health assessment

Health assessment Essay Paper

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Whereas adequate pain control is every patient’s fundamental rights, it is important to ensure that pain management medications are not abused. The health care providers ae challenged in dealing with these ethical scenarios of deciding the way to go in pain control versus the risk of abuse and misuse of prescribed medication.

In this context, the healthcare providers must perform health assessment adequately in order to identify the root cause of the chronic pain. Managing the causes of the chronic pain will simultaneously address the pain and consequently, reduce the incidences of potential abuse of narcotics (Wand, O’Connell, Di Pietro & Bulsara, 2011).

In this context, initial evaluation includes physical examination and patient history. The health assessment will help the healthcare provider identify red flags and warning signs of prescription abuse/ narcotics addiction. These include signs such as anxiety, depression, as well as the pain syndromes. Other signs include manipulative attitude and aberrant behaviour such as requesting refills frequently or experiencing withdrawal syndrome (Manchikanti, 2010).

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This helps in categorization of the chronic back pain as a) non-specific back pain; b) back pain associated with spinal stenosis of radiculopathy; c) back pain originating from the non-spinal source and d) back pain due to specific spinal source. For patients whose back pain is categorised as due to radiculopathy, specific spinal source or spinal stenosis; they should undergo Magnetic resonance imaging (MRI) as well as the Computed tomography (CT) to establish the exact diagnosis or the exact cause of the disease; which will facilitate in guiding the specific care plan (Wand, O’Connell, Di Pietro & Bulsara, 2011).

Other evaluations include laboratory assessment which should include complete blood count (CBC), erythrocyte sedimentation rates, and the level of C-reactive protein level. Urinalysis can also be performed to identify suspected infections as well other macronutrients levels such as alkaline phosphatase and the calcium levels. The laboratory findings can help diagnose the root cause of the infection.

For acute low back pain, they should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. I will also encourage non therapeutic interventions such as healthy diets, exercising, behavioural therapy and psychiatry sessions. This will help managing the chronic pain holistically (Manchikanti, 2010).

References

Manchikanti, L. (2010). Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up. International Journal Of Medical Sciences, 124. http://dx.doi.org/10.7150/ijms.7.124

Wand, B., O’Connell, N., Di Pietro, F., & Bulsara, M. (2011). Managing Chronic Nonspecific Low Back Pain With a Sensorimotor Retraining Approach: Exploratory Multiple-Baseline Study of 3 Participants. Physical Therapy, 91(4), 535-546. http://dx.doi.org/10.2522/ptj.20100150

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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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Critical patient care Case Study

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Critical patient care

Within the case provided, critical patient care coordination especially communication between medical providers and the patient including his family remains essential. As a NP, having been asked by Mr. Wiggin’s wife to make a decision in regards to progressive, critical patient care for the husband, I would consider the state of the patient, his unsuitability for dialysis. This factor has attributed to the general decline of his functionality resulting to complications that include organ failure (Cowan, 2016). The condition of this patient will deteriorate if other conventional treatment methods are not introduced.

I would incorporate a symptoms management approach in this stage in order to ensure t the patient gets opportunity to discuss his wishes in considering other conventional treatment options(‘Hare, Rodriguez,& Bowling, 2016). Before arriving at the decision, there will be a need to conduct consultations with other practitioners and engage the patient in the treatment discussion. In this instance it would be essential to also include the entire family especially in this state, thus providing the patient with support that encourages him to arrive at the decision of choosing another conventional treatment option.

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In facilitating critical patient care to this patient, it is essential to meet the patient’s needs, a factor that would require a shift from the tradition methods that focused on the disease to a more patient-centered approach where quality of live is considered as key (Garcin, 2015). Considering that this patient’s health condition is deteriorating, it is essential to encourage the patient through support in reviewing other treatment options that may be of benefit.

In addressing the need of the patients and their families, it is essential to consider including good communication with the aim of facilitating an informed decision (Thirsk, Moore, & Keyko, 2014). This would require an explanation of the results and progression of the disease and its prognosis are including the consideration of managing the patient within a home setting.

References

Cowan, D. 2016. Understanding The Journey Travelled By Patients And Carers Living With End Stage Kidney Disease And Haemodialysis. Australian Nursing & Midwifery Journal, 23(8), 27-29.Available from: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=113232640&site=ehost-live. (25^th April 2016)

Garcin, A. 2015. Care of the Patient with Chronic Kidney Disease. MEDSURG Nursing, 4-7.Retrived From: Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=113313826&site=ehost-live (25^th April 2016)

‘Hare, A. M., Rodriguez, R. A., & Bowling, C. B. 2016. Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care. Nephrology Dialysis Transplantation, 31(3), 368-375. doi:10.1093/ndt/gfv003. Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=113310258&site=ehost-live (25^th April 2016)

Thirsk, L. M., Moore, S. G., & Keyko, K. 2014. Influences on clinical reasoning in family and psychosocial interventions in nursing practice with patients and their families living with chronic kidney disease. Journal Of Advanced Nursing, 70(9), 2117-2127. doi:10.1111/jan.12370. Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=97431961&site=ehost-live (25^th April 2016)

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