Gerontology Speciality Nursing Assessment

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Gerontology Speciality Nursing Assessment

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Analyse, evaluate and demonstrate knowledge and clinical competence for safe person- and family-centred care relevant to the area of specialist practice.
Answer:

The following assignment will focus on the geriatric case study of a 70-year-old patient, Frank White, (pseudonym) who was rushed to the emergency department for the onset of wheezing and cough that seems to be an episode of asthma. He had a past medical history of hypertension and allergic rhinitis (AR). His medical records suggested that he had asthma symptoms with AR. This was evident from the fact that during the last summer, pollen count was high and he became wheezy and chest tightness for couple of weeks as reported by his family members. His non-compliance to medications resulted in poor management of asthma. Previous asthma attacks had interfered with his quality of life and there is lack of proper asthma action plan and patient education suggesting poor self-management. The nursing diagnosis comprises of management of spO2 levels, hypertension, allergic rhinitis and non-compliance to medications. The tables presented in the assignment outlines the gerontology speciality nursing assessments and care that is important to undertake for the patient in the case study. Therefore, the following assignment is an example to show how gerontology speciality nursing care was provided to the patient.

Health problem

Nursing assessment/diagnosis

Intervention

Rationale

Expected Outcome

Low spO2

Continuous monitoring of spO2

The expected oxygen saturation levels should be above 95% (O’Driscoll, 2012). However, the patient exhibited oxygen saturations below 90% at the time of admission.
Low spO2 levels suggested that the patient is not getting enough amount of oxygen and suggested acute asthma exacerbation (Reddel et al., 2015).
This condition is also a comfort measure and helps in understanding the physiological condition of the patient.

There is need for continuous oxygen monitoring using pulse oximeter. This device helps to detect the oxygenation changes (Higgins, 2015).

1. Delivery of supplemental oxygen therapy through nasal cannula, breathing tube or mask

2. Positioning of the patient with bed head elevated in a semi-Fowler’s position being 45 degrees as tolerable by supine.

3. There should be positioning of patient prone with the pelvis and upper thorax support that allow protruding of abdomen. Simultaneously, there should be monitoring of spo2 levels and turning back when de-saturation occurs.

1. This helps to provide supplemental oxygen that helps to maintain normal oxygen levels in the arterial blood (Bledsoe et al., 2012).
2. This position helps to increase the thoracic capacity with full diaphragm descent, increasing lung expansion and as a result, prevention of crowding of abdominal contents (Kuhajda et al., 2015).
3. It greatly improves the conditions of hypoxemia. The prone position is shown to increase due to arterial oxygen partial pressure due to greater diaphragm contraction (Sukul et al., 2015).

The spo2 levels are maintained above 92% in the patient exhibiting normal levels.

Allergic rhinitis

As Frank’s history suggests allergic rhinitis, allergy test like specific IgE (sIgE) or skin-prick tests blood tests can be done for identification of sensitization.
The skin is pricked and a small amount of allergen is introduced in the skin. If the skin reacts, it confirms that the allergy due to pollen that the patient was exposed. The antigen binds to IgE on skin’s mast cell and if the patient is sensitized, wheel and flare reaction occurs along with itching.
Another test that can be done is intradermal testing that is sensitive than the percutaneous testing through the introduction of allergen into dermis through percutaneous needle.
Nasal smear can be done as eosinophils can also indicate allergy.
Differential complete blood count (CBC) can be done as it indicates increased eosinophil count.

1. Corticosteroids that are topical intranasal can also be administered

2. Administration of oral histamines (OAH)

3. Avoiding allergens

4. Specific allergen immunotherapy or desensitization

1. This can be helpful in reducing inflammation in the nose lining being the best treatment for AR (Petersen & Agertoft, 2016).
2. These drugs help to reduce the symptoms of rhinitis like itching and sneezing, however, it cannot improve nasal blockage (Takahashi et al., 2012).
3. The nurse should encourage cleaning of beds and blankets as it can worsen the allergic condition
4. It is considered an effective treatment for AR treatment having lasting relief (Burks et al., 2013).

The patient is relieved from symptoms of AR with decrease in poorly controlled asthma.

Hypertension

There is poor management and self-care of hypertension that is a co-morbid condition worsening the present situation.
Activity intolerance that may be related to generalized weakness, imbalance between supply and demand of oxygen or exertion discomfort.

1. Continuous monitoring of blood pressure using sphygmomanometer when the patient is at rest as well as sitting position

2. Administration of medications like Thiazide diuretics, Calcium channel blockers – CCBs, Angiotensin-converting enzyme inhibitors –ACEIs and Angiotensin receptor blockers – ARBs

3.dietary restrictions with avoidance of fat, sodium and cholesterol

1. This helps to keep the BP levels under control and get a clear picture of scope of problem or vascular involvement in the present condition.
2. Diuretics are the first line of treatment for BP reducing the incidence of heart failure and stroke as it is poorly controlled. CCBs are also used for treating hypertension (Roush & Sica, 2016).

3. This helps to maintain fluid retention, decrease in myocardial workload and hypertensive response (Schwingshackl & Hoffmann, 2015).

The patient is expected to participate in daily activities with reduction in BP. There is also maintenance of blood pressure at acceptable range and stable cardiac rhythms that is within the normal range of the patient.

Non-compliance to medications

As evident from the case study, there is knowledge deficit that is related to lack of disease information, process and self-care. There is poor compliance to medications evidence by poorly controlled hypertension, asthma condition and ineffective self-care.

1. Assessment of knowledge of care of the patient

2. Assessment of knowledge of client regarding triggering symptoms and medications like using an inhaler, spacer and controllers

3. Explanation of the disease to the patient

4. Educating the patient about warning signs of asthma attack and early treatment

5. Encouraging the patient to adhere to treatment regimen, medications and keep follow-up appointments

1. It helps to know how the patient handle care
2. Identification of patient’s knowledge about asthma can help to know how one control during its onset episode. The correct use of spacers through breath-holding, slow and deep inhalation can be helpful in increasing the effectiveness of asthmatic condition (Rolnick et al., 2013). Improper spacer use will not allow the medications to get deep enough that might affect airway.
3. Misconceptions about asthma can be avoided through patient education reducing the need for emergency hospitalizations.
4. Reinforcing information can be helpful in reducing hospitalizations and worsening of asthmatic condition

Antihypertensive therapy needs cooperation and for successful treatment. Medication compliance can improve in a way when Frank will understand the causative factors and repercussions of inadequate interventions (Myat et al., 2012).

Verbalize understanding of his medical conditions, disease process, medication and treatment regimen. Maintenance of BP and acute asthma attacks

Anxiety

Respiratory distress, hypoxic condition and due to change in health status resulted in uneasy feeling or anxiety evidenced by dyspnea and restlessness.

1. Assessment of feelings of anxiety like uneasiness, fear, panic and restlessness

2. Providing comfort measures like quiet and calming environment.

3. The nurse need to stay with the client and explain procedure of deep and slow breathing

1. Asthmatic conditions can become worse if there is persisting anxiety as it a result in shallow and rapid breathing.
2. There is maintenance of calmness that help to reduce oxygen consumption and breathing condition (Avallone et al., 2012)
3. Anxiety can be decreased if the patient understand the treatment plan and giving off information can help in relieving apprehension

The patient will exhibit effective coping and verbalize reduction in anxiety level demonstrating cooperative behaviour and calm demeanour

Gerontological specialty nursing is involved in aged care nursing that emphasizes on promotion of highest quality care and wellness. Geriatric nurses focuses on care of the sick old people. A gerontological nurse performs many roles as a caregiver, healer, educator, advocator and innovator (Eliopoulos, 2013). In the give case study, 70-year-old Frank is suffering from symptoms of acute asthma with poor controlled hypertension and AR. The patient is experiencing activity intolerance due to weakness and physical discomfort. By restoring his functional activities and helping him to cope with the disease, the geriatric nurse is performing healer’s role. The nurse also performs caregiver’s role, as the patient is encouraged to take an active part in his self-care management by meeting his needs that is reflected in nursing care plan (Nettina, Msn & Nettina, 2013). In the case study, the nurse is focused on educating the patient about disease condition, its progression and treatment regimen performing the role of an educator. The geriatric nurse takes advantage of the informal and formal opportunities in sharing the skills and knowledge with the patient related to self-care and disease management (Hirst, Lane & Miller, 2015). Therefore, geriatric speciality nurse role in relation to assessment and care for the patient, Frank is significant in improving quality and reducing cost of care. Furthermore, with nursing interventions, there is reduction of complications that in turn shorten hospital stays and reduction of readmissions.
The above case study of Frank highlighted the role of specialized nursing assessments and plan of care required by geriatric nurses. Frank was admitted in the hospital for acute asthma attack and poor hypertension management that illustrates strong focus on skills and education of nurses for the patients. The specialized diagnosis and assessments designed for the patient, undertaken by the geriatric nurse helped to manage and resolve the deteriorating condition. Therefore, the specialized assessments illustrate the knowledge required by the geriatric speciality nurses in providing best quality care for each health problem.

References
Avallone, K. M., McLeish, A. C., Luberto, C. M., & Bernstein, J. A. (2012). Anxiety sensitivity, asthma control, and quality of life in adults with asthma. Journal of Asthma, 49(1), 57-62.
Bledsoe, B. E., Anderson, E., Hodnick, R., Johnson, L., Johnson, S., & Dievendorf, E. (2012). Low–fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting. Prehospital Emergency Care, 16(2), 217-221.
Burks, A. W., Calderon, M. A., Casale, T., Cox, L., Demoly, P., Jutel, M., … & Akdis, C. A. (2013). Update on allergy immunotherapy: American academy of allergy, asthma & immunology/European academy of allergy and clinical immunology/PRACTALL consensus report. Journal of Allergy and Clinical Immunology, 131(5), 1288-1296.
Eliopoulos, C. (2013). Gerontological nursing. Lippincott Williams & Wilkins.
Higgins, J. C. (2015). The’Crashing Asthmatic’. American Family Physician, 91.
Hirst, S. P., Lane, A. M., & Miller, C. A. (2015). Miller’s nursing for wellness in older adults. Wolters Kluwer.
Kuhajda, I., Djuric, D., Milos, K., Bijelovic, M., Milosevic, M., Ilincic, D., … & Mpakas, A. (2015). Semi-Fowler vs. lateral decubitus position for thoracoscopic sympathectomy in treatment of primary focal hyperhidrosis. Journal of thoracic disease, 7(Suppl 1), S5.
Myat, A., Redwood, S. R., Qureshi, A. C., Spertus, J. A., & Williams, B. (2012). Resistant hypertension. Bmj, 345(7884), e7473.
Nettina, S. M., Msn, A. B., & Nettina, S. M. (2013). Lippincott manual of nursing practice. Lippincott Williams & Wilkins.
O’Driscoll, R. (2012). Emergency oxygen use. BMJ, 345, e6856.
Petersen, T. H., & Agertoft, L. (2016). Corticosteroids for Allergic Rhinitis. Current Treatment Options in Allergy, 3(1), 18-30.
Reddel, H. K., Bateman, E. D., Becker, A., Boulet, L. P., Cruz, A. A., Drazen, J. M., … & Lemanske, R. F. (2015). A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal, 46(3), 622-639.
Rolnick, S. J., Pawloski, P. A., Hedblom, B. D., Asche, S. E., & Bruzek, R. J. (2013). Patient characteristics associated with medication adherence. Clinical medicine & research, cmr-2013.
Roush, G. C., & Sica, D. A. (2016). Diuretics for hypertension: a review and update. American journal of hypertension, 29(10), 1130-1137.
Schwingshackl, L., & Hoffmann, G. (2015). Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. Journal of the Academy of Nutrition and Dietetics, 115(5), 780-800.
Sukul, P., Trefz, P., Kamysek, S., Schubert, J. K., & Miekisch, W. (2015). Instant effects of changing body positions on compositions of exhaled breath. Journal of breath research, 9(4), 047105.
Takahashi, G., Matsuzaki, Z., Okamoto, A., Ito, E., Matsuoka, T., Nakayama, T., & Masuyama, K. (2012). A randomized control trail of stepwise treatment with fluticasone propionate nasal spray and fexofenadine hydrochloride tablet for seasonal allergic rhinitis. Allergology International, 61(1), 155-162

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