HLT54115 Nursing-Advantage of Nursing

An 85 years old male who was previously admitted to hospital on 28/05/15 for BIBA with dense left hemiparesis and left facial droop, diagnosed to be a right MCA stroke and diagnosed with depression. His current special needs/diagnosis are HT, hearing loss, skin cancer, GORD, Dysphagia, urinary incontinence, depression, hyperlipidaemia and osteoarthritis. He was unsuitable for inpatient rehabilitation due to resident mentation and unable to be sent home, therefore he was placed in high care residential aged care facility for long care treatment. He was also sent to TRRH via ambulance on the 26/5/17 as he was unwell and went into VT. While in hospital he was cardio converted successfully and was treated medically with nil surgical intervention. He has nil known allergies. His mobility appears unsafe/impulsive/forgets gait aid, ADLs risk taking behaviours or unsafe use of equipment/inappropriate foot wear or clothing’s. He is 16-20 high falls risk status. He has a mild postural sway, wide based gait, decrease trunk stability, decrease balance strategies. He uses a 4-wheel walker to maintain his balance in standing position . Has pain in his right hip, lower back, bilateral shoulder and neck. He also decreased general strength secondary to history of left CVA and right MCA. OT reviews him ever 3/12 or PRN.

His hobbies are reading playing hockey in his younger age, gardening, walking and his skills are Bee keeping. He also stated his interests are football, St George R.L and bird’s animals (native). Peter attends Church of England for his religion reasons. When asked about his daily life, Mr Alex stated he spends more time in his room because he doesn’t have the energy to go out and participate in activities happening in the nursing home. He also indicated that he experiences falling asleep at night and wakes up 3 am and is unable to go back to sleep.

A summary of findings from the Perceptions of Ageing Tool- current perceptions, expectations of ageing

According to the 85 years old man, old age has several disadvantages, however, society can learn a lot from the older generation. He also argued that as he gets older, he expects to become lonelier. He also opined that aging is also associated with various chronic diseases, as he agreed with the fact that old age is a time of ill-health. Loneliness is a key constrain in old age, age perceived by the old man.  He has also argued that in old age, he is not able to do things, which he does always, thereby reducing the freedom. However, he does not think old people as generally grumpy and miserable. With loss of freedom, he has also argued that old people do not get respect in society. However, according to him, growing old is not an issue, as he does not think that he is old. Therefore, it can be said that the psychological and spiritual issues related to the old age is associated with the perception of the person regarding the old age. However, regarding physical health, he believes that as he gets older his health will get worse. Another positive perception of the old person regarding old age is that retirement is a time of leisure. Therefore, according to him, older age is also influenced by the status of employment.

With age he has dropped many activities, as he lost interest on those. He also feels that his life is empty, while getting bored easily. He has also revealed several age related health issues including Sleep problems, Back problems or slipped disc, Painful joints, Not being mobile, Loss of balance, Loss of strength, Slowing down, Cramps, Bone or joint conditions, Cardiac or heart problems, Ear or hearing problems, Vision and eyesight changes, Respiratory problems, Foot problems, Depression, Anxiety and stress related symptoms. According to the interviewee, these health issues are significantly affecting his well being, independence and introducing loneliness or isolation in his life. Without employment and socialization and introduction of these age related health issues are usually creating the stress related symptoms, due to dissatisfaction from life.  Alex also expressed his thought about suicidal ideation by using the call bell wirer in his room and tied it around his neck and die.

According to the answers given by the interviewee, it argued that the end of the age is death. (Sparkman, 2008) They therefore live with fear day after day, thinking that their last day of breath is closer. Though not all people die because of being old, other diseases that act as the source of their death are brought about by aging. aging is compulsory for all people who do not face premature death, it comes about with its advantages and disadvantages. We can therefore conclude by saying that old age is gold, but fierce.

Mr Alex also described good ageing as a correspondence between self-acceptance and self-contentedness on one hand and engagement with life and self-growth in later life on the other. This perspective supports the concept of wisdom as a major contributor to successful aging. Interventions to improve well aging may include those that encourage productivity and social engagement along with effective coping strategies (Calvanese et al., 2009).

A summary of findings from the assessments including findings from the Part B Ageing Well Initial Assessment and other focused assessments

During his personal Nutrition assessment, I found that resident dose eats three good sized meals a day that includes 3-4 serves of protein and energy rich food and drink. Extra serves of meat, eggs, baked bean and cheese. 2 calc e.g. milk shake, desert e.g. ice-cream, custard cakes, biscuit and fruits.

Alex drinks 750mls of water, 150mls lemonade and 100mls of cordial everyday as part of his non-caffeinated fluid. He hasn’t gained or lost any k.gs and he has been stable. He has normal soft diet with thin fluids and supervision as per speech pathologist. He normally requires verbal prompting and encouragement to complete his meals and drinks. Staff also monitor for any signs of aspiration and remain upright post nutritional intake. His mobility appears unsafe/impulsive/forgets gait aid, ADLs risk taking behaviours or unsafe use of equipment/inappropriate foot wear or clothing’s (Charles & Carstensen, 2010).

He gets regular medical care because he lives in the nursing home and he gets it all the time. He also gets other regular health care services, while getting his nails and hair done, podiatrist, dentist, and religious minister; these services able to meet his health care needs. He does not receive any community services because he receives meals in a daily basis in the nursing home. He is interested in several things, football, St George R.L and birds animals; hobbies are reading, gardening and walking. Therefore, this assessment shown that he is significantly dependent upon others. Regarding physical exercise, he walks on my own with the 4 wheel walker without any assistance but with supervision. His skin is dry, seeking the application of moisturiser by his carer (Chung et al., 2011). No sleeping difficulty of problems with bowels continence has been noted; significant bladder continence has been noted. He is neither a smoker, nor a drinker. He has a fall history in 2009.

He provided the details of his nutritional status also. He consumes three good sized meals, i.e. Morning and afternoon tea that includes 3-4 serves of protein and energy rich food or drink, extra serves of meat, eggs, baked bean and cheese; 2 calc e.g. milk shake, desert e.g. ice-cream, custard cakes, biscuit and fruits. However, his daily diet lacks fruit and vegetables. Dairy products include eggs in his daily diet; non-caffeinated fluids in his daily diet include water, lemonade and cordial. Due to aging issues, he is having problems with swallowing; need to wears top and bottom denture, as he lost his teeth as a part of ageing. No significant weight loss or gain has been reported.

He has depression, has undergone a diagnosis of depression and took an antidepressant at night and his moods have been very stable for months now; maintains optimal quality of life and psychological well being. No mood or behavioural issues have been noted. He attends hygiene measures every morning with the help of staffs. He requires staffs to stand by him and provide assistance, verbal or physical with washing, drying and dressing. Invincible

His fall risk score was 8, which is significantly high. He consumes sedatives, anti-depression an anti-hypertension medication. His cognitive impairment has been rated as mild. He also decreased general strength secondary to history of left CVA and right MCA.

Regarding his social background, it has been revealed that Alex loves a glass of chateau Tanunda brandy that his family brings in. He goes for a daily walk around the facility and wonders down the hallway. He also helps the wards man push the pad trolley every day. He spoke English only. Alex has a history of climbing out of bed, he wears glasses at all times and talks really loud in his sleep and disturbs others (De Magalhães et al., 2009).

An evaluation describing how well the older person is ageing compared to a definition of ageing well/healthy ageing. Consider all the evidence/information that you have collected about this person including their perception of ageing.

While assessing the older person regarding his coping patterns with the aging related issues, staffs asked him to describe his feeling; Alex recognised and acknowledges the coping strategies that have been helpful in the past. For making Mr Alex aware about his depression and encouraging him to obtain further evaluation of his depression, nurses discussed with Alex about his signs and symptoms of depression, emphasising the fact that depression is a treatable condition; discussed the relationship between depression and the inability to cope effectively with stressful situation; and explained that antidepressant medication can be very effective when combined with counselling.

As a result Alex follows up with his psychiatrist and his regular doctor (Flynn & McCormack, 2010). For addressing Mr Alex’s decline in his overall status, staffs discussed with Alex several options for ongoing support and counselling to assist him in coping with his declining abilities, emphasised the importance of developing short-term goals that can be addressed through problem solving. As a result, Mr Alex attends support group in the nursing home to talk about his experiences he had during the weeks. Mr Alex participates in one meaningful activity each week for the months. Staffs provided counselling and social worker referral for Mr Alex.

Discussion of all the issues present and future that you are concerned about in relation to this person ageing well

Due to poor hearing capacity of old peoples, some people tent to become annoyed when the old people repeatedly asks for a word pardoning (Chung et al 2011) Though it sometimes sound annoying, it is important to allow the conversation to go on smoothly by repeating all words which the old person is requesting for pardon. The old people also lose their sight and find it difficult to view things at a point. They should be near something or someone to see clearly (Chung et al, 2009). Others even when near they see blurred. It is therefore necessary to ensure that when the old people are going out for a walk they are accompanied by someone who can take good care of them to protect them from ground calamities. During old age, old people also loss their memory thus making it hard to recall things. This can go to an extent that they can even not recognize their family members and pass given instructions or information in large. Their reasoning capacity decreases (Umberson et al, 2010).

It is therefore important to take care of the old people’s prescribed medication to ensure that they did not get an overdose of their drugs (Leeuwenburgh, 2009). When an overdose or an under dose is taken, there is possibility of failure to heal the condition or the health problem being treated. Again, the number of grandchildren that one has can be used to tell that they are aging. The more they are, the more aged they are termed.  Old people’s immune system declines. They are very prone to diseases. Almost every part of their body is aching and painful (Charles et al, 2010). They start walking in a curved manner, when bending downwards; they can’t be straight and mobility decrease.

The interviewee, Mr. Alex is currently experiencing several age related issues, which are hindering his healthy ageing, for which he needs adequate support from his family as well as the medical staffs. Mr. Alex has cognitive impairment, depression and stress related issues, which need to be handled delicately, for which socialization is an important step. On the other hand, there is a significant importance for making a care plan for ensuring he is free of fall risk. Other issues like reduced mobility can be reduced with the help of medical technology, which would further help him to cope with his loneliness.

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