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Kingdom of Bahrain University of Bahrain College of Health Sciences

Care of older Adult NUR 326

Salama Almudhky 0848 Submit to Teacher: Ms. Mona alaskary

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Introduction Client Profile Past History Family History Present Situation Relevant Investigations Treatment Modalities Physical Examination Findings Institutionalization Assessment of Dependency needs Impact of Institutionalization Analysis of client behavior in relation to theory Client Problems Nursing Goals & Interventions Implement the suggested nursing intervention Conclusion References


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Introduction Aging is the normal transition time after that flurry of activity. Although there are quite a few age-related changes that tax the body, disability is not necessarily a part of aging. Health and lifestyle factors together with the genetic makeup of the individual, and determines the response to these changes. Body functions that are most often affected by age; that may relate to decreased in all over body systems. So, care of elderly parents requires patience, tolerance and remembering to take care of yourself as well as your family and your parent. That can be a mighty big job and it can be overwhelming at times. It is important to remember that people who care for elderly parents need a good support system - and a respite from time to time.

Science has shown how the human body changes with aging; changes that drive the need to totally change the way we assess, plan, deliver and evaluate nursing care. The American Journal of Nursing (AJN) recognizes that nurses today will care for more adults over 65 than any other patient population. Caring for older adults requires specific expertise -- knowledge and skills that the majority of nurses did not learn in school, and for which less than one percent have had specialized training or certification.

Mr. S.A.S is Bahraini male, 86 years old, Muslim and divorce. He is living in an old house a lone lack for personal hygiene. Has no relationship with his own sons . Neighbors providing care to him. He was working 18 years as contractor. He is non smoker and doesn't do any physical activities he complain of blindness of right eye

Care of elderly 4 and left eye low vision , one surgery done in SMC, he dont remember when its done . He is a K\C of (hyperlipidemia) increase cholesterol level in the blood .

Because of his age, alone in the home and had no one to help him and advice him to reduce fats and direct him for healthy diet . Pt he is staying in Al- muharraq social welfare center. As a group, we had selected to visit Muharraq Social Welfare Centre to do our project which is a requirement for our course. So, we had assigned individually on one client to write a case about him/her. Moreover, I had taken my client . It was a really amazing to know how to deal with him, especially that I had live in a nuclear family with no grandmother or grandfather. . Client Profile (relevant history): Past Medical History: Mr S.A is not complain of any disease with good health . At the past he complained of loss of vision partially . There were known of (hyperlipidemia) high cholesterol level in blood and no allergy. He was hospitalized for one surgery done in SMC for his eyes . He is a non-smoker and not alcoholic. Family History: Mr. S.A has only one sister unknown if she was had a disease, and his mother unknown if she was had a diseases or well and his father also unknown and both of them died, also his sons and daughter unknown ( the patient dont remember because he lives alone for many years )

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Genogram key:

Present situation: Mr. S have ( hyperlipidemia) high cholesterol level and loss of vision . Relevant Investigations: They did certain investigation to Mr. S.A to make sure if they were in the normal level or not which they are: 1. (Lab results ) : -Full Blood Count:Test White Blood Count Red Blood Cells Hemoglobin Hematocrit Mean Cell Volume Mean Cell Hb Mean Cell Hemoglobin Con Red Cell Size Distribution Platelet Count Pct Result 5.8 5.41 14.5 0.44 81 27 33 266 Condition Normal Normal Normal Normal Normal Normal Normal Normal Normal range 3.6 - 9.6 x 10^9/1 4.2 - 5.8 x 10^12/1 13 - 15.5 g/dl 0.35 - 0.48 82 - 97 fl 27 - 33 pg 32 - 36 g/dl 140 - 440 x10^9/1 -

Care of elderly 6 MPV Platelet Size Distribution -

Whole Blood: Manual Differential:Test Polymorphs Lymphocytes Monocytes Esinophils Result 44 43 4 4 Condition Normal Normal Normal Normal Normal range 42.2 - 75.2 % 20.5 - 51.1 % 1.7 - 9.3 % 1-6 %

**Complete Blood Count to determine general health status and he has normal results. Type Cholesterol HDL LDL Results 6.0 1.2 3.94 Normal range 3.6-5.2 mmol\L 0.83-1.86mmol\L 1.68-3.37 mmol\L Interpretation High Normal High

** High cholesterol and LDL. Recent Treatment Modalities: The treatment for Mr. S.A.S the following medications to be administered for him: Name Route Dose Frequency Action for pt Reduce Lipostat PO 20 mg HS amount the of

cholesterol of the body. As supplement

Care of elderly 7 M.vit PO 1 tap Dialy

Other investigation: ECG done within normal. Chest X-ray done ( normal) Also these test is done before admitted to the center: HIV- HB VDRL the results for all were negative General appearance: Conscious, oriented to place and person and time as he recognize me as s student nurse Salama and he wasnt complaining of any pain.. Physical Examination Findings: V/S: Temp: 37.5 0C B.P: 125/68 mm\Hg Pulse: 92 / min

Institutionalization: (Reason of institutionalization):

Mr. S.A. was living in an old house a lone and divorce for many years , lack for personal hygiene. Has no relationship with his sons , neighbors providing care to him. He said to his neighbor wants to transferred to Al-muharraq social welfare center.

Assessment of dependency needs: Physiological needs: From the assessment tool and my observation, I found that Mr S. A is partially independent (with score of 4 according to Katz index of independence in ADL), he

Care of elderly 8 need assist of some daily activity such as :( bathing, dressing) . Otherwise he dont need any help for other things. (Assessment tool is attached with this project) Psychological needs: From the assessment tool "Geriatric depression scale, score 11" shows that Mr. S is mild depressed that may lead to losing his role as worker. Furthermore, that Mr. S has sensory losses especially vision which affects his emotional status which is normal aging process. So he need to, encourage him to verbalize his feelings. Instructed deep breathing exercise for relaxation, explain the procedure done to him, any treatment and the benefits from it. The Impact of institutionalization: The positive impact: There are many positive impacts of institutionalization on Mr. S.A he is receiving total health and medical care. The doctor examines hem at regular period and laboratory studies are frequently taken. he is taking his medications on time with the right dose. he is meeting his activities of daily livings such as bathing and walking. Physiotherapy is also provided once a day . Picnics are also arranged for the clients to interact with the society.

The negative impact: On the other hand there is also negative impacts of institutionalization according to Mr S.A he said that he still miss his village and his old friends as he loves the sea so much but could not go to him whenever he wants and The presence of person in the institutionalization home strip it of power and a sense of independence .

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Client dependency behavior in relation to theories: The Development Theory for Havinghurst indicates that personality is stable by the time an individual reaches old age. Personality patterns provide clues to how people adjust to changes in health, environment, or socioeconomic conditions, as well as what activities a person will pursue and getting satisfaction from life. This theory is best suitable for Mrs. S.A.S because he has verbalized satisfaction such as "I m not strong and young like youth and I cant go outside alone Whenever I want ". Also "the government provide us with food, clothes and place to live in and I am comfortable here". Client needs/ problems: I noticed some needs and problems when I was give Mr. S care and dealing with him while he is in center. 1. ND ( sensory perception((visual) disturbed R/T blindness ( aging process) : Short Term Objectives Mrs. S.A will state that blindness will not effect his daily activity in 3-4 days. Long Term Objectives Mrs. S.A. will practice his normal life process and his daily activity effectively during his residence in almuharraq social welfare.

Nursing Interventions 1. Orient the client always to the place and time and the changes that occur. 2. Teach the client how to arrive to the desired location ( counting steps). 3. Remove the hazard object from his

Rationale 1. to be sure that patient knows whats happening around him and increase his self steam. 2. to achieve his desired daily activity .

Care of elderly 10 approach and his staying area. 4. Reassure to keep the furniture at same position. 3. to avoid any injury might be happened. 4. to increase his safety measure.

2.The ND ( Risk for fall R/T blindness((aging process) Objective MR. S.A will remain safe and alert to his environment during his residence in almuharraq social welfare. Nursing Interventions 1. Observe the client all the time 2. Orient client to environment. 3. Wear proper clothes and shoes. 4. Insure that the medications not have a side effect which increase risk for dizziness and falling. Rationale 1. to detect any chances to fall and avoid it . 2. to minimize his chances of fall. 3. to avoid the risk of fall. 4. to reduce the risk to get injury.

1. Unable to bath himself. Diagnosis: self care deficit (bathing-hygiene) R/T process of aging and (blindness) Intervention: - Maintain privacy during bathing . - Instruct patient to select bath time when he is rested and unhurried. Because hurrying may cause an accident.

Care of elderly 11 - let patient take assistive devices (e.g., long-handled bath sponge; shower chair; safety mats for floor; grab bars for bath or shower). To help him in bathing. - Encourage patient to comb own hair. This enables the patient to maintain autonomy for as long as possible. - Encourage patient to do oral-facial hygiene . - Assist with brushing teeth and shaving, as needed. 2. Weight loss. Diagnosis: nutrition imbalance less than body requirement R/T aging process Intervention: - Consult dietitian for further assessment and recommendations regarding food preferences and nutritional support. Dietitians have a greater understanding of the nutritional value of foods - Suggest ways to assist patient with meals as needed. Ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. - Provide companionship during mealtime. Attention to the social aspects of eating is important in both the hospital and home settings. - Suggest liquid drinks for supplemental nutrition. - Discourage beverages that are caffeinated or carbonated. These may decrease appetite and lead to early satiety. - Encourage exercise. Metabolism and utilization of nutrients are enhanced by activity.

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3- Anxiety:

Listening actively and focus on the patient discussed his personal feelings. Instructed deep breathing exercise. Assess the need for spiritual counseling and refer as appropriate. Taking Medication regularly that reduces anxiety

Conclusion: To conclude, Mr. S.A who is 86years, male, Bahraini, lives in Muharaq Social Welfare Centre. He is complaining of hyperlipidemia and loss of vision . At the first time I saw him was lonely and quite and does not have a relationship with people there .when I talk with him, he was cooperating well with me .His health status improved with medical planning management. I faced few difficulties in this project; the main one was with collected information from pt. Because, of the aging process he was all the time want to sleep . Then, I get more information from file and the nurses help me.

Moharraq Social Welfare Centre needs more nurses to care about the elderly there. Also, they need more activities and programs out said the center.

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Reference: 1. Patient 2. Patient' file 3. Staff in Moharraq Social Welfare Centre http://www.nursingcenter.com/library/static.asp?pageid=730388