Sample Assignment - Complete evaluation of an elderly client

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Complete medical evaluation of an elderly client

Present paper describes, with the help of a case study, about the evaluation of an elderly client. It involves the description about his chronic and acute illness along with age associated illness. In this paper the current medication of the elderly client has been reviewed and his mental health status has been analyzed. Briefly, this paper presents a complete medical evaluation of an elderly client with specific focus on age associated diseases.

Brief history of client

The elderly client in this case is a 75 year old woman, Mrs. Julie. She was suffering from pneumonia for which she was admitted to hospital. After few days of medication and health care she was discharged. When she was admitted to hospital, during health evaluation, she was diagnosed with type-2 diabetes. She is a rheumatoid arthritis (RA) patient since last 10 years and suffering from chronic heart failure since last five years. At present she has cateract in one of her eyes for which she will undergo an operation after four months.

Mrs. Julie is a widow. She lost her husband six months back. She has two sons who stay abroad. At present she stays alone in her apartment which is on the 2 nd floor of a three four storied apartment. Due to rheumatoid arthritis, her mobility is restricted. She is unable to get involve in social activities .

Acute and chronic medical issues

The present case is an example of a typical age related issues which are very common these days. Type 2 diabetes and cardiovascular diseases are the two common medical illnesses affecting almost 66% of older people (Doha, 2008). However, these illnesses can be managed and quality of life can be improved if appropriate measures and interventions are applied. Rheumatoid arthritis is a painful autoimmune disease which is most common in older people (Kurebayashi et al, 2013). Besides arthritis, she is also having tyepe 2 diabetes. Generally, type 2 diabetes can be effectively managed with appropriate diet plan and adequate physical exercise. However, in present case both are difficult to apply. Since, Mrs. Julie lives alone; there is no one to get her appropriate food for her. Her diet should include adequate food and vegetables and she should avoid energy rich foods. However, at older age people are reluctant to avoid energy rich foods. Moreover, her arthritis is a major hindrance in her physical exercise. Arthritis patients experience severe joint pain which restrict their motility ( VanItallie, 2010). In present case, Mrs Julie lives on the 2nd floor which is again one of the reasons for her reduced physical activity. Because of joint pains she stays in her room and comes out only when there is an urgent need. This restricts her mobility and reduces her physical exercise. In addition, carrying out indoor physical exercise is also painful for her.

Mrs Julie is 170 cm tall having 110 kg body weight. Her blood sugar level (BGL) ranges between 18.5 to 15.6 mmol/L and blood pressure is 140/80. Current medications of Mrs Smith are: Frusemide, Digoxin, Licinopril, Atenolol, Aspirin, Amiodarone, Ibuprofen, Lantus.

Review of current medication

The aim of the current medication o Mrs Julie is to restore normal function of cardio vascular system. At present Mrs Julie is at higher risk of various cardio vascular diseases. Literature suggests that both RA and type 2 diabetes are associated with cardio vascular diseases ( Gallagher, LeRoith and Karnieli, 2008). . As mentioned above, RA is an autoimmune disease and causes inflammation specifically in joints. Inflammation in pericardium may also occur in certain cases. Inflammation in pericardium may cause heart attack. Therefore, the first priority of Mrs. Julie’s health care should be to minimise the risk of stroke and other cardiovascular diseases. Therefore, Mrs Julie is being administered frusemide, digoxin, licinopril, atenolol and amiodarone.

All the drugs described above are used for preventing heart diseases. However, their mode of action is different. Frusemide helps to reduce hypertension and oedema. Accumulation of fluid is known as oedema. Accumulation of fluid beneath pericardium may cause chest pain and difficulty in breathing. However, care should be taken while using frusemide because it interacts with aspirin and other salicylates. For controlling atrial fibrillation, digoxin is being used. It will help to prevent heart attack. Lisinopril and Atenolol are known to be effective for controlling blood pressure. Lisinopril is a class of angiotensin-converting enzyme (ACE) inhibitor while Atenolol is a beta blocker ( Wann et al., 2011).

For controlling her blood sugar level she is taking insulin. However, managing rheumatoid arthritis with medication is difficult as there is no cure for this disease. Therefore, the main goal of her arthritis management is to minimise inflammation and pain, and increasing joint function and preventing joint destruction. In severe cases, aggressive management may increase mobility by improving joint function and minimizing mobility. Generally, the treatment for RA is customized according to various factors which include type of joints, disease severity, age, health condition and occupation. Basically, there are two types of medications for the treatment of RA; fast acting fist line and slow acting second line. nonsteroidal anti-inflammatory drugs (NSAID) and aspirin are drugs of first line treatment. They are used to reduce inflammation, swelling and relieving pain. In present case, patient is being administered Aspirin and Ibuprofen. As mentioned earlier, frusemide interacts with aspirin; therefore, her current medication needs to be revised. Aspirin has both, analgesic and anti-inflammatory effect. Ibuprofen also helps in reducing inflammation and helps to manage arthritis.

Functional status

Mrs Julie’s daily life activity is very less because of arthritis. As she lives on the 2 nd floor, she rarely comes of her house. Moreover she stays alone. Therefore there is no one to accompany of force her to go for walk and assist in her physical exercise. Further her blood glucose is very high, therefore she cannot travel long distances. She does not have any one to assist her in taking insulin injection. However, she performs her daily activities herself. She lives a much disciplined life. She gets up in the morning, takes bath and performs her household works. Her sons send her money every month which is the only source of her income. She does not have job or any business. She prefers cooking herself. She maintains records of her expenses and takes her medicines timely. Therefore, she performs all her instrumental activities of daily life (IALD). However, she due to joint pain she does not participates in social activities and most of the times she stays alone at home.

Mental health status and cognitive impairment

There is no cognitive impairment in Mrs Julie. However, she is not mentally fit. Due to her loneliness, and her illness she is depressed and distressed. It is obvious, as she is suffering from various physical illnesses and it is well established the physical illness is closely associated with mental illness. She does not seem to be very happy with her life. The main reason of her mental illness is her loneliness. Depression at old age is quite common. At old age people should engage themselves in various activities to keep themselves busy. In present case Mrs Julie due to arthritis cannot mix with other people and spends most of her alone. It is not good for her safety because her blood glucose level is very high and she has hypertension. She is at high risk of cardiovascular diseases therefore; she may require urgent medical assistance any time. However, there is no one to look after her.

Recommendation

The first and foremost recommendation for Mrs Julie is to transfer her to an old age home where people can take care of her. Though she is able to carry out her daily living activities independently, however, she might require medical help suddenly. Therefore, keeping in mind her current medical records, she needs to be transferred to old age home urgently. Besides this, she needs to include certain activities in order to manage her obesity and diabetes. First of all she needs to eat adequate fresh fruits and vegetables. It has been shown that fruits and vegetables help to reduce weight. Since Mrs Julie is already suffering from diabetes and had chronic heart failure, therefore for her the first priority should be to reduce her weight. For this she needs to avoid energy rich food and perform adequate physical exercise. She should seek help from community nurse for assisting her in performing physical exercise. She requires monitoring her blood glucose level regularly. Also she needs to stay physically active in order to avoid stiffness of joints. Also she should meet her neighbours and participate in social activities in order to avoid loneliness. Loneliness is the main reason of her depression. Therefore, psychosocial care should also be included in her care plan.

Conclusion

In summary, above case describes various age related issues; both physical and mental faced by older people. With the increasing age both male and female increases, various health issues arise and need to be managed appropriately. Such health issues are further augmented with several personal and professional issues. In present case, the loneliness of Mrs Julie affected badly hear physical health. Therefore, care plan for older people should be designed after a thorough analysis of physical, mental and social status.

References

  1. American Diabetes Association. (2012). Standards of medical care in diabetes--2012. Diabetes Care .35 Suppl 1:S11-63

  2. Doh A (2008). 2007 Australian national children’s nutrition and physical activity survey. Main findings . Department of Health and Ageing, Australian Food and Grocery Council, Department of Agriculture, Fisheries and Forestry. Australian Government.

  3. Gallagher EJ, LeRoith D, Karnieli E. (2008). The metabolic syndrome–from insulin resistance to obesity and diabetes. Endocrinol Metab Clin North Am . ;37:559 –79, vii.

  4. Kurebayashi Y, Nagai S, Ikejiri A, Koyasu S (2013). "Recent advances in understanding the molecular mechanisms of the development and function of Th17 cells". Genes Cells 18 (4): 247–65

  5. VanItallie TB (2010). " Gout: epitome of painful arthritis ". Metab. Clin. Exp. 59(Suppl 1): S32–6

  6. Wann LS, Curtis AB, January CT, et al. (2011). ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . Circulation . Jan 4 2011;123(1):104-23