Viewpoint and purpose of the assignment
This paper analyses the possible health problems that the patient could be suffering from in the provided case. The paper will also explore the interventions that can be used and the outcomes of these actions.
Preliminary Problem List of Ms. N
The patient could be suffering from the following illnesses: Dementia, which is characterized by forgetfulness and confusion, but the symptoms are atypical making it difficult for the health providers to discover (Gray-Miceli 5). From the medical history, it is clear that the patient had previous treatment for her forgetfulness and confusion. In addition, the history, examination suggests that she could be suffering from dementia of the Alzheimer’s type because of the severe memory loss. It is also possible that the patient is suffering from Delirium because of the highly distracted state of mind. The patient is restless, experiencing illusions, and there is an inconsistency of thoughts and speech (Gray-Miceli 7).
Delirium is a suspect in this case because it occurred suddenly because the patient did not indicate these signs and symptoms a month ago when she was brought to the hospital (Gray-Miceli 5). In addition to this, Delirium can occur together with Dementia mostly because the patient is elderly.
Geriatric Depression is another possible condition that the patient could be suffering from. It is not a normal thing that comes with aging, hence if the patient is depressed, then there is a need for intervention.
Finally, Urinary Incontinence (UI) can also be a problem because of the uncontrolled passing of urine and an increase in falls. The patient is incapable of functioning alone, meaning that she is independent in activities of daily body processes. An assessment needs to be done to determine the causes of her UI and come up with interventions. Urinalysis and thyroid function examination should be carried out to determine why she cannot control her urine (Gray-Miceli 5).
The Most Important Information Given
The past medical history is significant because it helps the medical health practitioner to assess the previous signs and symptoms of a particular illness or condition. In this case, the patient had earlier treatment for mild forgetfulness and confusion, and this could be an indication that she was developing Dementia. The physical signs and symptoms are also important for the medical assessment. In this case, there is evident confusion, distraction, and problems in thought and speech (Dowling-Castronovo 279). These could also suggest problems in the cognitive ability of the patient.
Atypical Presentations and, or Geriatric Syndromes
The atypical presentation of geriatric syndromes includes falls whereby the client has an increased number of falls making it difficult for her to operate independently in daily activities (Gray-Miceli 15). Delirium is the other atypical presentation because the confusion linked to it can be confused with another illness other than geriatric syndrome. Urinary incontinence is evident in this case and the patient cannot function normally because of her inability to control her bladder. According to the study, UI has been never a normal consequence of aging and it should be managed to enable the patient to function normally (Gray-Miceli 16). The other atypical presentation is depression that suggests that a mental assessment should be carried out. A study has linked, falls, UI, and depression to geriatric syndromes and these signs are likely to exist together especially in older persons. The female gender is also more at risk of experiencing the geriatric conditions that are mostly related to cognitive impairment, depression, disturbed mobility, old age, and functional impairment (Gray-Miceli 17).
Subjective Data in Geriatric Syndromes: Problem-Focused History and Focused Physical History
- This history is taken can involve communicating with the client to determine why they think that someone who is out on a mission to kill her.
- The communication can also be utilized in assessing their mental status. Interviewing the patient will also provide subjective data to determine, for example, if she is experiencing any pain, discomfort, itchiness, among others (Dowling-Castronovo 278).
- The patient or the accompanying family member is in a position to state whether there are problems such as coughing and vomiting that the patient could be experiencing.
- Additionally, the nutritional assessment includes the dietary history, including the daily caloric intake, the availability of food, utilization of nutritional supplements, and the adequacy of the diet that the patient takes. This kind of data will enable the caregiver to get the opinion, interpretations, and beliefs of the patient (Dowling-Castronovo 280).
Objective Data in Geriatric Syndromes
The memory loss could be an indication of reduced cognitive performance in the patient. This memory loss is either a sign that indicates the possible development of Dementia in the present or future. Depression symptoms can be associated with premorbid intelligence and they reflect a realistic cognitive decline. The other objective data that need to be taken is taking the body weight of the patient to determine if there has been weight loss. Losing weight has been associated with malnutrition and this should be involved in taking the objective data (Dowling-Castronovo 278). The patient should be assessed for hypercholesterolemia and hypo-albuminuria to get the accurate evidence of malnutrition in the elderly patient. A functional assessment needs to be carried out using the activities of daily living (ADL) or instrumental activities of daily living (IADL) to assess the score to know the level of independence or dependence (Dowling-Castronovo 278).
Essential Tools for Screening
The tools to be used in this case include the Katz index of independence in Activities of Daily Living (ADL) that will help in identifying the ability of the patient to perform her daily activities (Shelkey and Meredith 20). The Mini-Cog will be useful in screening for cognitive impairment in the patient during the time of hospitalization. The ‘Urinary Distress Inventory-6 (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7)’ tools are helpful in identifying the type of UI that the patient is suffering (Shelkey and Meredith 20). The Geriatric Depression Scale is also useful in determining the depression levels in the patient. Dementia can also be discovered using this tool for patients suffering from it have a short attention span and easily get fatigued.
Proposed Interventions and Outcomes
The nursing interventions will include taking the daily intake and output, checking the vital signs frequently, body weight, and observing for pain, function, and behavior (Christine and Dowling-Castronovo 56). This form of intervention will be necessary for identifying progress in ensuring that the vital signs are stabilized. In addition to this, a toileting program needs to be put in place in order to manage the UI that is inhibiting normal daily functioning. However, this will be done first when the patient is hospitalized to monitor progress and manage falls (Christine and Dowling-Castronovo 66). Bladder diaries, pharmacology, surgery, urinary catheterization, and the use of absorbent products are interventions that can be used to manage UI.
Realistic and measurable projected outcomes
The goal of this intervention is to reduce the number of UI episode to a point that normal functioning possible for the patient. The caregivers should also be involved in the interventions to equip them with the ability to offer care to the patients at home.
Christine, Bradway and Dowling-Castronovo Annemarie. Assessment and Management of Older Adults with Urinary Incontinence 2007. [white paper] Presented at The National Gerontological Nursing Association (NGNA) of Colleges of Nursing Conference in St. Louis, Mo in 2008. Web.
Dowling-Castronovo, Annemarie. “Urinary Incontinence Assessment in Older Adults Part I–Transient Urinary Incontinence.” Obstetrics & Gynecology 109.2 (1985): 277-280. Web.
Gray-Miceli, Deanna. (in press). “Modification of assessment and atypical Presentation in older adults with complex illness”. In Gray-Miceli, D. (Eds.), AACN. Washington, DC: AACN.Web.
Shelkey, Mary and Meredith Wallace. “Katz index of independence in activities of daily living (ADL).” The Gerontologist 10.1 (1998): 20-30. Print.