Nursing Assignment: Health Assessment & Evidence-Based Plan of Care for Older Person
Question
Task: CASE STUDY- Type II Diabetes Introduction: Mr Gus Fenetti is an 81-year-old Italian gentleman who lives in an aged care facility where he has resided for the past 3 years after his wife passed away. He has two daughters who see him twice a week and 8 grandchildren who visit sporadicall. MrFenetti suffers from mild depression and requires assistance with showering and personal hygiene and he uses a wheely frame for ambulation. He is independent with feeding but requires some assistance with dressing, particularly to his lower extremities (E.g pulling up underwear, trousers and putting on socks). Lately MrFenetti has been feeling unwell and has been more confused than usual and not eating as much as he usually would. Urinalysis shows he has a UTI and cranberry tablets along with oral antibiotics have been ordered for him. Although MrFenetti is overweight, his lack of appetite and subsequent drop in BGLs requires further investigation.
Past medical/Surgical History: Type II Diabetes, Angina, Obesity, Hypertension, Osteoarthritis, THR, Benign enlarged prostate Presenting Situation: He has been referred to his GP clinic for further assessment: Referred to his GP clinic for further investigation of his Type II diabetes – lack of appetite and low BGLs.\ Social History: MrFenetti is generally quite sociable but has been more reserved and quiet recently. He used to be very active in the Italian community, but since his wife’s death and his move to residential care he has developed depression. He eats meals with the other residents, but prefers to spend most of the rest of his day watching TV or listening to the radio
Nursing Assignment Task: Please take a health history from MrFenetti when he visits your general practice clinic. Please focus particularly on his Type II diabetes and the possible contributing factors that may have caused his hypoglycaemia at present.
Answer
Introduction
In the following nursing assignment, health assessment and subsequent evidence-based plan of care for Italian geriatric 81 years old widower Mr. Gus Fenetti, living in an aged care facility for three years will be discussed. His medical history comprises of type II diabetes, angina, obesity, hypertension, osteoarthritis, total hip replacement (THR) and benign enlarged prostate and is currently under medications for these ailments. His prescribed regular medications include metformin, paracetamolosteo, nitroglycerine patch, nifedipine, venlafaxine ER as advised by the doctor in specific doses and in specific times. Mr. Fenetti has two daughters who visit him twice a week, while his eight grandchildren pay him a visit sporadically in the residential aged care facility. He has been diagnosed to be suffering from mild depression although his social history reveals that he was very active in the Italian community prior to his wife’s death and his transfer to the aged care facility. He requires assistance while showering, dressing to lower extremities and personal hygiene. However, he can feed independently and while ambulating needs a wheely frame. Mr. Fenetti has his meals with other residents but prefers to spend the rest of the day by himself watching television or listening to the radio.
Presenting health condition
Mr. Gus Fenetti despite having certain chronic illnesses has been found to have encountered certain other symptoms recently that call for necessary medical attention. Lately, he has been feeling unwell and felt more confused than usual. Moreover, he also has been eating less than what he usually has in recent days. Urinalysis revealed that he has contracted urinary tract infection (UTI). In order to treat this condition, cranberry tablets alongside oral antibiotics Trimethoprim/sulfamethoxazole (Bactrim) have been prescribed. Although Mr Fenetti is overweight, his symptoms such as that involving loss of appetite and subsequent fall in blood glucose levels (BGLs) call for thorough investigation and has therefore been referred to the GP clinic. Further, his social history suggests that he is generally quite sociable but has become more quiet and reserved recently. Thus, assessing from his presenting health condition, Mr. Fenetti will be examined primarily for prevailing Type II diabetes.
Legal and ethical issues
In aged care facilities, nurses and clinical staff are often encountered with great challenges involving ethical dilemmas and legal concerns arising due to complicated medical and psychosocial problems. These legal and ethical issues encompass situations where both the societal as well as individual obligations play immense role in tackling the imminent circumstances that may have arose. Nursing staff are bound by their moral and professional code of conduct to provide optimal healthcare facility to their patients that include the elderly also in a manner that do not compromise with their wellbeing or health overall (Collingridge, 1993). In order to ensure utmost protection of the vulnerable people that comprise of elderly individuals, certain laws and legislations have been promulgated in addition to the professional standards of practice for registered nurses that lay out the decorum and modality of operations in healthcare setting. Thus, a number of impositions and limitations have been put forth in terms of rendering interventions while maintaining the balance between autonomy and protection simultaneously. It has been suggested in suitable literatures that it is imperative for the clinicians and healthcare staff to keep themselves abreast of the situations and ethical dilemmas while caring for the elderly patients within the realm of healthcare setup. Further, such incidents concerning ethical dilemmas often emanate due to poor patient-clinician communication. Situations of ethical dilemmas may include cases of ensuring informed consent and confidentiality, protection of patient’s rights and human dignity, determination of decision-making capacity, promotion of advanced care planning and endorsing advanced care directives. Other ethical dilemmas may arise due to surrogate decision making, withdrawing and withholding interventions, utilizing cardiopulmonary resuscitations and do-not-resuscitate orders among many. Therefore, for mitigating such daunting ethical dilemmas, an approach constituting review of the medical indications, taking into consideration patient preferences, quality of life and several other elements in the context may be employed(Mueller et al., 2004).
In the given case scenario, Mr. Fenetti who has been suffering from mild depression recently and has multiple health issues is likely to be presented with situations that bring out ethical and legal issues for the attending nursing staff. As stated in the case study, Mr. Fenetti is an Italian widower who is survived by his two daughters and eight grandchildren who pays visit to him in the aged care facility. Due to his pre-existing condition of osteoarthritis and medical history of THR, his autonomy is somewhat compromised as he has to depend on assistance for showering, dressing and personal hygiene, and maintains awheely frame while ambulating. In view of his condition, it may be said that Mr. Fenetti need not be kept in restraints. Restraints are typically used in case of frail, elderly patients who are likely to fall or have history of falling. However, in case of patients with illness like dementia who roam about in a manner that is unsafe or have some behavioral symptoms, restraints are used. Reducing the use of physical restraint is a challenging task on the part of the healthcare team and optimal outcomes may be generated by employing a collaborative approach that include involvement of healthcare staff and family members of the patient concerned (Martin, 2002). Instead, in case of Mr. Fenetti, utilization of a team approach in deciphering the meaning of the behavior of the patient may be devised. His changed behavior recently may be monitored more closely for rendering better services.
As per the given case study, owing to the social history of Mr. Fenetti it is rather unusual that he has become quite reserved and quiet recently. Therefore, it will be prudent on the part of the healthcare team to try to find out the real reason behind this changed behavior and intervene accordingly. Moreover, it is also noteworthy that prior to coming in the age care facility, he was quite a sociable Italian man. It has been widely reported that abuse among the elderly people is a matter of serious concern that often endanger or affect the quality of their lives. Despite the efforts of the healthcare team and physician tocombat the situation and lowering the burdens of the elderly through promotion of independence and provision of support, managing ethical challenges remain a daunting task for them mainly due to unsatisfactory performance of the healthcare team or inadequate interaction with the patient. Types of abuse in this context include, physical abuse, emotional abuse, financial or material abuse, sexual abuse, abandonment, neglect or self-neglect (Saghafi et al., 2019). In case of Mr. Fenetti, symptoms for elderly abuse must be thoroughly examined and if found then must be reported to the appropriate authority as per existing mandated reporting laws (Rodríguez et al., 2006). However, while deciding on matters relevant to elderly abuse, ethical principles such as beneficence, non-maleficence, autonomy and competency must be taken into account. No beliefs should be imposed on the elderly person as far as the social decision-making capacity or living environment is concerned. Family members of Mr. Fenetti including his two daughters and grandchildren may be approached for devising better healthcare plan. Communication and consultation may be the key in this regard to expect best outcome without compromising on the autonomy and privacy of the patient.
Application of evidence-based learning
In view of the case study, it has been found that Mr. Fenetti has a number of chronic illnesses for which he has to take regular medications. Recently due to contraction of UTI, he has been undergoing treatment with oral antibiotics and cranberry tablets. However, his presenting symptoms of lack of appetite and lowered BGLs alongside existing Type II diabetes condition prompted for referral to GP. Moreover, his existing condition due to osteoarthritis and THR also needs attention as his movements, mobility is restricted and he needs wheely frame for ambulation. Besides, he has angina, hypertension, type II diabetes and benign enlarged prostatefor which he takes medicines. Therefore, it is essential to monitor that he maintains his compliance with the prescribed medicines and take them timely as directed by the physician. Moreover, he is also obese that also call for proper monitoring and weight management. Weight management has been identified as a crucial therapeutic task for type II diabetes patients (Anderson et al., 2003). Moreover, he is under Metformin treatment owing to his diabetic condition that acts as an insulin-sensitizing agent with potent anti-hyperglycemic actions (Kirpichnikov et al., 2002). However, the hypoglycemic action of metformin needs to be routinely monitored so that dosage may be recommended and administered accordingly. Interventions made in this regard should be individualized that cater to the preferences of the patient and are in line with his existing co-morbidities and capacity to perform activities of daily living. Health prognosis must be taken into consideration while preparing the care plan (Kaminsky et al., 2020). Furthermore, as research suggests that health literacy of the patients are also vital in management of type II diabetes and nurse must adopt strategies in encouraging health promoting behaviors for Mr. Fenetti (Chahardah-Cherik et al., 2018).
References
Anderson, J. W., Kendall, C. W., & Jenkins, D. J. (2003). Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. Journal of the American college of nutrition, 22(5), 331-339.
Chahardah-Cherik, S., Gheibizadeh, M., Jahani, S., &Cheraghian, B. (2018).The relationship between health literacy and health promoting behaviors in patients with type 2 diabetes. International journal of community based nursing and midwifery, 6(1), 65.
Collingridge, M. (1993). Protection of the elderly: Some legal and ethical issues. Australian Journal on ageing, 12(4), 32-36.
Kaminsky, T., Ozalas, S. M., & Brandt, N. J. (2020). Update on Type 2 Diabetes Mellitus and Older Adults. Journal of gerontological nursing, 46(4), 7-12.
Kirpichnikov, D., McFarlane, S. I., & Sowers, J. R. (2002). Metformin: an update. Annals of internal medicine, 137(1), 25-33.
Martin, B. (2002). Restraint use in acute and critical care settings: changing practice. AACN Advanced Critical Care, 13(2), 294-306. Mueller, P. S., Hook, C. C., & Fleming, K. C. (2004). Ethical issues in geriatrics: a guide for clinicians. In Mayo Clinic Proceedings (Vol. 79, No. 4, pp. 554-562).Elsevier.
Rodríguez, M. A., Wallace, S. P., Woolf, N. H., &Mangione, C. M. (2006). Mandatory reporting of elder abuse: Between a rock and a hard place. The Annals of Family Medicine, 4(5), 403-409.
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., &Navab, E. (2019).Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and history of medicine, 12.
