Care of elderly 1

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

 Care of elderly 2

Content:

Introduction 3-4

Client Profile
Past History
Family History 4-5

Present Situation 5

Relevant Investigations 5-6

Treatment Modalities 6-7

Physical Examination Findings 7

Institutionalization 7

Assessment of Dependency needs 8

Impact of Institutionalization 8-9

Analysis of client behavior in relation to 9

theory
Client Problems 10-11

Nursing Goals & Interventions 11

Implement the suggested nursing 11
intervention

Conclusion 12

References 12
 Care of elderly 3

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 )

 Care of elderly 5

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 Result Condition Normal range

White Blood Count 5.8 Normal 3.6 - 9.6 x 10^9/1
Red Blood Cells 5.41 Normal 4.2 - 5.8 x 10^12/1
Hemoglobin 14.5 Normal 13 - 15.5 g/dl
Hematocrit 0.44 Normal 0.35 - 0.48
Mean Cell Volume 81 Normal 82 - 97 fl
Mean Cell Hb 27 Normal 27 - 33 pg
Mean Cell Hemoglobin Con 33 Normal 32 - 36 g/dl
Red Cell Size Distribution - - -
Platelet Count 266 Normal 140 - 440 x10^9/1
Pct - - -
 Care of elderly 6

MPV - - -
Platelet Size Distribution - - -

Whole Blood: Manual Differential:-

Test Result Condition Normal range
Polymorphs 44 Normal 42.2 - 75.2 %
Lymphocytes 43 Normal 20.5 - 51.1 %
Monocytes 4 Normal 1.7 - 9.3 %
Esinophils 4 Normal 1-6 %
**Complete Blood Count to determine general health status and he has normal

results.

Type Results Normal range Interpretation

Cholesterol 6.0 3.6-5.2 mmol\L High

HDL 1.2 0.83-1.86mmol\L Normal

LDL 3.94 1.68-3.37 mmol\L 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 the

Lipostat amount of

PO 20 mg HS 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 .

 Care of elderly 9

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 Long Term Objectives

Mrs. S.A will state that blindness will not Mrs. S.A. will practice his normal life
effect his daily activity in 3-4 days. process and his daily activity effectively
during his residence in almuharraq social
welfare.

Nursing Interventions Rationale

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
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. 3. to avoid any injury might be happened.
4. Reassure to keep the furniture at same
4. to increase his safety measure.
position.

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 Rationale

1. Observe the client all the time 1. to detect any chances to fall and
avoid it .
2. Orient client to environment.

3. Wear proper clothes and shoes. 2. to minimize his chances of fall.

4. Insure that the medications not have a 3. to avoid the risk of fall.

side effect which increase risk for 4. to reduce the risk to get injury.

dizziness and falling.

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.
 Care of elderly 12

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.
 Care of elderly 13

Reference:

1. Patient

2. Patient' file

3. Staff in Moharraq Social Welfare Centre

http://www.nursingcenter.com/library/static.asp?pageid=730388