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Older Adult Community Health Assignment Part B Nicole Patten and Vera Prchal Vancouver Community College

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Health 2 Class 178 Cathy Siems May 7, 2012 Echomap

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Actual Findings Health Maintenance Pattern 1. The client states that she normally only goes to the doctor when she is not feeling well or needs a new prescription of her medication. 2. The client states that she takes medication for hypertension. 3. The client maintains her safety by remaining within close proximity to her family for moral support. She does not drink or smoke. 4. The client stays healthy by

COMMUNITY HEALTH working in her very large garden. 5. The client feels that her health has been good over the last few years with the medication she takes and monitoring of her blood pressure at London Drugs and the doctors office. She admits that diabetes runs in her family health history. Nutrition-Metabolic Pattern

1. The clients typical meal pattern for 1 day is to eat a small breakfast, lunch and larger dinner every day. She eats small amounts. 2. The client does not drink a lot of water but rather tea, coffee and juices. She prefers flavoured drinks. 3. The client cooks all the meals in the house and really enjoys eating sweets. 4. The client does not take any vitamins or supplements and

COMMUNITY HEALTH believes she gets enough nutrition from her food. 5. The client has noticed a slight weight gain since her retirement two years ago and now prefers sweet foods to savory foods. 1. The client states that she has a

bowel movement at least once per day and that there is minimal effort to go. 2. When the client is constipated she eats dried prunes and dates or fruit. Elimination Pattern 3. The client has noticed she is less able to hold her urine for longer periods of time and also wakes up more frequently at night to urinate then 10 years ago. 4. The client has experienced leaking of urine upon coughing or laughing. 1. The client does not have a regular exercise regime.

COMMUNITY HEALTH 2. The things that prevent the client from exercising are that she feels she is too busy with taking care of her home and garden. She would exercise but feel unmotivated to do it alone. Activity-Exercise Pattern 3. The client states that exercise would benefit her in losing her tummy. 4. The client does all of the household cleaning and shopping and claims her husband does not help enough. 5. The client does go to the park once in a while with her grandchildren and spends a lot of time working in her garden

especially in the summer. She also likes to play cards and go to the casino with her sister and daughter-in-law. Sleep-Rest Pattern 1. The client states that she gets 5 to 6 hours of sleep each night.

COMMUNITY HEALTH 2. The client feels mostly rested after a usual nights sleep. 3. The client has difficulty falling asleep when she is worried about family members or has had coffee in the late afternoon. 4. The client watches a movie or television when she wants to rest. 5. The client doesnt wake up in the middle of the night unless it is to urinate. Cognitive-Perceptual Pattern 1. The client plays cards with friends, socializes with family and works in the garden to keep active but states that her knees hurt more at the end of the day. 2. The client states she is very assertive and has no problems making decisions. 3. The client describes her

peripheral vision to be fine but she wears reading glasses and frequently gets sore eyes towards

COMMUNITY HEALTH the end of the day. The client states that she doesnt schedule regular eye checkups. 4. The client finds that she must have the television volume turned up louder in order to hear it better.

1. The client states she wishes she had fewer wrinkles and was as muscular as she used to be but is overall accepting of her appearance. 2. The clients general mood is overall happy but she worries and Self-Perception-Self-Concept is nervous for her daughters Pattern seizure condition. 3. The client feels she has more aches and pains then she did when she was young. 4. The client is happy in her life and is satisfied with what she has accomplished. Role-Relationship Pattern 1. The client is very close with her

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9 adult children, sees them regularly and enjoys spending time with her grandchildren. 2. The client lives with her husband but no longer shares a bedroom with him. 3. The client has several garage sales every year arranged with neighbours but otherwise keeps to herself. 4. The client sees her grandchildren almost every day.

Sexuality-Reproduction Pattern

1. The client has 2 children, one boy and one girl. 2. The client does not regularly conduct a self-breast examination but had a mammogram 3 years ago. 3. The client is no longer sexually active with her husband. They live together only for financial, domestic, and convenience purposes.

COMMUNITY HEALTH 4. The client is still legally married. 5. The client stated that menopause began at age fiftyone. 1. The client found her daughter unconscious on the floor from a grand mal seizure and had to call

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an ambulance, this was a stressful event. 2. A recent stress for the client has been her husbands verbal abuse towards their daughter and the fact that her daughter and Coping-Stress Tolerance Pattern husband no longer speak to one another. 3. The client tries to manage her stress by working in the garden and feels this is effective. 4. The clients biggest change is having her young granddaughter around the house and adjusting to a lower salary due to retirement.

COMMUNITY HEALTH 1. The client considers how decisions will affect her family before making a decision. 2. The three things the client values most are her family, her home/garden and her finances. 3. The client is a non-practicing Value-Belief Pattern Catholic who attends church for Easter and Christmas. 4. The client comes from an Eastern European background where you deal with your stress on your own rather than seeking support from others.

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Compare and Contrast Findings

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Health-Perception Maintenance Pattern (Vera) The client maintains her health by taking her prescribed medications for hypertension and visiting the doctor when she has a medical concern or needs her prescription filled. The difference between this actual finding and the expected finding is that the client should be visiting the doctor more often to monitor her hypertension and update her immunizations and vaccines regularly. Routine laboratory tests should be performed for the investigation of all clients with hypertension including urinalysis, blood chemistry, fasting glucose, fasting cholesterol and lipid profiles and standard 12-lead electrocardiography (Lewis, p. 830, 2010). The client also has a history of diabetes in her family, which can lead to further complications if not detected early. By not visiting the doctor regularly, underlying health problems can grow and cause serious problems that may be difficult to treat. A health strength for this client is that she takes her anti-hypertensive medication regularly and keeps active by working in her garden. Other health strengths are that she is not obese, rarely drinks alcohol, does not smoke and stays in close contact with her family. Nutrition-Metabolic Pattern (Vera) The actual findings for our client are that she does not drink the recommended amount of fluids in a 24-hour period. The expected outcomes state that the client should be drinking 1.6- 2.5 L of water per

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day to maintain proper hydration for an older adult. According to Potter & Perry, a low fluid intake can cause constipation and slow peristalsis (2009, p. 1125). Proper hydration can also decrease the risk of colon cancer, breast cancer and decrease the risk of bladder cancer (Potter & Perry, 2009). A health strength for this client is that she is still able to cook for herself and her family and prepares all foods from a health food store. A health weakness is she may not be getting the proper vitamins and nutrients daily in her own food and should consider taking supplements. Calcium and vitamin D help prevent osteoporosis (Potter & Perry, p. 780, 2009). The client should also minimize sodium intake due to her hypertension and sugar intake due to her family history of diabetes. Elimination Pattern (Vera) The actual findings for this pattern show that the client still has full control of her bowel movements and still feels she is going regularly. The client feels she has less control of her bladder and finds she has occasional leaking and urinates more frequently. Reduced bladder control is an expected finding in an older adult (Potter and Perry, p. 385, 2009). There is also a higher potential for constipation due to lack of fluids and fiber in the diet. The client does not drink enough liquid in an average day according to her 24-hour diet recall and therefore is more prone to constipation as she gets older. Although the client is having regular bowel movements, her increasing appetite for savory foods (high

COMMUNITY HEALTH sodium) and sweets mixed with a lack of fiber and fluids could eventually lead to other health problems such as constipation, secondary hypertension, diabetes, atherosclerosis and heart disease

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(Potter & Perry, 2009). A health strength for this client is that she is able to recognize that prunes and dates can assist with bowel movements. A health weakness would be her increasing need to void and reduced bladder function, which may interfere with sleep and social events.

Activity-Exercise Pattern (Vera) The actual findings for this pattern are that the client is still mobile and works in her garden 4 times a week for 2-3 hours. The expected findings are that the older adult is still enjoying activity as she can tolerate it within her natural capacity. Working in the garden contributes to the clients health in that she is outdoors and physically moving each day. Gardening is relaxing and rewarding for the client, which is a health strength. A health weakness could be the client not finding time to do other physical activities such as walking or other low impact exercises such as riding an exercise bike or exercising in a swimming pool, which help protect the musculoskeletal system and joints (Potter, p. 393, 2009). A health strength is that the client still remains active in activities that she enjoys and tries to keep up with her grandchildren. Sleep-Rest Pattern (Vera) The actual findings for this pattern show that the client sleeps the

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average amount of hours as other older adults (5-6 hours). There is not much difference between expected findings and actual findings. The client has also admitted to needing less sleep at night but realizes that she needs to rest more throughout the day. The client will take small rests throughout the day by either watching television or taking a short nap on the couch. This is normal for an older adult but can contribute to a feeling of frustration since a deep sleep can sometimes not be achieved due to sleeping in the middle of the day. The client already has trouble falling asleep when worried about her family and could become more susceptible to colds and illness if not properly rested. Lack of sleep could contribute as a weakness because sleeping is essential to your physical health and emotional well-being. According to the help guide for insomnia in older adults, for seniors sleeping, a good nights sleep is especially important because it helps improves concentration and memory formation, allows your body to repair any cell damage that occurred during the day and refreshes your immune system, which in turn helps prevent disease (http://www.helpguide.org/life/sleep_aging.htm). A strength for the client is when she feels tired she knows it is time to rest. She takes a break and rests and therefore may be at less risk for a fall. Cognitive-Perceptual Pattern (Nicole) The actual findings for this pattern show that the client uses an assistive device (reading glasses) and doesnt have any problems with her

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peripheral vision, however she does not have annual eye checkups. The client also notices that her hearing isnt as good as it used to be and she often finds herself turning the volume up on the TV to hear it. The client maintains a healthy social life by gathering regularly with friends and family. A health strength for the client is that she maintains her social relationships and continues to be assertive and make decisions for herself. A health weakness for this client is that she doesnt have regular eye exams which could affect her overall eye health and lead to further vision impairment, vision loss, and could eventually affect her ADLs. Self-Perception-Self Concept (Nicole) The actual findings for this pattern show that the client meets the expected outcomes for this pattern. The client perceives herself as overall healthy and feels involved in her own life. She makes use of supports and is satisfied with what she has accomplished in her life so far. She generally enjoys her life. The clients outlook on life is a health strength, she a positively minded thinker and although she wishes for less wrinkles and more muscle strength she has an overall positive attitude which will continue to help her remain healthy. Role-Relationship Pattern (Nicole) The actual findings for this pattern show that the client meets the expected outcomes. She has close relationships with her family and friends; she enjoys spending time with them and arranging activities with them in her neighbourhood. The client at times feels isolated due to

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her relationship with her husband and her tendencies to keep to herself. A health strength for the client is that she spends a lot of time with her adult children and her grandchildren. A health weakness is her inclination to keep to herself and her feelings of loneliness and isolation. These feelings could lead to depression or cause her to lack motivation to remain active therefore disrupting her overall health.

Sexuality-Reproduction Pattern (Nicole) The actual findings for this pattern show that the client has children and grandchildren and that the client began menopause at the age of fiftyone. Contrary to the expected outcomes, the client does not perform regular breast self-examinations and had a mammogram three years prior. The client is not sexually active with her husband as they only live together for financial and convenience purposes however they remain married. A health weakness for the client is that she does not perform breast self-examinations, which could affect her health and the prevention of breast cancer. Coping-Stress Tolerance Pattern (Nicole) The actual findings for this pattern show that the client has some stressful problems and issues (financial issues related to retirement, her daughters health problems, growing tension between her daughter and her husband) in her life that cause her anxiety and worry. She does her best to manage her stress by working in her garden and remains upbeat

COMMUNITY HEALTH despite her stresses. Although the client finds support in her family

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members and relies on them to cope, she is often asked to look after her grandchildren, which she finds to be a challenge. A health strength for the client is that she finds gardening a good stress-reliever and is able to manage her stress by focusing on an activity that she finds enjoyable. A health weakness for the client is the stress and anxiety she faces because of the problems in her family. The undue stress on the client could exacerbate her hypertension and lead to further health problems such as depression, gastric ulcers, heart attack, and thyroiditis. Stress reactions also produce changes in the structure and chemicals of the body that cause irreversible damage. Value-Belief Pattern (Nicole) The actual findings for this pattern show that the client considers her decisions and how they affect her family. The client places great value on her family, her home, and her finances. Contrary to the expected outcomes for this pattern, the client remains a non-practicing catholic and attends church only for major holidays such as Easter and Christmas. Due to the clients Eastern European background, she often deals with her stresses on her own rather than seeking support from others. A health strength for this client is the value she puts on her family especially when making decisions that may affect them and on her home and well-being. A health weakness is the inability for the client to seek out support other than her family (i.e. community resources,

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support groups) given her ethnic background. Her preference for dealing with stresses on her own could eventually affect her health and wellbeing and lead to depression. Support groups and networks are so important for the older population in maintaining mental and physical health. 24 - Hour Dietary Recall (Food and Fluids) Breakfast 1 glass orange juice = 112 cal 2 slices of rye toast = 136 cal 2 tbsp butter = 204 cal 2 tbsp of raspberry jam = 100 cal 2 cups of coffee (with 2 tsp sugar and cream) = 121 cal Lunch 1 bowl of vegetable soup = 115 cal 4 crackers = 104 cal 4 cookies = 400 cal 2 cups of apple juice = 234 cal Dinner 1 cup of green peas = 134 cal 1 baked potato (with butter and chives) = 390 cal 1 pork chop (with BBQ sauce) = 228 cal 1 glass of lemonade soda = 112 cal 1 dinner roll (with 1 tsp butter) = 154 cal Snack 2 cups of tea (with milk and sugar) = 69 cal 2 slice of lemon cake = 478 cal

Canada Food Guide Expectations Servings expected as per Canada Food Guide 7 servings Fruit/Vegetables 6 servings Grain Products 3 servings Milk & Alternatives Servings found for older adult 7 servings (5 servings from juice) 2 servings 0 servings

COMMUNITY HEALTH 2 servings Meat & Alternatives Calorie intake required: 1850/day Fluid intake required: 1.6 2.5 L/day 1 servings Actual calorie intake: 3091/day Actual fluid intake: 1.75 L/day

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Local Resources 1. Kitsilano Community Centre Kitsilano Community Centre is just across the street from the clients home. They have many senior programs and activities to choose from such as dance, yoga, health and wellness programs, education and development and a fitness room. Even though the client gets exercise in her garden, riding a stationary bike or joining a senior aerobics weighttraining class could help improve her cardio and muscle strengthening. This could further prevent older adult complications such as heart disease, osteoporosis and peripheral vascular disease. Socializing and learning new skills can also help build relationships with other older adults in her community and promote independence and a sense of wellbeing. 2. Kitsilano Neighbourhood House (KNH)

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Kitsilano Neighbourhood House is located near to the clients home and offers many older adult programs. These programs include senior advisory groups (promotes strengths and skills of participants), seniors drop in programs for activities such as games, entertainment, lectures, and discussions, as well as a seniors peer counseling program and a seniors link program (for seniors that require extra help around the house). This association would greatly benefit the client in helping provide her with community support and to build new friendships. By attending Kits Neighbourhood house, the client would have the opportunity to relieve some of her family stresses and perhaps provide some wisdom for others. By participating in some of the programs at KNH, the client could become more active and les isolated and lonely.

References Gordon, Marjory. (1987) Nursing diagnosis and application. Mc Graw Hill. New York Health Canada. (2011, Sept. 1). Canadas Food Guide. Retrieved from http://www.hcsc.gc.ca/fn-an/food-guide-aliment/index-eng.php

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Lewis, S. H., Heitkemper, M. M., Dirksen, S. R., OBrien, P. G., Bucher, L. (2010). Medical-Surgical Nursing in Canada (2nd ed.). Toronto, ON: Mosby Elsevier. Newfield, S., Hinz, M., Tilley, D., Sridaromont, K., & Maramba, P. (2007). Cox's Clinical Applications of Nursing Diagnosis. Philadelphia, Pennsylvania: F.A. Davis. Potter, P.A., Perry, A.G., Ross-Kerr, J.C., & Wood, M.J. (Eds.). (2010). Canadian Fundamentals of Nursing (4th ed.). Toronto: Elsevier Canada. Robinson, L., Kemp, G., Segal, R. (2012, April). Insomnia in Older Adults. Retrieved from http://www.helpguide.org/life/sleep_aging.htm School of Nursing. (2011) Practical Nursing Guide, Health 2, Class 178, Vancouver, BC, Canada: Vancouver Community College. School of Nursing. (2011) Handout: Gordons Functional Health Patterns Family Assessment, Health 2, Class 178, Vancouver, BC, Canada: Vancouver Community College.

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