NRSG259 Promoting Health in Extended Care

Process information – to interpret, discriminate, relate, infer, match the data and predict an outcome.

Identify problems/issues – synthesise all the information that has been collected and processed in order to identify the most significant patient problems or issues.

Establish goals – setting up the goal with the patient (demonstrating dignity) for the particular nursing issue.

The goal should be specific, measurable, achievable, realistic and timely (SMART).

The goals for managing ineffective breathing pattern could be:

• Giuseppe’s frequency and severity of the shortness of breath will be reduced to the level that John can tolerate within a week.
• Giuseppe will be able to climb the stairs with decreased breathlessness in one month

Answer:

Introduction

Identification and prioritization of important nursing care issues is crucial in ensuring that acceptable services are given to patients.  The topic is best illuminated by Mr. Dinh Nguyen’s case study.  The overall plan of the paper is to consider the patient while collecting relevant cues, interpret the information, with the purpose of identifying medical issues, prioritizing medical issues and establishing goals to guide specific actions to be taken to aid Nguyen. Outcomes and reflection will wind up the paper towards the end of the paper. Nguyen is an 83-year-old widower with a known Multiple Sclerosis (MS) of six years. He was also diagnosed with osteoarthritis, a year later after MS was confirmed. Multiple trips to the hospital have enabled him to manage both osteoarthritis and MS. Together with his wife, Mr. Nguyen migrated from Vietnam. The Nguyen’s did not have any children. Presently, he lives alone in a two storey home. His wife passed on a year ago. Despite his determination to live an independent life, grief and isolation exacerbated by MS and osteoarthritis are taking a toll on his health. Mr. Nguyen has no immediate family; however, his brother (Bao) and his family live nearby.

Body (Medical Issues and Actions)

Further medical examination reveals that Mr. Nguyen’s has been experiencing blurred vision, numbness in the face as well as an “electric shock” in the head and neck. He recounts that the “electric shock” travels down his back towards the legs; which has since depressed his posture and gait. Simple household chores such as cooking, dressing, showering and even assuming the right posture to tie his shoelaces have taken a toll. Mr. Nguyen’s is beginning to view his future as bleak one following a recent experience of urinal incontinence. To manage his MS, osteoarthritis, and pain, Mr. Nguyen is currently on Panadol Osteo 6/24 given orally (maximum 6 on a daily basis), 14mg of oral Teriflunomide administered daily and 25mg Prednisolone 25mg Oral during BD exacerbation.

Grief, isolation, and loneliness emanate from the fact that Mr. Nguyen is widowed and has no children. According to Nalungwe (2009), loneliness among elderly people who have lost spouses can be very traumatizing. Loneliness overrides the boundaries of wanting company or wanting to undertake a task or chore with another person. It is common for widowers to be overwhelmed by feelings of having been cut off and disconnected from goings on around them. Such feelings can render it painstakingly difficult for such a person to have substantial and meaningful human contact. In the current case, Mr. Nguyen is reportedly shying away from any contact with his brother and family who happen to live close by. Such individuals experience a subjective sense of inner emptiness left by spousal death (Nalungwe, 2009). It is safe to assume that most of Mr. Nguyen’s age mates are grandparents. People with immediate families may experience loneliness but have reduced chances of living lonely lives.

Social isolation has been known to impact the health and wellbeing of senior citizens in society in various ways, the most critical being mediocre dietary intake. In the current case, some chores such as cooking are proving difficult. From the narrative, it is one can gather that he has been doing well since last year. Over the years, her wife must have played a fundamental role in meal preparation and providing company to have meals with. With the wife gone, no children social isolation, there is nobody to ‘compete’ with or enjoy a meal with. According to Chernoff (2006), meals are best eaten in a company of other people. In addition, in a company of friends and children and spouses, it is easier for one to be psyched up to prepare meals. Mr. Nguyen being alone and growing tired every day in addition to painful gait, he is unable to prepare meals.

Numbness in the face is related to Multiple Sclerosis. Declining sensation is often in the hands and feet. However, it is possible to experience them in other parts of the body. Safety of patients experiencing loss of sensation is paramount when especially towards their extremities. Possible sources injuries include burns, cuts and bruises, pressure sores that pose a danger because they can go easily unnoticed. It is important for patients to be aware of sensory loss and be extra vigilant to ensure that MS management is successful. In MS, the immune system is said to attack myelin causing communication difficulties to the rest of the body from the brain.

Mr. Nguyen has a myriad of medical and social issues that need to be addressed. It is imperative to prioritize certain issues because they cannot all be addressed at once. Management of MS signs and symptoms has been given the first priority. The second priority will be given to addressing Mr. Nguyen’s social isolation and loneliness. The third priority will encompass educating him on self-management as a viable tactic that may alleviate the symptoms linked to MS.

Meeting the highlighted will require certain goals to be met within specific timeframes. These goals are listed below:

1. Nguyen pain and gait improve to enable him to tie his take a shower and tie his own shoelaces in two weeks’ time.
2. Nguyen accepts to involve his brother and family in the management of his social isolation and loneliness in the send week.

• Nguyen learns skills on self-management of MS signs and symptoms such as tiredness by the second week.

MS symptoms such as blurred vision, numbness in the face and “electric shock” in the head and neck that travels down to lower extremities (Kitago & Krakauer, 2013) can reduce the quality of life substantially. As recounted earlier, these symptoms are making it difficult for Mr. Nguyen to move due severe gait, cook and even take a shower. Simple tasks like bending to tie shoelaces are becoming near impossible. Being unable to perform such tasks can exert a lot of psychological and psychosocial pressure on the patients (Hunter (Ed), 2016).  The main goal of treatment will be geared towards the improvement of the quality of life by addressing certain symptoms. It is also important to slow the progression of the disease and shorten exacerbations. In addition, the nursing care plan ought to augment Mr. Nguyen’s safety which correlates with the quality of life (Burks, Bigley & Hill 2009).

Mr. Nguyen’s treatment can also include immunotherapy that can aid in slowing down the frequency and severity of attacks in the event that he relapses (Multiple sclerosis (MS), (2018). Some of the medications that can be used include Corticosteroids known to expedite relief following a relapse (Kitago & Krakauer, 2013). Literature indicates that MS patients with a history of depression tend to entertain suicidal ideations as well as other mental health conditions such as anxiety (Fraser et al., 2013). It is prudent that such conditions be addressed during rehabilitation program psychiatrists as stipulated in the clinical reasoning cycle (Levett-Jones (Ed.), 2013). Physiotherapists following administration of medications can help Mr. Nguyen overcome muscle problems by easing spasms, tremors as well as numbness of the face. Certain exercise programs can be provided to enhance the strength, gait, coordination, and flexibility when bending and doing other chores. Mr. Nguyen also reports fatigue which can be managed through sleep regulation coupled with narcolepsy treatment (Multiple sclerosis (MS), (2018). Medical personnel can also teach Mr. Nguyen on energy saving skills with the use of aids in addition to learning coping strategies to deal with fatigue.

Since Mr. Nguyen does not have an immediate family and has opted not to bother his brother and family, there are two forms of interventions that he can pursue to mitigate social isolation and loneliness. One such intervention is group-based. It may encompass a support group, elderly homes, rumination therapy or video conferencing (Chiang et al., 2010). The other is a one-on-one intervention that may involve computer training (Cotton et al., 2013), companionship from animals (Bernabei et al., 2013 & Cotton et al., 2013) as well as visitor volunteers. In his case, it is recommendable that he checks into an elderly nursing home. It will be beneficial to him in several ways. Nursing homes have trained staff on MS and its symptoms. Currently, Mr. Nguyen is unable to cook, launder his clothes, take showers and even tie his shoelaces. During recovery, the elderly nursing home personnel can be helpful in ensuring that Mr. Nguyen meals and hygiene needs are met. The little savings he has can be utilized in meeting his expenses at the nursing home. Besides, in a nursing home, he can meet plenty of age-mates with similar problems with whom he can share meals and have good companionship (Cotton et al., 2013 & Bernabei et al., 2013). Reminiscence therapy is also very practical for a group of people. Although he does not desire to involve his brother and his family, while in a nursing home, they can serve as volunteer visitors (Bernabei et al., 2013).

Self-management interventions (SMI) are a new concept of healthcare but are progressively gaining support management of long-term conditions such as MS (Kidd et al., 2017 & Fraser et al., 2013). It is known that self-management is beneficial for people with MS because there is some evidence of its achievement in imparting skills for managing certain clinical outcomes including fatigue and medication adherence. Mr. Nguyen can also benefit from self-management because it confers the chance to gain skills for augmenting psychological well-being. Despite there being fairly little known about SMI effect on MS patients, such people increasingly experience anxiety and depression (Fraser et al., 2013).

Conclusion

Up to this point, I now understand that management of chronic conditions is a team effort. It requires multidisciplinary and interdisciplinary efforts to ensure that all goals and priorities are met. He is an integral member of the team and should never be neglected. His brother’s family too has a part to play. They can visit him from time to time. These interventions are beneficial in that they focus on social training, enhancement of social support, more opportunities for social interaction as well as social cognitive training and functionality through the availability of services such transport and medical care and timely delivery of meals. During social training, Mr. Nguyen can learn how to start a friendship as well as stratagems for developing social support for people undergoing the same problems. Further deterioration can necessitate permanent nerve damage and movement difficulties. Electric shock in the head and neck related to immobility and gait severity are all symptoms of quickly advancing MS. As such, the nursing care plan will need to support rehabilitation in order to counteract complications as well as secondary disabilities.

References

Bernabei, V., De Ronchi, D., La Ferla, T., Moretti, F., Tonelli, L., Ferrari, B., ... & Atti, A. R. (2013). Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: a review. Journal of psychiatric research, 47(6), 762-773.

Burks, J. S., Bigley, G. K., & Hill, H. H. (2009). Rehabilitation challenges in multiple sclerosis. Annals of Indian Academy of Neurology, 12(4), 296.

Chernoff, R. (2006). Geriatric nutrition: The health professional's handbook. Sudbury: Mass.

Chiang, K. J., Chu, H., Chang, H. J., Chung, M. H., Chen, C. H., Chiou, H. Y., & Chou, K. R. (2010). The effects of reminiscence therapy on psychological well?being, depression, and loneliness among the institutionalized aged. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 25(4), 380-388.

Cotten, S. R., Anderson, W. A., & McCullough, B. M. (2013). Impact of internet use on loneliness and contact with others among older adults: a cross-sectional analysis. Journal of medical Internet research, 15(2).

Fraser, R., Ehde, D., Amtmann, D., Verrall, A., Johnson, K. L., Johnson, E., & Kraft, G. H. (2013). Self-management for people with multiple sclerosis: a report from the first international consensus conference, November 15, 2010. International Journal of MS care, 15(2), 99-106.

Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.

Kidd, T., Carey, N., Mold, F., Westwood, S., Miklaucich, M., Konstantara, E., ... & Cooke, D. (2017). A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety, and quality of life. PloS one, 12(10).

Kitago, T. O. M. O. K. O., & Krakauer, J. W. (2013). Motor learning principles for neurorehabilitation. In Handbook of clinical neurology (Vol. 110, pp. 93-103). Elsevier.

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.

Multiple sclerosis (MS). (2018). Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/multiple-sclerosis-ms

Nalungwe, P. (2009). Loneliness among elderly widows and it’s effect on their mental well being: a Literature review.