Risk Factors and Causes of Deficiencies
Question:
Discuss about the Micromedex Consumer Medication Information.
The nurse professional would monitor the cognitive functionality and physical condition of Rosie in the clinical setting with the objective of analysing her risk of falls and associated trauma. The registered nurse would also require investigating and study the environmental factors that contribute to the pattern of patient’s acopia and associated manifestations. The evaluation of patient’s mental status would give an insight regarding the state of confusion experienced by the patient that might have contributed to her physical and mental instability. The absence of assessment of patient’s environmental factors and cognitive status due to the communication barriers could lead to the inappropriate understanding of the extrinsic and intrinsic influences leading to frequent injuries and related clinical complications (Norouzinia, Aghabarari, Shiri, Karimi, & Samimi, 2016).
The clinical assessment of memory and communication skills of the treated patient is necessarily warranted in the context of identifying the cause of self-insufficiency, weakness and absence of coping skills. Evidence-based research literature correlates the memory deficits of patients with their loss of functionality and independence (Marchant & Williams, 2011). The deterioration in patients’ memory substantially impacts their quality of life and wellness outcomes across the community environment. Therefore, the absence of memory assessment might lead to inappropriate findings regarding the cause of patient’s functional dependence on her husband in the context of undertaking the activities of daily living and personal care.
The nurse professional needs to effectively assess the nutritional intake of the elderly patient in the context of identifying the dietary deficits that might have contributed towards the pattern of her weakness and debility (Ahmed & Haboubi, 2010). The nutrition assessment would require the systematic evaluation of patient’s dietary regimen and accordingly the nurse professional might clinically correlate the recorded clinical manifestations with the dietary deficiencies (Ahmed & Haboubi, 2010). For example, any defect in the dietary plan might assist the nurse professional in the context of configuring remedial strategies for effectively managing her weight as well as intensity of debility and consciousness. The absence of a concrete dietary regimen might lead continued consumption of junk food and frozen meals (by the patient), thereby, impacting her wellness outcomes.
Task 1 (Care Planning)
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Nursing Problem |
Underlying Cause |
Goal of Care |
Bedside Nursing Interventions |
Rationale |
Indicators/Outcomes |
|
Fatigue and Weakness |
Inappropriate nutrition and age-factor |
1. The effective evaluation of the pattern of fatigue and its associated adverse influence on the quality of life of the treated patient. 2. The identification of patient’s understanding of the intrinsic and extrinsic factors that potentially elevate the pattern of her fatigue and associated adverse outcomes. 3. The development of systematic energy conservation interventions with the objective of decreasing the intensity of her debility. 4. The tracking and identification of remedial strategies from day-to-day routine that could significantly increase the energy level of the treated patient. |
1. The nurse professional requires assessing the pattern of patient’s emotional state, psychological functionality, medication regimen as well as sleep duration in the context of determining the causes of debility and associated adverse manifestations. 2. Accordingly, the appropriate dietary regimen would require administration for enhancing the energy level of the treated patient. |
The systematic evaluation of the causes and factors linked with patient’s fatigue could assist in configuring an effective nursing care plan for enhancing patient’s wellness outcomes. The enhancement of patient’s knowledge regarding the debility causes would significantly improve the pattern of her self-sufficiency and health related autonomy across the community environment (Cónsul-Giribet & Medina-Moya , 2014). |
Reduction in the intensity of patient’s fatigue and tiredness under the influence of the administered dietary plan. |
|
High frequency of patient’s falling episodes |
Absence of a concrete social support system, age advancement as well as sustained memory deficit. |
1. The patient will understand the requirement of undertaking safety measures in the context of reducing her risk of experiencing falls and associated traumatic manifestations like contusions, bruises and lacerations. 2. The patient will learn evidence-based muscle strengthening strategies in collaboration with the nurse professional for effectively preventing the occurrence of falling episodes. |
1. The nurse professional requires decreasing the height of patient’s bed while elevating the rails for reducing the scope of failing. 2. The registered nurse needs to track and monitor the age-related changes in patient’s anatomical structure as well as psychosocial function. 3. The nurse professional requires assisting the patient in terms of undertaking muscle strengthening exercises while encouraging her active participation in strength training sessions. |
1. The regular assessment of patient’s anatomical structure as well as physiological changes assists in evaluating the pattern of her muscular endurance as well as visual functionality (Phelan, Mahoney, Voit, & Stevens, 2015). 2. The tracking of the conditions like unsteady gait, defected perception and response time will assist the nurse in calculating the risk of patient’s falls and configuring evidence-based strategies for assisting her in terms of undertaking activities of daily living and personal-care (Borowicz, Zasadzka, Gaczkowska, Gaczkowska, & Pawlaczyk, 2016). 3. The administration of muscle training sessions will assist in the effective enhancement of patient’s muscle endurance and overall physical strength (Lee & Park, 2013). |
The patient will gain a stable state of consciousness and vision as well as inner stamina for reducing the frequency of falling episodes. The patient will acquire increased muscle strength and balance while overcoming the pattern of weakness, thereby leading to the effective reduction in falling episodes. |
|
Hypertension |
Patient’s dietary insufficiency appears to be the preliminary cause of her chronic hypertension. |
1. Organization of self-care sessions in the context of effectively controlling the sustained blood pressure elevation. 2. Prevention of the development and progression of cardiovascular conditions and associated clinical complications |
1. Implementation of dietary restriction approaches for the patient in the context of reducing the intake of electrolytes and fat. 2. Organization of training sessions with the objective of improving the pattern of patient’s physical activities. 3. The nurse professional needs to encourage the patient in terms of regular consumption of green leafy vegetable and fruits for stabilizing cardiovascular functionality. |
1. The establishment of goals related to the consumption of sodium, potassium and magnesium assists in the stabilization of patient’s systolic and diastolic blood pressures (Bazzano, Green, Harrison, & Reynolds, 2013). 2. The daily consumption of vegetables and reduction in fat diet leads to the reciprocal reduction in the saturated fat and elevation in the monounsaturated fat levels in the patient’s body that effectively reduces the abnormal rise in blood pressure levels (Bazzano, Green, Harrison, & Reynolds , 2013). 3. The physical activities including exercise and walking assist in the systematic stabilization of the cardiovascular system that reciprocally reduces the risk of abnormal blood pressure elevation (Diaz & Shimbo, 2013). |
Patient’s blood pressure would remain within the normal range of 110-140 [Systolic]/70-90 [Diastolic] mmHg. |
|
Anxiety |
Recurrent injuries, weakness, absence of patient’s self-confidence and debility. |
1. Effective training of the patient in terms of acquiring various coping mechanisms in the context of overcoming the pattern of anxiety and associated psychosocial manifestations. 2. Improvement of patient’s cognitive capacity, memory as well as concentration and focus. |
1. Nurse professional needs to administer therapeutic communication in the context of configuring culturally appropriate strategies for reducing the state of patient’s anxiety. 2. The registered nurse requires enhancing the coping skills of the patient with the objective controlling the pattern of her negative thought process and facilitating her adjustment with the immediate surrounding. |
1. The administration of therapeutic communication by the nurse professional would assist in the accurate evaluation of patient’s anxiety, memory span and related symptomatology (Popa-Velea & Purc?rea, 2014). 2. Therapeutic relationship with the patient would help the nurse professional in configuring the pattern of trust with the treated patient and improve her level of compliance to the recommended therapeutic regimen (Popa-Velea & Purc?rea, 2014). |
Patient will not experience anxiety and feel confident and capable of coping with her existing health adversities. |
|
Difficulty in Breathing |
Low oxygen saturation level |
1. Stabilization of patient’s respiratory rate 2. Improvement in the patient’s oxygen saturation level 3. Facilitation of patient’s breathing pattern through the administration of respiratory exercises |
1. Regular evaluation of patient’s oxygen saturation level and assessment of patient’s arterial blood gas (ABG) level 2. Regular evaluation of patient’s respiratory depth and frequency 3. Administration of oxygen therapy in a case of medical emergency |
1. The evaluation of patient’s oxygen saturation index assists in identifying the probability of patient’s respiratory failure (Rawat, et al., 2015). 2. Oxygen therapy is the recommended treatment option for controlling the progression of dyspnoea associated respiratory failure (Baldwin & Cox, 2016). |
Patient will experience improvement in the pattern of her breathing as well as elevation in the oxygen saturation level. |
Task 3 (Medication Management)
Atorvastatin (20mg daily) is prescribed to the patient in relation to the effective management of her state of hypercholesterolemia (Adams, Tsang, & Wright, 2015). Patient’s clinical history of hypercholesterolemia warrants the stabilization of her lipid levels attributing to triglycerides, LDL, HDL and total cholesterol. The nurse professional will evaluate the findings of patient’s hepatic function panel before and after the administration of Atrovastatin therapy. The registered nurse would also periodically monitor the lipid levels of the patient in the context of dose adjustment of the prescribed Atrovastatin. The qualified nurse will closely monitor the pattern of allergic reaction, blistering, fever, muscle pain and nausea that the patient might experience after the regular administration of Atrovastatin (THA, 2014).
Falls Prevention
Ramipril is prescribed to the patient in the context of controlling the pattern of patient’s hypertension. Ramipril is an ACE inhibitor and effectively induces vasodilation that resultantly stabilizes patient’s systolic and diastolic blood pressures (PubChem, 2017). The nurse professional needs to ascertain patient’s compliance in relation to the administration of the prescribed dosage of Ramipril. The nurse professional requires monitoring the blood pressure of the treated patient after every three hours of Ramipril administration and report the pattern of blood pressure to the concerned physician in the context of dosage adjustment. The pattern of the head and neck swelling (if experienced by the patient after Ramipril administration requires reporting by the nurse professional to the treating physician in the context of undertaking the remedial intervention (THA, 2017). The nurse professional must monitor patient’s symptomatology in relation to the development of liver and kidney conditions during Ramipril administration. The administration of Ramipril requires careful monitoring the by the nurse professional in the context of reducing the scope of its overdose or missed dosage. The missed dose might induce the blood pressure elevation; however, over dosage could lead to the occurrence of hypotension and associated clinical manifestations.
The nurse professional requires explaining the hypertension treatment considerations to the patient with the objective of reducing her scope of development of cardiovascular disorders attributing to coronary artery disease and myocardial infarction (Managing Hypertension in the Elderly: A Common Chronic Disease with Increasing Age, 2012). The nurse also requires explaining the requirement of patient’s lifestyle modification in the context of controlling the pattern of her systolic and diastolic blood pressure elevation. The nurse also requires explaining the patient regarding the pattern of postural (orthostatic) hypotension that she might experience while standing or taking a supine position, while concomitantly receiving the antihypertensive medication. Indeed, orthostatic hypertension might become the cause of patient’s prospective falls and trauma. The nurse professional needs to make sure regarding the level of understanding attained by the patient in the context of effectively coping with her chronic hypertension and associated adverse clinical manifestations. The nurse professional must conduct periodic interview sessions with the patient and evaluate the level of her understanding and perception regarding the benefits of physical activity and healthy diet in terms of effectively controlling the abnormal blood pressure variations (CDC, 2014). Regular evaluation of patient’s weight and body mass index is necessarily required for calculating her risk of sustaining the pattern of hypertension for the longer-term.
Nutrition Assessment
The patient in the presented clinical scenario appears to experience acute respiratory failure. Acute respiratory distress is manifested by the signs of an elevated respiratory rate, peripheral edema, reduced oxygen saturation level as well as cyanosis. Most of these signs and symptoms experienced by the patient in the presented case scenario, thereby confirming the occurrence of acute respiratory distress and failure (Sweeney, McAuley, & Matthay, 2011). Nurse professional needs to monitor the ABG findings of the patient and administer oxygen therapy with the objective of stabilizing the respiratory rate of the patient (Brill & Wedzicha, 2014). The registered nurse should also evaluate the hydration requirement of the patient and administer hydration infusion (in case of decreased hydration level) with the objective of reducing the risk of development of pulmonary effusion and cardiac failure. Nurse professional needs to induce assisted coughing in the context of decreasing excessive sputum secretion and facilitating patient’s breathing pattern.
|
Identify |
Patient’s MRN |
XXXX |
|
Patient’s Name |
Rosie |
|
|
DOB/Age |
76 years |
|
|
Staff Title |
Registered Nurse Professional |
|
|
Situation |
Rosie was admitted to the inpatient ward in relation to the treatment of her absence of coping skills, dizziness, pain, loss of consciousness, falling episodes, memory loss, fatigue and debility. The patient exhibited a clinical history of hypertension and hypercholesterolemia. The patient was transferred from the emergency department to the inpatient unit through hospital ambulance. |
|
|
Background |
Patient experienced the clinical history of memory loss, elevated blood pressure as well as an increased level of blood cholesterol. Patient exhibited the state of social isolation and experienced limited psychosocial support. |
|
|
Assessment |
Patient’s vital assessment resulted in the following recordings: Systolic blood pressure: 150 mmHg Diastolic blood pressure: 95 mmHg Heart Rate: 110/min RR: 20/min Oxygen saturation level: 90% Weak radial pulse Skin Colour: bluish and pale Other findings: ankles swelling, dyspnoea, shallow respiration and cyanosis |
|
|
Recommendation |
The physicians and nurse professionals in the coronary unit must immediately stabilize patient’s respiratory stress and undertake diagnostic and treatment interventions for accessing and remediating the cardiovascular complications that the patient might encounter under the influence of acute respiratory failure. |
References
Adams, S. P., Tsang, M., & Wright, J. M. (2015). Lipid-lowering efficacy of atorvastatin. The Cochrane Database of Systematic Reviews, 12(3). doi:10.1002/14651858.CD008226.pub3
Ahmed, T., & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health. Clinical Interventions in Aging, 207-216. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920201/
Baldwin, J., & Cox, J. (2016). Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients? The Medical Clinics of North America, 1123-1130. doi:10.1016/j.mcna.2016.04.018
Bazzano, L. A., Green, T., Harrison, T. N., & Reynolds , K. (2013). Dietary Approaches to Prevent Hypertension. Current Hypertension Reports, 15(6), 694-702. doi:10.1007/s11906-013-0390-z
Borowicz, A., Zasadzka, E., Gaczkowska, A., Gaczkowska, O., & Pawlaczyk, M. (2016). Assessing gait and balance impairment in elderly residents of nursing homes. Journal of Physical Therapy Science, 2486-2490. doi:10.1589/jpts.28.2486
Brill, S. E., & Wedzicha, J. A. (2014). Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 1241-1252. doi:10.2147/COPD.S41476
CDC. (2014, July 7). High Blood Pressure. Retrieved from https://www.cdc.gov/bloodpressure/healthy_living.htm
Cónsul-Giribet, M., & Medina-Moya , J. L. (2014). Strengths and weaknesses of Problem Based Learning from the professional perspective of registered nurses. Rev. Latinoam. Enfermagem, 22(5), 724-730. doi:10.1590/0104-1169.3236.2473
Diaz, K. M., & Shimbo, D. (2013). Physical Activity and the Prevention of Hypertension. Current Hypertension Reports, 15(6), 659-668. doi:10.1007/s11906-013-0386-8
Lee, I. H., & Park, S. Y. (2013). Balance Improvement by Strength Training for the Elderly. Journal of Physical Therapy Science, 25(12), 1591-1593. doi:10.1589/jpts.25.1591
Managing Hypertension in the Elderly: A Common Chronic Disease with Increasing Age. (2012). American Health and Drug Benefits, 5(3), 146-153. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046467/
Marchant, J. A., & Williams, K. N. (2011). MEMORY MATTERS IN ASSISTED LIVING. Rehabilitation Nursing, 36(2), 83-88. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577922/
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samimi, E. (2016). Communication Barriers Perceived by Nurses and Patients. Global Journal of Health Science, 65-74. doi:10.5539/gjhs.v8n6p65
Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 99(2), 281-293. doi:10.1016/j.mcna.2014.11.004
Popa-Velea, O., & Purc?rea, V. L. (2014). Issues of therapeutic communication relevant for improving quality of care. Journal of Medicine and Life, 7(4), 39-45. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813615/
PubChem. (2017). Ramipril. Retrieved from Compound Summary for CID 5362129: https://pubchem.ncbi.nlm.nih.gov/compound/ramipril#section=Top
Rawat, M., Chandrasekharan, P. K., Williams , A., Gugino , S., Koenigsknecht , C., Swartz , D., . . . Lakshminrusimha , S. (2015). Oxygen saturation index and severity of hypoxic respiratory failure. Neonatology, 107(3), 161-166. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25592054
Sweeney, R. M., McAuley, D. F., & Matthay, M. A. (2011). Acute Lung Failure. Seminars in Respiratory and Critical Care Medicine, 32(5), 607-625. doi:10.1055/s-0031-1287870
THA. (2014, 08 01). Atorvastatin (By mouth). Retrieved from Micromedex Consumer Medication Information: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009143/?report=details#side_effects
THA. (2017, 08 01). Ramipril (By mouth). Retrieved from Micromedex Consumer Medication Information: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011943/?report=details
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