Enhancing Primary Care Of Elderly People -Myassignmenthelp.Com

Question: Discuss About The Enhancing Primary Care Of Elderly People? Answer: Introducation It is necessary to collect Mrs. Walkers past medical history in order to understand the health complications she had suffered in the past as this would form the basis of the treatment plan at present. Further, it is necessary to interact with her family members for understanding the preferences of the patient and other information such as sleep patterns, allergies and dietary routine (Ackley et al., 2016). The health assessment process has many steps integrated into it, of which the interview stage is referred to the conversation taking place between the patient and the care giver with the purpose of highlighting patient information. The purpose of such interviews is to gain insight into the present as well as past physical condition of the patient and related physiological concerns. Based on the information collected from the interview, the care plan for the patient is to be outlined so that desirable patient outcomes are achieved (Cress, 2015). Assessment tools for older adult patients in a clinical setting are used for carrying out a comprehensive health assessment. Such tools are specific for highlighting patient concerns pertaining to impairments, health complaints and comorbidities suffered by older adults (Boltz et al., 2016). Older patients have higher chances of suffering medical morbidity and functional decline, both physical and cognitive. Assessment tools address each of these risk factors through their diverse elements embedded int he tools. For carrying out an assessment for Mrs. Walker, the two assessment tool that would be appropriate are Patient Health Questionnaire-9 (PHQ-9) and Katz Index of Independence in Activities of Daily Living. The concerns about Mrs. Walker regarding her emotional instability and anxiousness are to be discussed on an immediate basis with the psychogeriatrician she had consulted. The mental condition of a patient potentially interferes with the physical well-being of the patient and thus it is important for a nurse to address these issues. The attempts of communicating with the client on the nurses part are to be discussed. The tool that can be used for assessing the mental health condition of Mrs. Walker is the Mini-Mental State Examination tool. Research indicates that this tool, a 30-point questionnaire, is useful for the effective detection of the mental health status of the patient along with any cognitive impairment that the patient has suffered (Dains et al., 2015). The Standard 6 for the Enrolled Nurse relates to the decision making process and provision of care. As per this standard, a nurse is supposed to demonstrate her professionalism by providing timely and high quality care to a patient while upholding the provision of involvement of the patient in the care process. In a clinical setting, restraint is any equipment, device or material that is placed near the patients body or is attached to the body itself so that the patients movement is restricted to a desirable extent. The aim of such restraints is to reduce the ability of the patient to make an inappropriate movement that might cause harm to the patient herself or others. The person who is is ultimately responsible for authorizing the use of restraint is the enrolled nurse delivering care to the patient (Foebel et al., 2016). The psychology restraints appropriate for Mrs. Walker are sided rails that prevent the patient from moving out of bed and enclosure bed. The purpose is to reduce the chances of patient fall. The obligation is to make sure that the patient is able to make the necessary movements required for her comfort. The first and main reason for the weight loss of Mrs. Walker can be attributed to poor nutrition as she has been found to refuse eating. According to Rose et al., (2013) inadequate nutrition is the primary cause of weight loss in patients. The other potential factors leading to the weight loss include psychological status, social isolation, and ill health. The patient has been suffering from dementia in which the patient looses cognitive ability and memory, often leading to poor nutritional intake. Psychological factors like depression is also a cause of wight loss. Lastly, the patient had been living alone, and research indicates an association between social isolation and weight loss. Mrs. Walkers mobility is impaired, and she is physically weak. Mobility issues and, functional impairment lead to falls and reduced body functions. This has a negative impact on the nutritional intake of the patient. As the patient lives alone, she must have been facing difficulties in ensuring proper nutritional intake (Cress, 2015). Referral for Mrs. Walker is to be made to three professionals who would provide specialist care; recreational therapist, exercise physiologist, and dietician. The role of the recreational therapist would be to apply activity-based interventions for addressing mental health concerns. The dietician would outline a dietary chart for appropriate nutritional intake. Lastly, the exercise therapist would aid in increased patient mobility (Wold, 2013). A patient having poor oral hygiene suffers difficulty in eating and subsequently has a less nutritional intake. The rationale is a limitation in food choices due to difficulty in eating. Further, a dry mouth is the cause of speaking difficulties. The patient also has reduced pleasures associated with eating. Moreover, poor appearance due to poor oral hygiene is a significant reason for low self-esteem. Lastly, there is a link between poor oral hygiene and health complications such as cardiovascular disease and diabetes (Bhayade et al., 2016). The oral health assessment for Mrs. Walker need to include aspects such as texture of the gum between the teeth as well as under them, colour of the tongue and lips, texture of the same, production of saliva, condition of tissue inside cheek and on roof and floor of mouth, oral cleanliness and any concerns related to dentures. The dentures need special mention as the same had ben found to be kept in inappropriate places at the patients home (Gil et al., 2015). Dentures are a removable replacement for teeth not present naturally in a patient. They are prosthetic devices helping in eating ability of the individual. Since the prosthetic device is placed within the mouth, they are to be kept clean and free of stains. Soon after using the denture they are to be removed from the mouth and cleaned for removal of the food particles. They are then to be placed at an appropriate place for avoiding damage. Caution is to be taken so that the denture does not become enlarged, indicating its uselessness. Simultaneously, the patient needs to clean her mouth after removing the denture. A toothbrush can be used for this purpose that is helpful in cleaning the palate and tongue. For maintaining the shape of the denture, it is advisable to soak it in water overnight. For cleaning the denture, a mild cleanser is to be used (Mylonas et al., 2016). A gait assessment would be essential for Mrs. Walker as she has impaired mobility and is not able to stand on her feet while maintaining balance. Such as assessment is imperative for evaluating the level of steadiness for the patient. The assessor can understand the changes in walking posture and difficulty faced by patient related to a patient stance. An orthopedic professional would be the concerned professional for this assessment (Pierre Conley, 2017). Dementia is defined as the chronic mental disordered suffered by patients in which the individual has reduced levels of cognitive skills and memory along with a decline in thinking and judgment ability. A person suffering from this persistent disorder has impaired communication and reasoning skills (Mller et al., 2017). Alzheimers disease, a progressive neurodegenerative disorder, whose early stage is marked by memory loss in a mild stage. With the progress of the disease, the patient gradually losses the ability to engage in an appropriate conversation with other and interact with the social environment. The symptoms include language problem, mood swings, disorientation, loss of motivation and behavioural issues. Responding to the changes in the surrounding is difficult under such conditions. A patient suffering from this disease has impaired the ability to carry out activities of daily living. The rationale for this is reduced mental status. Research indicates that approximately 80 % of reported cases of dementia are of Alzheimers (Devanand et al., 2015). Lack of knowledge about the differences between palliative care and end-of-life care has often led to the need of educating patients and their families about the same. As opined by Hui et al., (2014) there is a distinct difference between the two forms of care. Palliative care is known as the form of care whose key focus is on the improvement of patients quality of life and care delivered when it comes to addressing life-limiting or life-threatening heath complications. The objective is to guide the patient and the family through the complete process of prevention and relief of pain and suffering. It is imperative to detect the physical, psychosocial and spiritual concerns pertaining to the patient condition. End-of-life care, though an element of palliative care, is more directed towards patient care when the individual is nearing the end of his life. Such form of care aims to maintain the quality of life before the patient dies (Boltz et al., 2016). Stimulation therapy would be the first approach helpful for Mrs. Walker to address her mental instability. According to Wold (2013) stimulating therapy is useful for distracting patients from the disturbing environment and engaging them in different activities. In the present case, the patient has been suffering from anxiety that could be addressed through this. Engaging in different activities would ensure that her feelings of loneliness would be diminished and she would regain self-confidence. Secondly, cognitive behavioural therapy (CBT) would be significant as a form of psychosocial intervention. Such interventions are effective for reduction of symptoms of depression and social stress. The model acts through establishing the relationship between emotional and cognitive status. Since patients suffering from dementia have multiple dysfunctions, the therapy would aid Mrs. Walker in modifying the dysfunctions and build upon emotions t is necessary for a healthcare professional to ensure that the patient is presented with an environment that is emotionally and physically safe. The aim is to create an environment that promotes the physical and mental wellbeing of the patient (Pierre Conley, 2017). It is known that the environment in which a patient lives in has a profound impact on the health outcomes. Patients are likely to react in an inappropriate manner if the environment is not safe and such responses have a negative impact on the patient condition. A safe and secured physical environment ensures that the patient is not presented with any risk of physical harm. Since Mrs. Walker has a decreased mobility, a safe physical environment would reduce chances of patient falls and other injuries. An emotionally safe environment would permit the patient to remain in a calm and serene state of mind, and this is crucial since she has been suffering from dementia. The Carers Recognition Act 2010 was brought into a function with the aim of increasing awareness and recognition of the functions and role care providers are to fulfill while providing care to patients suffering from mental illness and disability. The objective was to point out the contribution care givers have in the promotion of wellbeing of the community (Carer Recognition Act 2010). Three ethical considerations included in the 10 key principles in the Carers Recognition Act 2010 are as follows- Equal rights given to carers of children Equal payment for all carers promoting well-being of the community Acknowledgement to be given to the personal needs of the carers Legal requirements are to be fulfilled in relation to handling a patient after death prior to the post-mortem examination. A certified physician is to examine the patient and prepare necessary documents. The nurse must convey the information to the respective family members. The standard precautions to be applied while caring for a deceased body are as follows- Universal infection control measures are to be abided by Manual handling of the patient needs to be done carefully Personal protective measures are to be used (Netting Williams, 2014) As an enrolled nurse, it is a responsibility to provide comfort and support to the grieving family. This can be done by consoling the individuals and explaining the suffering of the patient due to the illness. It is also crucial to engage in an informal conversation for showing sympathy and condolence (Boerner et al., 2015). References Ackley, B. J., Ladwig, G. B., Makic, M. B. F. (2016). Nursing diagnosis handbook: an evidence-based guide to planning care. Elsevier Health Sciences. Bhayade, S. S., Mittal, R., Chandak, S., Bhondey, A. (2016). Assessment of social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur.Journal of Indian Society of Pedodontics and Preventive Dentistry,34(2), 124. Boerner, K., Burack, O. R., Jopp, D. S., Mock, S. E. (2015). Grief after patient death: Direct care staff in nursing homes and homecare.Journal of pain and symptom management,49(2), 214-222. Boltz, M., Capezuti, E., Fulmer, T. T., Zwicker, D. (Eds.). (2016).Evidence-based geriatric nursing protocols for best practice. Springer Publishing Company. Carer Recognition Act 2010 (2017). Retrieved 4 October 2017, from https://www.dss.gov.au/sites/default/files/documents/05_2016/carer_recognition_act_2010_guidelines_april_2016.pdf Cress, C. J. (2015).Handbook of geriatric care management. Jones Bartlett Publishers. Dains, J. E., Baumann, L. C., Scheibel, P. (2015).Advanced Health Assessment Clinical Diagnosis in Primary Care. Elsevier Health Sciences. Devanand, D. P., Lee, S., Manly, J., Andrews, H., Schupf, N., Doty, R. L., ... Mayeux, R. (2015). Olfactory deficits predict cognitive decline and Alzheimer dementia in an urban community.Neurology,84(2), 182-189. Foebel, A. D., Onder, G., Finne-Soveri, H., Lukas, A., Denkinger, M. D., Carfi, A., ... Liperoti, R. (2016). Physical restraint and antipsychotic medication use among nursing home residents with dementia.Journal of the American Medical Directors Association,17(2), 184-e9. Gil, G. S., Morikava, F. S., Santin, G. C., Pintarelli, T. P., Fraiz, F. C., Ferreira, F. M. (2015). Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: a cross-sectional study.BMC medical research methodology,15(1), 14. Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients.Cancer,120(11), 1743-1749. Mller, J., Chan, K., Myers, J. N. (2017, February). Association Between Exercise Capacity and Late Onset of Dementia, Alzheimer Disease, and Cognitive Impairment. InMayo Clinic Proceedings(Vol. 92, No. 2, pp. 211-217). Elsevier. Mylonas, P., Attrill, D. C., Walmsley, A. D. (2016). Evaluating denture cleanliness of patients in a regional dental hospital.BDJ Team,3(10), 16171. Netting, F. E., Williams, F. G. (2014).Enhancing primary care of elderly people. Routledge. Pierre, J. S., Conley, D. M. (2017). Introduction to gerontological nursing.Gerontological Nursing Competencies for Care, 1. Rose, S. A., Poynter, P. S., Anderson, J. W., Noar, S. M., Conigliaro, J. (2013). Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data.International journal of obesity,37(1), 118. Wold, G. H. (2013).Basic geriatric nursing. Elsevier Health Sciences.