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Geriatric Placement Essay Paper

Geriatric Placement

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Geriatric Placement

With the rapid increase in the aging population, it is important for the advanced nurse to assess the factors that influence the placement appropriateness. My experiences in geriatric placement have made me learn that the patient’s transition from home into permanent nursing home can be traumatic, especially because such placement occurs often during distress and crisis (Desai & Grossberg, 2010). For effective transitions, the patient must be prepared psychologically. Change is not rapid and it can be overwhelming if not properly planned.

For instance, Mrs. B, 76 years old Puerto Rican female lived in New York City. Her neighbourhood was a low income neighbourhood, where she lived with her son George. She had a myriad of diseases including diabetes, asthma, hypertension and cancer. On this particular day, it was noted that the patient was not compliant to medication. She had failed to honour the last six follow up clinic.

Upon the analysis of her environment, it was clear that the patient was not safe (Payne, Hahn & Mauer, 2013). The patient was placed at CDE home care settings as the patient need palliative care. This is one of the most challenging cases as it was my first assignment as an advanced practitioner.

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The patient cognitive impairment had progressed significantly. The patient health status and financial instability are some of the factors that hindered effective transition from one healthcare setting to another. The situation was stressful as the patient thought of leaving all they have known was unbearable. This made the patient to be vulnerable as she felt like she had lost her identity and independence (Phillips & Guo, 2011).

She became so depressed that within the first month she had Alzheimer disease mild symptoms. Few weeks later, she fell into a comma. Fortunately, during one of her clinics she had filled an advance directive that stated that she did not favour mechanisms of having her life prolonged. She passed on one day later. I believe the poor planning of her transition was so traumatizing for her health to embrace the change.

From this experience, I have learnt to develop tailor made strategies to help the patient and their family members when dealing with healthcare setting transition. The general matters such as finance issues are discussed before transition to ensure that the patient understands their responsibilities as well as the sources the patients are eligible. Secondly, I have learnt that it is important to have an open communication. This enhances trust and relationship that makes the client feel secure about their decisions (Bauer & Nay, 2011).

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References

Bauer, M., & Nay, R. (2011). Improving family-staff relationships in assisted living facilities: the views of family. Journal Of Advanced Nursing, 67(6), 1232-1241. http://dx.doi.org/10.1111/j.1365-2648.2010.05575.x

Desai, A., & Grossberg, G. (2010). Psychiatric consultation in long-term care. Baltimore: Johns Hopkins University Press.

Payne, W., Hahn, D., & Mauer, E. (2013). Understanding your health. New York, NY: McGraw-Hill.

Phillips, L., & Guo, G. (2011). Mistreatment in Assisted Living Facilities: Complaints, Substantiations, and Risk Factors. The Gerontologist, 51(3), 343-353. http://dx.doi.org/10.1093/geront/gnq122

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Geriatric Assessment Essay Paper

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Geriatric Assessment

The main areas that need to be assessed in this patient are cognitive and functional needs. Therefore, a comprehensive geriatric assessment tool is the most appropriate tool for this case study, as it will help evaluate the overall impact of environment stressors on patient’s health status.

This assessment should be conducted at the clinic and at patient’s home. This will help identify possible aggravating factors that are associated with patient’s health condition; and if possible, the patient caregiver (the daughter) should be present to point out her concerns (Mattace Raso, Polidori & Pilotto, 2014).

Evidence based research indicates that age as the best morbidity indicator; which determines the increased use of healthcare services. Most elderly patients are associated with multiple health issues and medications. Therefore, their psychosocial problems cannot be addressed adequately with a single visit to the healthcare providers.

It is important to evaluate patients function ability in their environment. This comprehensive geriatric assessment requires involvement of multidisciplinary team including the geriatrician, social worker and geriatric nurse. Other disciplines such as psychiatrist, dieticians, and pharmacists are involved after the assessment (Slee-Valentijn & Maier, 2014).

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This tool comprehensively analyses patient cognitive, hearing abilities, vision, mobility, and patient function analysis. The tool measures patient’s cognitive impairment, which facilitates early detection of psychosocial disorders and appropriate pharmacologic treatment. Additionally, the patient basic activity of daily living (BADL) should be assessed. These include tasks such as toileting, dressing, and feeding.

The patient also has difficulty in performing instrumental activities such as grocery shopping, driving and in management of her finances. Therefore, Instrumental activities of daily living (IADLs) assessment are vital as it will help identify the exact need, and extent of disease progression. The advanced activities of daily living (AADLs) measurement is essential as it helps in early detection of patient’s functional changes; and in early detection to disease progression and onset of disability (Mattace Raso, Polidori & Pilotto, 2014).

This geriatric assessment tool is chosen due to its unique ability to focus in geriatric patients with complex health issues, increased emphasis on patient function ability and integration of interdisciplinary healthcare team; thereby improving the patient quality of life. This covers the medical and social aspects that are nearly missed by other assessment tools (Rosen & Reuben, 2011).

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References

Mattace Raso, F., Polidori, M., & Pilotto, A. (2014). SS6.02: Comprehensive geriatric assessment: the methodology of geriatric medicine. European Geriatric Medicine, 5, S34. http://dx.doi.org/10.1016/s1878-7649(14)70070-1

Rosen, S., & Reuben, D. (2011). Geriatric Assessment Tools. Mount Sinai Journal Of Medicine: A Journal Of Translational And Personalized Medicine, 78(4), 489-497. http://dx.doi.org/10.1002/msj.20277

Slee-Valentijn, M., & Maier, A. (2014). The impact of comprehensive geriatric assessment on final treatment decisions. Journal Of Geriatric Oncology, 5, S58. http://dx.doi.org/10.1016/j.jgo.2014.09.098

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Interdisciplinary geriatric teams Essay Paper

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Interdisciplinary geriatric teams

At my current practicum site, which is the hospital setting, the interdisciplinary geriatric team used comprises doctors, nurses, and pharmacists. The hospital-based team provides the geriatric patient with acute care in the hospital setting. Nurses and doctors carry out a preliminary evaluation, monitor the health status of the patient by making rounds, and work together in formulating an effective treatment plan (Liken, 2011).

The interdisciplinary geriatric team used in home care settings includes a nurse practitioner, a geriatrician, a social worker and a doctor who regularly visit the elderly in his home to help the patient with his medical problems and to monitor the capability of the patient to live at home. Long-term care includes nursing home services, assisted living services and life care communities. The interdisciplinary team includes social workers, nurses, occupational therapist, geriatrician, pharmacists, an ethicist and physicians (Deschodt, 2016).

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Since the patient’s medical problems are usually complex, chronic, and at times typified by reduced cognitive ability, the elderly patient is not really able to keep living at his home. Whenever this happens, the long-term care facility provides an interdisciplinary geriatrics team with a setting for monitoring and treating the chronic diseases of the elderly patients on an ongoing basis (Wieland, 2013).

The role of advanced practiced nurse (APN) differs according to the site of care in that in the hospital setting, the APN takes medical histories of the frail patient and performs physical exams; prescribes treatments and medicines; and diagnoses and treats chronic and acute problems. In the long term/nursing home/assisted living care setting, the APN basically augments the role of the doctor.

In nursing homes, APNs provide consultative services to nursing homes and in collaboration with doctors, they provide primary care to individual residents (Bakerjian, 2011). In the home care setting, the APN provides high-touch, high-tech services to a patient with acute health care needs. The nurse is also responsible for family and patient teaching and for contacting community resources as well as coordinating the continuing care of the patient (Deschodt, 2016).

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Based on the model used for the interdisciplinary geriatric team at my practicum site, care should be facilitated for the patient in the case study in that the nurse practitioner, doctor and pharmacist need to provide integrated and coordinated care with shared resources and responsibilities and collectively set goals. Care should not be duplicated and the most qualified practitioner needs to provide care for each of the patient’s problem (Liken, 2011).

References

Bakerjian, D. (2011). Care of nursing home residents by advanced practice nurses: A review of the literature. Res Gereontol Nurs, 1(3): 177-185

Deschodt, M., Claes, V., Grootven, B., Heede, V. K., Boland, B., & Milisen, K. (2016). Structure and processes of interdisciplinary geriatric consultation teams in acute care hospitals: A scoping review. Int J Nurs Stud, 55(9): 98-114

Liken, M. A. (2011). Interdisciplinary geriatric teams: experiences of Alzheimer’s family caregivers. National Academies of Practice Forum: Issues in Interdisciplinary Care, 1(7):123–130.

Wieland, D., Kramer, B. J., Waite, M., Rubenstein, L. Z. (2013). The interdisciplinary team in geriatric care. American Behavioural Scientist, 29(6): 655-664

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Delirium Diagnosis in Geriatric Patient Case Study

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Delirium Diagnosis in Geriatric Patient

Case study 1

Delirium, dementia and depression are serious health complication common among geriatric population. The clinical manifestation of these healthcare complications is mainly impaired cognitive function, which makes it difficult to differentiate. This is usually a challenge because most of geriatric patients often present with multiple medical comorbidities which contribute to the affective and cognitive changes. Advanced nurse practitioners are expected to understand the key differences between these diseases as it is the first step to effective treatment (Holt, Young & Heseltine, 2013).

In this case study, the list of differential diagnosis would include dementia, depression and delirium. However, the fact that the patient is very confused, agitated, mental status fluctuates and rambles in an incoherent and disorganized manner, then, the most likely definitive diagnosis is the patient is derelict. Delirium is differentiated from the other two mental disorders by a) onset, b) Attention, c) and d) fluctuation of the symptoms.

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The onset of delirium in geriatric population occurs rapidly as compared to other two diseases where symptoms onset is mainly gradual and worsens progressively. In patients that are derelict, the patient is unable to remain focused. In early stages of dementia and depression, the patient is generally able to remain alert. In delirium patients, the signs and symptoms fluctuation is predominant throughout the day (Flaherty & Resnick, 2011).

To further confirm the diagnosis, the cognitive assessment should be done using comprehensive geriatric assessment tool. The physical exams, neurological exam, blood test and urine test should be conducted to check indicators of underlying health complications. I would not request from brain imaging test unless the aforementioned diagnostic tests fails to confirm delirium or underlying health complications (Featherstone, Hopton & Siddiqi, 2010).

The first step in treatment of the patient is to address underlying triggers. This includes terminating medication identified as underlying cause. With regard to pharmacological management of delirium, the patient should be give antipsychotics of choice, administered at lowest dosage.

Therefore, the patient should be administered Haloperidol and benzodiazepines. The healthcare provider must ensure that the patient gets an individualized care plan to treat and prevent further complications. This includes devising environmental interventions to address the disorientation and cognitive impairments (Holroyd-Leduc & Reddy, 2012).

Reference

Featherstone, I., Hopton, A., & Siddiqi, N. (2010). An intervention to reduce delirium in care homes. Nursing Older People, 22(4), 16-21. http://dx.doi.org/10.7748/nop2010.05.22.4.16.c7732

Flaherty, E., & Resnick, B. (2011). GNRS. New York, NY: American Geriatrics Society.

Holroyd-Leduc, J., & Reddy, M. (2012). Evidence-based geriatric medicine. Chichester, West Sussex, UK: Blackwell Pub.

Holt, R., Young, J., & Heseltine, D. (2013). Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age and Ageing, 42(6), 721-727. http://dx.doi.org/10.1093/ageing/aft120

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Geriatric Dermatology Diagnosis Essay

Geriatric Dermatology

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Introduction

There is an increased focus on geriatric dermatology due to the growing trend towards aging populations in several countries across the globe. Elderly individuals are predisposed to many dermatological conditions as a result of senile changes in their skin. Although sometimes skin problems seem to be minor compared to major chronic diseases frequently seen in elderly patients, proper diagnosis and management aids in reducing the morbidity and influences positively their quality of life.

How to Properly Diagnose Skin Wounds in Frail Elders

Diagnosis is based on patient history. It is also founded on physical examination whereby a physician inspects the appearance of the condition, mode of distribution, arrangement and configuration, size of individual lesion, color. Surface characteristics such as rough, smooth, waxy or warty, and shape which can either be oval, round, or linear. Diagnostic tests can also be carried our such as skin scrapings that are important in detecting fungal infections, skin prick tests for allergies, and skin biopsies.

In an infection, germs are present in the body and are responsible for signs and symptoms such as pus from wounds, fever, and increased leukocyte count. Conversely, in colonization germs are present in the body but the patients do not present any signs and symptoms.

Type of Skin Wound

I selected herpes. This is an infection caused by the herpes simplex virus. Individuals with this infection have sores anywhere on their skin. Usually, it occurs around the nose, mouth, genitals, and buttocks. The infection is a painful experience, embarrassing and recurs time after time. Herpes is generally associated with genital herpes. However, herpes is actually a term referring to a family of viruses ranging from Epstein-Barr virus (causes infectious mononucleosis), varicella zoster virus (causes shingles), herpes virus 1/HSV-1, to herpes virus 2 HVS-2. Under a microscope, HSV-1 and HSV-2 look identical. Either type can infect the genitals and the mouth.

Herpes simplex has been ranked as one of the most common infections with approximately one out every five individuals in US having HSV-2 and about half to three quarter of all adults having a positive test for HSV-1. However, just ten percent of exposed persons get visible sores.

During the infection, the viruses, HSV-1 and HSV-2, traverse into the nerves where they blend with the DNA forcing the body to make copies of them so that they can be spread easily to other people. However, the body’s immune system attacks the viruses and the products overcoming them. In individuals with a weakened immune system, the virus traverses to the skin where it leaks out in tiny blisters that are painful, burning or unusually tender.

Herpes infection is severe in individuals whose immune system is weak such as children and the elderly. Often, it is a mild infection in that it goes unnoticed in majority of the people who are infected. The infected persons perceive the infections as normal skin irritation or chaffing. However, HSV can recur years later and be mistaken as an initial attack resulting in unfair accusations of infidelity between partners.

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Treatment

Anti-viral pills such as acyclovir, famyclovir, and valacyclovir are used in treatment herpes. Topical application ointments also help in reducing the healing time as well as the duration of symptoms. Some of the topical applications that are prescribed include penciclovir, acyclovir, and docosanol cream.

There are several risk factors in geriatric dermatology that can predispose one to developing herpes. Some of these factors include, a history of a prior sexually transmitted infection, engaging in sexual intercourse at an early age, having several sexual partners, and poor socioeconomic status. Research by Bernstein et al., (2013) indicated that HSV-2 is transmitted easily from men to women than vice versa. This explains why females have a high likelihood of developing HSV-2 infection than men. Individuals whose immunity is compromised such as patients with HIV are also at a high risk of acquiring herpes infection.

Prevention

Herpes is a contagious infection whose prevention before and after an outbreak is of great significance. If signs of recurrence such as itching, tingling, burning or tenderness are felt at any area of the body, then that area should be kept away from other people. Patients that have mouth lesions should avoid sharing cups, lip makeup, or kissing. Sharing of towels and clothing should be avoided strictly.

Avoidance of sexual activity among patients with genital herpes is an important intervention. Sharing of sexual toys should also be avoided highly as they may promote transmission of herpes. Use of condoms is the most effective intervention of preventing herpes transmission. Partners should also go for medical check-ups in case one of them experiences herpes symptoms.

Conclusion

Individuals who have had the infection should maintain general good health and keep stress as low as possible to lit chances of having recurrences which fortunately are milder than the initial attack. Infected patients should take care of the affected skin area by keeping it dry and clean during outbreaks to facilitate healing. Physical contact should be avoided until all skin sores heal completely, not just scabbed-over.

If one touches a sore he/she should wash hands thoroughly with soap and water failure to which the hands can transmit the virus to other body parts such as eyes causing herpes keratitis a condition that causes pain and sensitivity to light and is accompanied with discharge. Geriatric dermatology practice has to be by professional who have studied and understand their geriatric patients.

Reference

Bernstein, D. I., Bellamy, A. R., Hook, E. W., Levin, M. J., Wald, A., Ewell, M. G., & Belshe, R. B. (2013). Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clinical Infectious Diseases, 56(3), 344-351.

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Nutrition Assessment of Geriatric Patients

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Nutrition

Careful assessment of the patient is essential for the development and the successful diagnosis of the comprehensive treatment plans for the many nutrition issues. The geriatric patient’s assessment will be carried out using the Lawton instrument activities of daily living (IADL scale).The 75-year-old female patient presents some problems. The following activities preparation of food, handling medications, handling of cooking items such as gas and stove.

Using transportation and movement ability is also assessed using the IADL scale (Nykanen et al, 2012). The scores for the patient read lowest values as been 3 and highest to be six which implies poor physical and cognitive functioning (Naseer et al, 2015).

The patient is malnutrition thus has lost a lot of weight. The patient is independent in her activities of daily living, and the poor functioning has impacted the nutrition and hydration of the patient causing malnutrition (Nykanen et al, 2012). The patient experiences the low oral intake due to mild cognitive impairment to prepare meals and carry out other functions as assessed using the IADL scale (Graf, 2013).

The patient suffers from the coronary artery disease thus is at risk of also having the stroke medical condition. The patient has some dietary needs that have contributed to the malnourishment and also the high risk of developing the coronary artery medical condition.

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Vitamin deficiencies such as folate, vitamin B6 and B12 lacks in her diet (Graf, 2013). These deficiencies are associated with the cognitive inability of the patient. The vascular functioning of the patient is affected by the lack of these vitamins, thus causing malnutrition (Naseer et al, 2015).The patient is currently not attempting for any of the medical issues since the ability to handling medication has also been a major problem for the independent geriatric patient (Naseer et al, 2015).

The nutrition problem presented during the assessment of the patient can be solved through the supplementation using the B12 and B6 vitamins for the patient. Provision of a care giver for the patient will also reduce the high rate of independence. The elderly patient’s oral intake improves when there is the person to help in preparation of the meals and also carrying out other activities(Nykanen et al,2012).A diet with low fats contributes to eliminating the vascular risk factors. Nutrition intervention after the assessment of the patient improves the quality of life.

References

Graf, C. (2013). The Lawton Instrumental Activities of Daily Living (IADL) Scale. Try this: Best Practices in Nursing Care to Older Adults.

Naseer, M., Forssell, H., & Fagerström, C. (2015). Malnutrition, functional ability and mortality among older people aged &ges; 60 years: a 7-year longitudinal study. European journal of clinical nutrition.

Nykänen, I., Lönnroos, E., Kautiainen, H., Sulkava, R., & Hartikainen, S. (2012). Nutritional screening in a population-based cohort of community-dwelling older people. The European Journal of Public Health, cks026.

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