Nursing Care Plan for the Elderly

1 Nursing Care Plan for the Elderly The modern healthcare system places maximum attention to patient care. The health system encourages healthcare specialists to take part in the process of patient care. The participation of various specialists in care processes is supported by the principles of an interdisciplinary approach to care (Daly & Jackson, 2020). These principles include team-work, competent leadership, person-centered care, and effective communication. The ultimate obligation of the care providers is to deliver quality care to the patients (Panagiotis, 2016). Daly and Jackson (2020) noted that to achieve this objective, health care professionals perform a comprehensive assessment of a patient to determine his/her health needs and interests. The health care team further analyzes the potential treatment strategies applicable to the patient. The team relies on knowledge, experience and expertise to make accurate medical decisions.

The decision-making role of the health team comes in handy when dealing with vulnerable populations (Hawkins et al., 2016). The collaborative approach to care employed by healthcare teams helps ensure that vulnerable patients are not at risk of adverse health outcomes (Daly & Jackson, 2020. When dealing with elderly persons suffering from conditions such as diabetes, hypertension, and obesity, the healthcare team must develop a nursing care plan that suits individual patient’s health needs (Hawkins et al., 2016).

This approach clears the path to recovery and health improvement for the patient.

Readmission rates to the hospital are subsequently reduced while improving the patient’s level of satisfaction with care (Panagiotis, 2016). The utilization of an interdisciplinary approach to care holds the promise of improving the future of healthcare delivery to vulnerable populations. This discussion highlights the interdisciplinary nursing care plan for an elderly person suffering from diabetes and hypertension.

2 Background Information Patient Name: J.T Age: 63 years Sex: Male Ethnicity: Caucasian Condition: Diabetes and Hypertension Situation: The patient has been experiencing increased thirst and blurry vision Medical History J.T is a 63-year-old male patient who presented to the E.R with complaints of excessive thirst, frequent urination, and blurry vision. The patient started experiencing these symptoms a week prior to the visit. He has also been experiencing nausea and vomiting, which have affected his daily routine. The patient noted that he was diagnosed with diabetes and hypertension 7 years ago. He complains that living with diabetes is extremely challenging for him since he does not have anyone to help him at home. Further, the client does not check his blood glucose levels regularly as required in diabetes management protocols. The client is worried that he may be at risk of developing diabetes-related complications.

Apart from diabetes and hypertension, the client does not suffer from other chronic conditions. He, however, has a family history of diabetes, hypertension, arthritis and myocardial infarction. The vital signs indicate that the client has a blood pressure of 141/84, oxygen saturation of 98%, and temperature 36.50. Physical assessment of the patient reveals a BMI of 32, sunken eyes, fruity-smelling breath, skin turgor of three seconds, and dry flushed skin. The current medications being taken by the client are 1 tablet of Lortab 10-325mg every 6 hours or as needed for pain, 1 tablet Neurontin 300mg PO BID, and 1 tablet Metformin 1000 mg PO BID.

3 Medical Assessment The medical assessment shows that the client has poor physical health and poorly managed diabetes. For instance, he has a BMI of 32 that is way above the recommended value of 24. J.T also rarely engages in physical activity and does not monitor his blood glucose level as required.

Nanda Care Plan It is irrefutable that health promotion for elderly persons is a complex task due to many health needs that typify this vulnerable population. Panagiotis (2016) argued that a comprehensive health assessment is required to ensure practical health promotion and a disease prevention plan for elderly people. This assessment generates information that should be integrated into the care plan. In J.T's case, health history assessment reveals that he has poorly controlled diabetes and hypertension. Therefore, treatment for this patient requires a coordinated plan attracting the role of several nursing specialists, including nutritionists and physical therapists. Improved ability to self-care will contribute significantly to the reduction of diabetes complications. The care plan focuses on improving the client's lifestyle, which is crucial to the management of diabetes. Further, the plan highlights the importance of compliance with mediation and dietary regimen.

Nursing Intervention

Rationale

Determine the personal factors

A wide range of factors may result in glucose stability problems in elderly persons.

that contribute to the risk of

These factors include physical inactivity, eating disorders, poor glucose control, and

unstable blood glucose level

failure to monitor changes in blood glucose levels (Beale, 2017).

Monitoring the client for signs

A person using insulin for diabetes type-2 treatment is at significant risk of developing

of hypoglycemia

hypoglycemia. Hypoglycemia may further subject the patient to severe complications

4 such as decreased glucose supply to the brain and elevated adrenergic activity, which may subsequently cause tachycardia, dizziness, fatigue, and visual changes (Delamater & Marrero, 2020).

Evaluate the client for signs of

Blood glucose levels may shoot in cases where the patient has an insufficient amount

hyperglycemia

of insulin. Elevated blood glucose levels trigger a series of physiological effects, including hunger, increased thirst, and frequent urination. Blurry vision and fatigue are also associated with elevated blood glucose levels.

Monitoring the blood glucose

This assessment is crucial since it helps determine the blood glucose variation from

levels at bedtime and before

the normal range of between 140-180 mg/dL. Blood glucose testing after meals is an

meals

essential task that helps the patient and the clinician determine how the blood sugar level was affected by the meal (Delamater & Marrero, 2020).

Monitoring the HbA1c

The recommended range of HbA1c is 6.5 %– 7%. The glycosylated hemoglobin helps to determine the client's level of blood glucose within the last two months. This information is crucial since it reveals the client's ability to self-care and manage his blood glucose levels.

Training the client how to

Diabetes management guidelines recommend that blood glucose levels should be

perform blood glucose

monitored before meals and at bedtime. The information obtained from these

monitoring at home

assessments is used to adjust the insulin doses or medications prescribed to the patient.

Assess the client’s blood

Hypertension is one of the comorbidities of diabetes. Regular blood pressure

pressure regularly

assessment is crucial since it lays the ground for preventing stroke, nephropathy, and retinopathy (Delamater & Marrero, 2020).

Assessing the physical activity

Physical activity is an important health improvement strategy for persons with

patterns of the client

diabetes and hypertension. Regular exercises have been touted as an integral aspect of diabetes and hypertension management. To improve the physical health of the client,

5 he should participate in simple physical exercises.

Assisting the client to

Diabetic patients have strict dietary guidelines aimed at maintaining blood glucose

understand how diet can reduce

levels near normal levels as possible. Non-compliance with these guidelines may lead

the risk of diabetes-related

to hyperglycemia. An evaluation of the client's understanding of the dietary guidelines

complications

helps generate information that can be used to develop a person-centered dietary plan (Hejazi et al., 2017).

Assess the psychological impact The patient is assessed for anxiety, depression, fear, and other psychological of diabetes on the client

symptoms. Further, the client is assessed for changes in speech. This assessment is beneficial due to the increased risk of psychological complications associated with diabetes.

Evaluating the extremities for

This assessment generates information that helps the clinician to determine the

intolerance to health and cold.

patient’s risk of neuropathy.

Reinforce the significance of

Compliance with the prescribed medication is vital in diabetes management. The

compliance with the treatment

client's ability to follow the clinician's instructions creates a way for improved health

regimen

outcomes (Beale, 2017).

Health promotion and Treatment Goal The main treatment goal for J.T is the improvement of blood glucose level. The other goals include improving the client’s BMI to a value below 30 in addition to lowering the blood pressure to a value below 120/80. The plan is also intended to increase the client’s capacity to self-care. This indicates that the plan is focused on increasing the client's understanding of diabetes and hypertension and the non-pharmacological interventions applicable to the treatment of these conditions. The client will participate in the learning process. Education will enhance the client’s capacity to identify the risk factors to diabetes complications and the most effective ways to prevent these risks. This includes the use of preventive and primary care services, in

6 addition to monitoring and controlling blood glucose levels and blood pressure (Delamater & Marrero, 2020).

The plan will also increase the patient’s level of physical activity and enhance compliance with healthy dietary patterns. Lifestyle modification plays a remarkable role in the management of diabetes, hypertension and other chronic conditions. Beale (2017) noted that diabetes has a strong link to lifestyle and family history. Most families struggling with diabetes have a history of obesity as well as poor heating behaviors and physical activity patterns. It is challenging to determine if an elderly person developed diabetes due to genetic predisposition or lifestyle-related risk factors. Therefore, to effectively manage diabetes lifestyle modification is necessary.

The HealthyPeopl.gov (2020) noted that lifestyle modification is effective in delaying the onset of diabetes and reduces the chances of developing complications among those with this condition. Lifestyle intervention, which includes a healthy diet and increased physical activity, has its greatest impact on elderly persons with diabetes (HealthyPeopl.gov, 2020). Further, translational studies indicate that the use of lifestyle intervention in group settings at the community level effectively reduces the risk of diabetes type-2 (HealthyPeopl.gov, 2020).

7 References Beale, L., (2017). Human Disease and Health Promotion. John Wiley & Sons, Daly, J., & Jackson, D. (2020). Contexts of Nursing: An Introduction. Elsevier Health Sciences, Delamater, A. M., & Marrero, D. G. (2020). Behavioral Diabetes: Social-Ecological Perspectives for Pediatric and Adult Populations. Springer Nature.

Hawkins, R. E., Lawson, L. E., Starr, S. R., Borkan, J., & Gonzalo, J. D. (2016). Health Systems Science E-Book. Elsevier Health Sciences, HealthyPeopl.gov (2020). Diabetes. https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes Hejazi, S., Peyman, N., Tajfard, M., & Esmaily, H. (2017). The impact of education based on self-efficacy theory on health literacy, self-efficacy and self-care behaviors in patients with type 2 diabetes. Iranian Journal of Health Education and Health Promotion, 5(4), 296-303. http://DOI:10.30699/acadpub.ijhehp.5.4.296 Panagiotis, M., (2016). Effective Methods for Modern Healthcare Service Quality and Evaluation. IGI Global.