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72 year old Leonie- case stude

72 year old Leonie- case stude

Introduction

The case study includes a 72-year-old Leonie and she was recently administered to the emergency department because Leonie was confused and agitated in the market. The initial assessment of the reveal that she is febrile and increase blood pressure also observed after that she was diagnosed with UTI then prescribed with antibiotics. The medical history of the patient reveals that she had a pressure ulcer on her left leg, urinary urgency, arthritis in her knees and hypertension.  The family background of the Leonie indicates that the reason for deteriorated health is her husband’s death and she does not have a child but have 2 sisters.  There are certain issues raised by her sister regarding the lifestyle of the Leonie that has increased her complication which include increasing consumption of microwave meal, increased weight and decreased personal care. The report is going to discuss a different issue and possible intervention for Leonie.

Behavioural health risk factors

The body mass index of Leonie indicates that she has encountered obesity and according to her family she has gained 6-10kg in the past 6 months. In recent years obesity has increased the rate of mortality in the population and it is considered to be a major health care burden. Obesity in encountered when the individual is overweight concerning the body mass index and have increase belly fat. Obesity is a chronic disease that directly increases the complication for multiple disorder like diabetes, heart attack and genitourinary disorder.  The increase in weight directly increases the complication as it leads to greater burden over body functioning unit that leads to deteriorated health status (Fruh, 2017). The change in the lifestyle after Leonie’s husband death leads to a decrease in physical activity which ultimately leads to a sedentary lifestyle. A sedentary lifestyle is considered to be a decrease in physical activity that directly increases the complication of the individual. The decrease in physical activity increased the risk as it directly increases the burden over different body functioning unit.   The increase sedentary lifestyle has increased the risk for non-communicable disease the directly increase the risk for deteriorated health and mortality of individual (González et al., 2017). The poor dietary routine is one of the behavioural risk factors faced by Leonie that increase the prevalence of the different disorders.  The microwave meal is preferred by Leonie’s since the past 6 months that directly affected her weight and deteriorated health status. The body requires the proper amount of nutrition on a daily bases to sustain properly and maintain health status.  The nutrition’s are required in fixed amount decrease or increase nutrition intake can lead to issue for the individual. Poor nutrition intake which includes insufficient intake or high intake leads to many complications like obesity, hypertension, hypercholesterolemia and heart disease (Khan et al., 2018).  

Best-practice assessment tools

The first assessment tools that can be utilized to improving the understanding toward the patient deteriorated health condition include ABCDE assessment. The ABCDE assessment is considered to be the first lien assessment tools that are to be used by nurses to understand the patient health status. The ABCDE include different like which include airways, breathing, circulation, disability and exposure that are needed to be checked to understand the patient health status. The airways assessment includes breathing sound, the voice of the patient to understand the presence of nay airways obstruction. The breathing assessment includes analysing breathing rate, chest percussion, lung auscultation and chest wall movement. The circulation assessment includes palpating pulse rate, skin colour, capillary refill time and heart auscultation. Disability assessment should be performed by checking consciousness, light reflexes and limb movement. The last assessment is exposure assessment which includes exposure skin and temp (Fernández-Méndez et al., 2019).

The pressure ulcer on the left leg of the Leonie’s is also one of the major concerns and the Braden Scale is required to assess the pressure ulcer. The pressure ulcer one of the painful condition that is encountered by the patient and immediate diagnosis should be done to decrease the chances of complication. One of the most common assessment tools is the Braden scale that helps to evaluate the pressure ulcer to analyse the current condition of the ulcer. Braden scale utilizes six aspects that include sensory perception, nutrition, moisture, activity, mobility and friction. These different aspects are utilized to evaluate the ulcer condition by combining with intensity and duration of the ulcer (Park & Lee, 2016). The Confusion Assessment Method (CAM) can be utilized to understand the confusion and agitation of the Leonie as she is still facing difficulty in planning. The confusion assessment tool utilizes the clinical practise skill for cognitive assessment of the patient to evaluate the current health status. The CAM help to early recognition of the sign and symptoms associated with delirium and that include four aspects which include fluctuating course, altered level of consciousness disorganized thinking and decrease attention (Green et al., 2019).

 Interventions

 The deteriorated health status of the Leonie urgently requires lifestyle changes to improve the health status as it works to improve the all-round betterment of the patient. The lifestyle intervention utilized different aspect that will be utilized to uplift the health of the patient. The first aspect that will address by the intervention is the diet and it helps to maintain the proper nutrition intake that will reduce burden over the body functioning while improving nutrition intake. The second aspect includes physical activity that helps to reduce the sedentary lifestyle by incorporating supervise exercise in the daily routine that can help to improve endurance and strength of the individual. The third aspect includes a socializing aspect that includes increasing social presence that helps to improve the social circle that leads to improved mental and physical wellbeing (Mountain et al., 2017). The lifestyle intervention will help to maintain the blood pressure, poor dietary habit and sedentary lifestyle of the Leonie that help to maintain health status. 

Cognitive therapy is also one of the methods that can be utilized to improve the mental distress of the Leonie to improve the mental wellbeing of the individual. Cognitive-behavioural therapy includes the behavioral and cognitive therapy to improve the emotional or behaviour of the individual. The cognitive-behavioral therapy helps to improve the self-skill of the individual to control over the thought, behavior and feeling of the individual. Cognitive therapy aims to change the distorted thinking of the individual and behavioral therapy includes skill modification to improve mental wellbeing. The nurses can help the patient by identity in the negative thought followed by the challenging thought process and least step is to replacement of the though proves to more realistic form.  The main objective of the therapy is to improve the mental wellbeing by teaching, coaching and reinforcing positive behavior in mentally low individual to improve the mental wellbeing. Many aspects are addressed by the therapy which includes mood disorder, anxiety, personality disorder, eating disorder and confusion to improve mental wellbeing (Lorenzo-Luaces et al., 2016).  

 Registered Nurse obligation

The intervention that is utilized to help Leonie to increase the health wellbeing is framed as per the patient current health status to provide person-centred care. Nursing and Midwifery Board (2017a) code of conduct state that nurses should provide the person-centred care to improve the wellbeing of the patient. Nurses should work in a manner that encourages the patient to indulge in the decision that will tailor the treatment process as per the patient requirement.  The patient should be informed about the treatment process to increase the awareness of the individual.

The interventions are tailored to improve the patient health status by utilizing an accurate assessment that helps provide proper care to the patient. The Registered Nurse standard includes seven principles that are needed to be followed during the patient to promote quality of care. The 4 standard states that nurses are expected to conduct a timely assessment by utilizing a holistic approach that is culturally safe. The nurse should work in partnership during the treatment process to improve the wellbeing of the patient by providing cultural and patient appropriate care.  The nurses should utilize the clinical skill during the assessment to predict the accurate treatment that aims to improve the patient health status (Nursing and Midwifery Board, 2017). The interventions that are utilized to increase the health status of the patient are accurate as they are planned after patient assessment to increase the quality of care. Nursing and Midwifery Board have proposed code of ethics that help the nurse to work according to the ethical and legal framework to improve the care process. The first code of ethics states that nurses are expected to provide accurate care that aims to decrease recovery time. Health care associates utilize decision making skill during patient care to ensure accurate care. The nurse should value quality nursing care ability with collaboration to patient preference to deliver the quality of care (Nursing and Midwifery Board, 2017b).

The report discusses the case study related to Leonie as she was recently admitted to the emergency department as she was confused and agitated. After the case analysis, it was revealed some behavioural factor associated with the patient are obesity, sedentary lifestyle and the poor dietary that lead to the deteriorated health of the Leonie. The assessments that were can be conducted for the patient includes ABCDE assessment, Braden Scale and Confusion Assessment Method to understand the issue with individual health status. Two interventions were suggested to improve the health status that includes lifestyle modification and cognitive behavioural therapy to reduce health-associated complication. The interventions that are suggested by utilizing professional skill to increase the patient wellbeing that includes code of ethics, professional standards and code of conduct and.

 

 References

Fernández-Méndez, F., Otero-Agra, M., Abelairas-Gómez, C., Sáez-Gallego, N. M., Rodríguez-Núñez, A., & Barcala-Furelos, R. 2019. ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study. PloS one, vol. 14, no. 4, pp. 1-12. https://doi.org/10.1371/journal.pone.0212080

Fruh S. M. 2017. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. Journal of the American Association of Nurse Practitioners, vol. 29, no. S1, pp. S3–S14. https://doi.org/10.1002/2327-6924.12510

González, K., Fuentes, J., & Márquez, J. L. 2017. Physical inactivity, sedentary behaviour and chronic diseases. Korean Journal of family medicine, vol. 38, no. 3, pp. 111–115. https://doi.org/10.4082/kjfm.2017.38.3.111

Green, J. R., Smith, J., Teale, E. 2019. Use of the confusion assessment method in multicentre delirium trials: training and standardisation. BMC Geriatr, vol. 19, no. 107, pp. 1-9. https://doi.org/10.1186/s12877-019-1129-8

Khan, A., Khan, S. U., Khan, S. Zia-ul-islam, S., Baber, N. K. & Khan M. 2018. Nutritional complications and its effects on human health. Journal of Food Science and Nutrition, vol. 1, no. 1, pp. 17-20.

Lorenzo-Luaces, L., Keefe, J. & DeRubeis, R. 2016. Cognitive-behavioural therapy: nature and relation to non-cognitive behavioral therapy. Behaviour Therapy, vol. 47, pp.1-19.  10.1016/j.beth.2016.02.012.

Mountain, G., Windle, G., Hind, D., Walters, S., Keertharuth, A., Chatters, R., Sprange, K., Craig, C., Cook, S., Lee, E., Chater, T., Woods, R., Newbould, L., Powell, L., Shortland, K., & Roberts, J. 2017. A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial. Age and Ageing, vol. 46, no. 4, pp. 627–634. https://doi.org/10.1093/ageing/afx021

Nursing and Midwifery Board. 2017. Registered nurse standards for practice. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Nursing and Midwifery Board. 2017a. Professional Standards. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursing and Midwifery Board. 2017b. Professional Standards. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Park, S. H., & Lee, H. S. 2016. Assessing predictive validity of pressure ulcer risk scales- a systematic review and meta-analysis. Iranian journal of public health, vol. 45, no. 2, pp. 122–133.

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