pain could be a sign or symptom of his illness/patho?

6- Ingestion of toiletries and small objects because of dementia and confusion.

Answer to Question: BNURS20 Nursing

Introduction

Mr. X, a 87year-old male, was admitted into the care facility for multiple health concerns.

The patient’s identity has been kept secret because of ethical concerns.

The patient, a retired professor, lives with his spouse who is the primary caregiver.

The patient had aspiration pneumonia, and was admitted to the FMC.

Because his wife couldn’t cope with the stress of caring, he was made a permanent resident at the aged care facility. The patient has been suffering from Alzheimer disease, depression for the last few months, anxiety, type 2 diabetes mellitus, hearing loss, hypercholesterolaemia, glaucoma, stent-femoral artery, macular degeneration, TURP since the last ten years, peripheral vascular disease, chronic heart failure and chronic lower back pain.

To improve the patient’s health, it is imperative that they are assessed for their main conditions. A care plan must be established to address these issues.

The current paper will describe the pathophysiology, as well as the pharmacological options for treating these conditions.

This would include the effects of the durg, adverse side effects, contraindications, and nursing considerations.

Discussions would focus on the assessment and investigation of the patient to highlight the potential impact on the care plan.

Finally, we would make recommendations to improve the patient’s outcomes.

Pathophysiology, Pharmacology

The patient had multiple symptoms when he was admitted to the aged-care facility.

The patient’s primary concern is the possibility of falling from the result of hearing loss, visual impairment or confusion. This might lead to injury to the body.

The patient is currently suffering from Alzheimer’s Disease.

Wimo (2013, page 15), hearing and vision loss are the most common complications of Alzheimer’s, a form dementia.

Many cross-sectional studies suggest that dementia sufferers may experience cognitive decline as a result of sensory impairments.

These sensory impairments can include hearing loss and visual impairment.

Alzheimer’s disease is a major disorder that affects people aged 70 or older. It can cause a variety of problems.

The pathology of dementia is marked by abnormal beta-amyloid accumulations in the brain. These plaques form neurofibrillary tangles with abnormally phosphorylated tau.

A variety of visual problems can result from dementia including color vision loss and visual acuity losses, changes to the pupillary response, abnormally phosphoryated tau neurofibrillary tangles, eye movements defects, and disturbances to complex optical functions like reading or detecting objects.

Because of changes in brain functioning, the decline in hearing ability can be attributed to neurological impairment.

Extrinsic and intrinsic factors both contribute to the risk of falls in older people.

Balance impairment, cognition loss, balance impairments, cognitive problems, muscle strength, vision, gait, depression symptoms, and other factors are important.

In older adults over 65, hearing dysfunctions is the third most common chronic disease.

Hearing impairment can impact the quality and quantity of life.

Many studies have linked hearing impairment to fall-related dangers.

Hearing impairment patients require greater attention to the processing and detection of auditory cues. This leaves them with reduced attention for balance control (Steinberg and co., 2015, p. 446).

Falls are directly linked to vision impairment.

It is simple and direct that people with vision impairments don’t recognize environmental hazards beyond their lines of sight (Beltran 2015, p.E5844-45)

Other symptoms include confusion and disorientation that require attention.

The patient was often wandering and predisposed to getting lost.

He was also gaining entry to other residents’ rooms.

These conditions increase his risk of getting hurt.

These conditions are associated with Alzhiemr’s syndrome.

Alzhemier’s patients lose their short term memory, but their long term memories link them to their past lives.

Mrs. X’s wandering behavior is due to the fact he was a paediatric doctor and used to wander around in the hospital looking after his patients.

Alzheimer’s disease, which is causing progressive brain damage, is the main cause of the confusion.

The brain’s functioning is severely affected, so the patient has difficulty understanding the environment. (Berry (2014), p. 123).

Caregivers should be alert for chronic lower back discomfort (LBP).

If normal connective tissues fail to heal within 3 months, then lower back pain can be considered chronic.

Chronic LBP can only be resolved by slow tissue repair in an avascular intervertebral disk.

Chronic LBP can result from traumatizing and degenerative spine conditions (Arneja (2016), p. 453).

In this instance, the patient was suffering from an ADL (activities of daily living) that had impacted his daily life.

The patient is dependent on his wife for all aspects of daily life.

The dementia patient has difficulty expressing his pain.

Reduced communication skills and cognitive ability are the reasons.

In this situation, patients find their own relief methods (van Kooten 2017: p.523).

In this instance, the patient may be seeking relief from chronic back pain.

ADLs may also be impaired by pain.

Researhers suggest that ADL impairment can be caused by pain or functional impairment.

Based on the symptoms and signs that the patient is showing, the pharmacological treatments for this patient would include Paracetamol and Mirtazapine.

Paracetamol, also known as acetaminophen or paracetamol, is a common drug that patients use to reduce pain.

It has been recommended to be used as a first-line therapy for low back pain.

While the drug generally has no side effects, some patients may experience dizziness, liver problems, severe dizziness, or difficulty in breathing.

Poor nutrition, renal impairment, and acute inflammation in the liver are some of the contraindications.

A nurse should verify that paracetamol is not being taken by the patient.

Also, it is crucial to assess the patient’s therapeutic response (Lehne& Rosenthal 2014. p. 254).

Mirtazapine has been used in the treatment of depression.

The drug’s efficacy is measured by its ability to elevate mood.

The drug can cause side effects such as nervousness and delusions, restlessness, drowsiness or dysphagia, constipation, dysphagia, weakness, headache, constipation, insomnia, mood elevation, and dizziness.

The contraindications to this drug are hypersensitivity, acute Myocardial Infarction (AMI), infection, fever, jaundice and ethanol intoxication.

The nurse should monitor patients for the signs and symptoms of depression.

A history of cerebrovascular disorder and orthostatic hypotension are to be taken into consideration.

Oxazepam, the preferred drug for managing anxiety in patients, is the most popular.

The drug has anxiolytic, sedative and hypnotic effects.

Side effects of this drug include dizziness. vertigo. mental confusion. lethargy.

Hypersensitivity to this drug and other benzodiazepines or psychoses is a contraindication.

There are signs of overdose that should be considered by nurses.

A physician must be informed if the patient’s daytime psychomotor function is impaired (Karch&Karch (2016), p. 87).Investigation

Alzheimer’s disease is the most common form of dementia. It is essential to perform a neurological evaluation in order for the patient to understand the extent and severity of their cognitive function decline.

Nielsen et.al. (2016) have a good explanation of the importance of neurological evaluation in dementia. They claim that cognitive deficits due to dementia are not the same as those caused by age-related conditions. This makes neurological assessment more complex.

Assessment of neurological functioning in patients can help to diagnose disease earlier, such as the case of Mr. X.

This assessment is crucial for understanding executive dysfunctions responsible for mental manipulation of information, cue-directed behavior and problem solving skills.

It will include the tests for reflexes and eye movement as well speech, coordination, muscle strength, tone, sensation, and coordination.

In this case, it was determined that Mr. X suffered from anxiety and confusion.

Since dementia can be caused by heart disease, it is important to perform a cardiovascular evaluation.

It is well-known that decreased cerebral blood flow (CBF), as a result heart disease, can worsen the brain’s vascular homeostasis.

Patients with tau protein build-up and beta-protein build-up have more cognitive problems.

Studies show that dementia patients with a history or heart disease are more likely than those without it to have structural and/or functional cardiac abnormalities.

Mr. X was assessed cardiovascularly and his blood pressure was measured at 151/85 mmHg.

This reading is higher that the normal BP value of 120/80 mmHg.

Normal heart rate was 90 bpm. The normal values are 60-100.

This information indicates the need to manage blood pressure with medication and proper dietary habits.

An important part of the patient’s care is renal assessment. This helps identify kidney impairments, track disease progress, and determine baseline measurements to start taking medication.

The patient in this instance will be required to take a number medicines to treat his symptoms.

The results of the assessment will help determine the right medication regimen for the patient (Wanner et. al., 2016, page 325).

The patient in this case reported faecal dysfunction.

In this instance, a complete gastrointestinal assessment is required.

This condition can be described as the involuntary discharge of feces or the inability for the patient to control it.

A nurse could assess the condition to help the patient live a better quality of their lives.

To relieve Mr. X from the complications of faecal Incontinence, it would be a good idea to address his limitations in performing ADLs by himself.

The care facility didn’t record vital signs of patients for three months, even though it is their policy to collect monthly vitals for each resident.

Vital signs are the primary indicator of a patient’s overall health. They determine the patient’s respiratory, neural and circulatory functions, as well as their endocrinal function.

Vital signs are used to communicate information such as the patient’s disease severity and condition.

These parameters assist nurses in identifying which interventions should be made to the patient and in making decisions regarding the response to treatment.

Black (2016). Vitals refers to the physiological measurement of bloodpressure, heart rate and temperature.

BGL for Mr. X must be taken on Friday before meal, per the doctor’s instructions. Since 6/6/2017, they have also missed it.

On 6/6/2017, BGL results pre-meal were 6.4 mmol/l. Currently it is 6.1mmol/l.

BGL levels should be checked at least once per week in order to maintain control (Aleppo., 2017, page 539).

Low blood sugar can be caused by certain oral drugs. It is important to monitor your levels regularly.

BGL levels can be affected by changes to body weight. This means that it is important to monitor BGL regularly if the patient has been diagnosed with Type 2 Diabetes.

A diabetic patient should be provided with a diet that is both nutritious and low in glucose.

Normal blood sugar levels for healthy people range from 4.0 to 6.0 mmol/L, 72 to 108 mg/dL fasting, to 7.8 to 140 mg/dL 2 hours after eating.

The mini mental status exam (MMSE) was used to determine MrX’s mental state.

A patient’s overall examination should include a mental health assessment.

It is an addition to other components of assessment such the atienthistoryof complains.

While the medical history may seem static, the mental condition is dynamic.

The mental status exam is used to provide structure data on the patient’s mental functioning (Pasi, 2015, p. 253).

Recommendation

Based on the assessment findings and patient conditions, several recommendations can be made to address the individual patient’s concerns.

The first is to support the patient in reaching optimal health and well-being through participation with different activities.

This must include both social and medical health care.

The patient is suffering with dementia, so special attention must be paid to his cognitive function.

The patient may be given memory activities like puzzles to improve his cognitive skills and reduce social isolation. However, the patient should still engage in any recreational activity.

An expert can help with this (Butcher and colleagues, 2013, p.214).

A physiotherapist, who can make improvements in the patient’s ability to perform activities independently and his body functioning impaired due to chronic back pain and impairments, would be a good choice.

Fall prevention is essential in the patient’s care.

First, an armband must be given to patients to help professionals recognize high-risk individuals and take appropriate action.

Carers would be alerted about potential falls by using a visual cue located outside the patient’s door.

When there are more safety buddies, they can ensure that disoriented patients, such as Mr. X get continuous monitoring and supervision to prevent them from falling.

Bed alarms allow patients to call for assistance any time of the night or day.

It is essential to ensure that your bed has siderails and that your washroom has handrails.

The floors must be dry and not slippy.

Spills are to be avoided. Also, the floor must not be laden with heavy furniture or other items that could cause injury (Potter et. al., 2016, P. 56).

Patients care would consist of dietary intake as well as pain management, BGL evaluation, and observation of vital signs to monitor changes in patient condition.

Black, 2016, page 57.

With regular administration of medications, pain management is possible.

BGL assessment is essential to ensure that the patient receives the right diet.

A social worker could encourage the patient’s wellbeing by offering emotional support and allowing him to express his feelings.

The five S rule of communication between the patient and the social worker is essential for dementia patients. It’s slow, simple, specific, show & smile.

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