Well elder project - create a care plan for a patient seen in clinical practice PDF

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create a care plan for a patient seen in clinical practice...

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Questions during phone visit 1 1. How do you perceive your current health? A little on the bad sise but she is doing everything she can to get things under control and feel better. Currently her main complaint is that she recently had an onset of left hand joint pain that came out of nowhere and will not stop. This has hindered her from doing many of her ADL’s on her own and required a lot of pain medication and assistance from her husband at home who is mostly in good health. She states that her health use to be better and wishes she could go back to her optimal health from when she was younger. 2. What is the most difficult thing about growing older? She stated that the most difficult thing about getting older is that everything just seems to be going downhill. As of a couple years ago she has had medical problems with her lipedema that just get worse and worse. She has recently had a debridement on both her lower legs and has been trying to recover and heal for over a year. Or, that everyday there is something new that is affecting her. 3. A normal day for her is getting up late in the morning because she is not a morning person. She likes to knit various things but that seems to be getting harder because of the pain in her left hand getting worse even with taking OTC medication. Also, attending many doctors visits and going to get lab and diagnostic tests done. Other than that, she spends most of her time in her reclining chair getting up one or less times a day until it's time to go to bed or if she needs to go to the bathroom. Questions for house visit 1 1. What is the most important lesson you have learned in life? Marlene states that the most important lesson she has learned in life is to not always let things get to you and make you upset. Her motto in life is to go with the flow and to just learn to live in the moment. As she goes day by day, she tries to be more understanding of what gets thrown at her. 2. What is your biggest accomplishment Marlene states that her biggest accomplishment is learning how to walk again after being bed bound from her first debridement surgery. She said she was constantly making goals for herself for the day and always met or went beyond what her daily goal is. 3. What activities do you do to stay healthy? Marlene states that the only thing she does to stay healthy is to try to walk a couple steps a day but is usually unsuccessful.

Teaching plan Marlene is an elderly woman living at home with her husband and 3 dogs. She currently suffers from lipedema on both extremities and is very limited to mobility. She is mostly bed bound or chair bound for a major part of her day. She states she tries to get walking incorporated in her day but says she is constantly in pain which unmotivates her. While completing the home visit and the health assessments, I noticed there were some teachings that could be done in order to optimize her health. While doing the nutrition assessment, she scored a total of 7 which put her at a high nutritional risk. What put her the most at risk is the lack of knowledge on what to incorporate in her daily meals and not having any restrictions or diet in motion. She stated that she generally eats whatever she wants or is craving weather that be a home cooked meal made by her husband or having him go out to buy fast food. They also get service by meals on wheels whenever her husband is unable to cook the meals for them. When it comes to grocery shopping her husband said a lot of the meals they eat are frozen and heated in the microwave. That is due to his limited ability and knowledge on how to cook due to his wife being the food maker previously. My learning outcome for Marlene would be to teach her what types of food groups she should be incorporating in her diet in order to have a well balanced diet. Which include more fruits and vegetables and more protein rich unprocessed meats. Also, making sure that her husband also has a good grasp on it to so when they go grocery shopping they know what foods to buy for their next grocery store visit. Not only that, I would also teach them different recipes that are easy to make and do not require a lot of steps or ingredients. I believe that her learning about good nutrition will give her more energy to be able to get up and moving. Furthermore, it will help her feel better day by day since she did state to me that everyday there seems to be something wrong or hurting.

While going over her immunization records she stated that she has not gotten her flu vaccine due to the fact that she is allergic to eggs and thinks that she cannot get it. I think that a good learning need for her would be to inform her that even though she is allergic to eggs she can still get the flu vaccine because there is only little amounts in it. Furthermore, there is also a flu vaccine made egg free in case her allergy is very severe. I could show her what options she has with handout from the CDC. Hopefully, she will have the knowledge to make the decision to go and get her flu shot with her primary health care provider or at a nearby store that offers it by my next visit. Making sure that the elderly get their annual flu shot is very important because of their age. Being older means that their immune system is compromised so it is easier for them to get sick. While I did my home visits I noticed that Marlene was sick the first time and then was worse the next. From this I could observe that her immune system is already compromised so getting a flu shot is something that is highly recommended for her. Lastly, while asking her about her daily routine she stated that she does not do much throughout the day. She goes to sleep late at night therefore she wakes up late the next day. When she wakes up she lays in bed for a while before getting the energy to actually get up. When she finally gets up, she is able to wash and dress herself with minimal assistance from her husband. Once she is set and ready to go, she goes downstairs via their chair lift on their stairs and sits in her recliner for the remainder of the day. That is, unless he has doctors appointments to attend or if her and her husband take a trip to the grocery store which is every 2 weeks weather permitting. If the weather does not permit that, they just order food or meals to their house. Since Marlene is constantly in pain from her lipedema she spends the majority of her time sitting in her reclining chair. What she does not realize is that by her not moving or doing any exercise, she is letting all her other muscles atrophy. Something that I can teach her is that even though her legs are what

hurt she can still do exercises with her upper extremities. I could teach her that using low weight lifts 3 times a day can help strengthen her upper muscles. Also, so she does not lose that strength and it is easier for her to move in bed or her chair. Over the span of a month, she can see if there is any improvement with her upper body strength and if it helps when she moves herself in her chair or bed.

The well elder project is a project that is made to make me become more familiar with the elderly population living at home within the community. This project was made to make me see the role of a home nurse and bring in what concepts I have learned in class to the real world. My elder M.M is a 70 year old female that lives at home with her husband and 3 dogs. Her

current health status according to her is good but could be better. For the past few years she has been dealing with lipedema in her lower extremities which makes it extremely hard for her to get around and move. When I asked my elder to describe her health, she described that it has not been so good lately. In the past four years she has a debridement surgery on both her legs and that was a struggle for her and still continues to be a struggle to this day. It has limited her mobility to almost being completely imobile and leaving her not being able to do much. As a result, she said everyday she feels like there is something wrong with her. Aging has not been the best to her the last couple of years and states that she hopes to soon get well and stay well. Her main priority and concern is keeping up with her wound changes on her legs and being able to keep active weather it be on her feet or doing resting exercises. Her responses to those questions were alined with the situation. According to Erickson’s stages of development M.M should be in ego integrity v.s despair which is the eighth and final stage. During this stage is when one looks back or reflects on their life and thinks if they have accomplished everything or have lived a fulfilling life. If they see themselves as having lived a successful life then they develop integrity if not they develop despair. I believe that M.M is in this stage and does see that her life has been successful and fulfilled. While asking her questions for this project, one of them had me ask her about the biggest lesson she has learned in life. While getting the answer to this question, she told me a lot about her life and life story. While he was telling me about her life, she was always talking about all the things she had done and how it has helped shaped who she is today. By that answer I got the idea that she has lived a fulfilling life where she got to do the things that she wanted. Never

during her answer did she express any regret about anything that she never got to do or accomplish. According to Maslow’s hierarchy of needs the need that needs to be met the most is physiological needs. These needs include access to the most basic human needs such as water, nutrition, air, sleep, and shelter. Based on my home health assessments and the questionnaires and assessment of ADL’s she gets all the basic needs. She does have limited mobility but due to the side from her husband, she is able to get all the things that she needs. He does the cooking or get take out food, or they have food delivered to them, so she has her nutrition. They both receive help from social security and on top of that from a veterans agency/organization since her husband is a veteran from the Vietnam War so they do not struggle to be able to buy their necessities. When it comes to having a network of support M.M has a limited amount of people but she seems to be content with the people who do support her. As mentioned before, her husband is her main form of support in everyday living. Apart from that, they have a son that tries to visit them weekly to help them out with things that need to be done around the house such as cutting the grass. They expressed how he is a huge help to them when he is able to make it over. Not only that, but they have 4 grandchildren who also come over to help when their dad comes over and gift her with all the cool and fancy electronic things that help her. For example, she had showed me how her grandkids bought and installed a device called Alexa into her house to help her turn things on that are out of her reach. While doing some of the assessments she showed me how all she had to do was talk and the lights would turn on without her having to move or ask her husband. Also, they installed security camera devices around the house in order to help them feel more safe and secure about what's going on outside and around their house or neighborhood.

According to M.M she also still stays in touch with her closest friends and says that they also show a lot of support to her by also coming over various times during the week to help out with household chores. She had told me that just that week that I did her home visit her friend came over to help with cleaning the house. At the wound care clinic that she goes to she stated that she has also found a support system in all the healthcare professionals that care for her. She sees them twice a week and has developed a very close bond with them that helps her stay informed or all her treatments and her progress. She says that they always make sure her visit goes as smoothly as possible and they make her health and needs a priority. Not only that, but they have gotten to know her at a personal level and she says that at this point they also feel like family to her. M.M is a spouse to her husband with whom she has a single son with. From their only son, they have four grandchildren. As for other immediate family they are mainly from her husband's side or everyone else has passed away. As a wife, she told me that she greatly appreciates his help everyday and enjoys everyday that she has with him. From observing their interactions while I was there, I could see that they both still have much love for each other and enjoy each others company. As for her son, she has a good relationship with him and his kids but they only get to see each other a couple times a month. But she stated that she understands that they are busy with their work and school. Although she did state that she feels upset about having to miss out on a majority of family events or holiday celebration. That is due in part to her not being able to walk long distances or being able to get up or down stairs on her own. At her house she has a lift installed that carries her up and down the stairs which makes it possible for her to get up to bed and just to the upstairs level in general. But, at her son's house, he does not have anything like that installed that could help her go up all the flights of stairs so she usually skips

out on family gatherings of any sort. She recognizes that it mainly due to her condition but states that, that is something that drives her to getting better everyday. As for her grandchildren, she told me about how she got the opportunity to be able to babysit all four of them while they grew up. So, during that time she developed a very close relationship with all of them that she still has to this day. As for her coping, I believe that M.M has learned to cope with all the changes that have occurred with her and her husband as far as her health and lifestyle. She does have various health issues and concerns but she seems to know that as long as she takes care of herself and tries to get better everything will be okay. She has also learned about different things or adaptive devices to be used in order to help her complete various ADL’s such as her chair lift in her house and having three commodes to help decrease the distance she has to go in order to go to the bathroom. When doing the depression scale on her, she scored less than five which is indicative of not being at risk or having depression. The only thing that I do see her struggling with is the concept of aging. She accepts the fact that she is aging but does not like the side effects of it. As for aging I could help aide her or give her ways to relieve her stress about aging and all the things she can do to feel better about it. Some in class concepts that apply to M.M are mobility and nutrition. As for mobility, she is very immobile most of her day which puts her at risk for muscle wasting and increased healing time of her wounds. Due to her lipedema, she has a hard time being mobile and getting her exercise in. From what I observed having her husband do everything for her is very helpful but also sometimes hinders her progress because she knows that she always has him to do things which sometimes makes her not want to do anything. Same can apply to nutrition, since she is very immobile her nutrition is very limited to what her husband is able to do for her. Previously

before all her health issues she was the main one who would cook all their meals. But now, her husband cooks what is easy which sometimes means frozen microwaveable food or even ordering take out food which is very poor in nutrition. Some interventions that could be applied is having her assist her husband in as many activities as possible. She is very immobile but maybe her husband could go to her when doing various things so she can feel included or when it comes to making food have her get in her steps for the day to the kitchen to help in preparing the food. To go along with food preparation maybe teaching them about my plate and how they need to make sure that they are getting in their daily intake of fruits, vegetables, protein, grain and dairy. When it came to presenting the teaching plan to M.M, she was very open to all the suggestions that I made. She also said that the things that I presented to her she kind of had an idea about and knew that there was room for improvement in those areas. My biggest struggle when presenting my teaching plan is learning how to make it more interactive so M.M would be able to retain the information. Not only that, but something else I struggled with was being able to get M.M motivated to being able to apply this to her everyday routine. Although she did recognize that what I was telling her was important she stated that she usually struggles to find the motivation to do things just because she is constantly in pain. I tried to find ways to get her motivated by saying that having her become more mobile and eating better will ultimately help her feel better in the long run. Something that I would change about my session is thinking of more creative ways to present the teaching and find out better ways to get her motivated. When it came to clinical judgement, there were two instances where I applied to my visit. The first time was when I noticed that her house is very cluttered. While doing her interview and questionnaires, we were sitting in the living which I realized was very crowded with various

boxes that had numerous items. That posed a concern for me because her husband is diabetic and did not have a lot of space to move around freely and posed a high fall risk for both of them. Something else I noted was that maybe having too many dogs as pets. She said that all her life she has always had dogs that are rescues. Something that poses a concern for me is having too many dogs that she cannot take care of and having them also be a risk for falls for her and her husband when they are running around. Doing this project helped me take what I learned in class and apply it to real patients. This really helped me expand my learning and see what it is actually like to be a nurse. Taking care of the elderly population is very important to know and be aware about because they are usually the people most at risk for many diseases. I enjoyed my time completing this project and really got to learn many new things....