HI6006 Competitive Strategy Editing Service
Delivery in day(s): 4
This report is aiming to identify, critically evaluate and focus on the importance of independent living among elders and the role of person centered approach in treatment for development of this independence. This report will be assessing different aspects of independent living among elderly and different relevant assessment which might be useful for its development.A person centred approach refers to treating and providing service to a client on the basis of his individual requirements and not applying generalised rule on every patient. This practice is quite commonly used in many health and social care settings. Patients from diverse backgrounds having different needs, they are treated with person centred approach keeping individual requirements in mind. For example, if a person is a vegetarian then his diet regime would be designed with vegetarian healthy contents. In addition, people with learning disabilities are given special session to make them understand things or to know their problems. Hence, this approach helps in providing satisfactory services and a better level of care to the users (Epstein et al. 2010).
For example in this case Loretta is residing alone and her age is advanced with previous medical history. Patient in this situation need to involve in her own treatment plan because she is most suitable person to tell what suits her and what does not in terms of medicine, life style and exercises etc. In health and social care settings, when service providers give health treatment and provide social care to the patients, sometimes the situations of ethical dilemmas arise. It may even be said that such situations are unavoidable at a health organisation as the views of service provider and the user may clash at any moment and both are justified at their place. In such situation involvement of patient himself and family in the treatment plan helps in resolving the ethical dilemma to a great extent. It is also ensured in person centred approach that people with some disabilities are addressed and treated with the set standards to ensure that their rights are protected and all kinds of harm, any physical, mental or emotional abuses are prevented. It has also been reported that involvement in social processes helps in developing a person centred approach too, hence it may be stated that social processes are not just the part of day to day life but has multiple effects on health and social services (Bate, 2004). In order to describe the concepts associated with this area there are various definitions but the major key principles which are include in the person centred care is including patients, patient’s families as well as the carers with full respect and dignity. This is followed by encouragement along with full supported participation with the patients, patients families, consumers and carers while decision making (Nolan, 2001).
Patient Loreeta is of 82 years old and she already has a history of congestive cardiac failure. With advancing age, many changes occur in anatomy and physiology of cardiovascular system in adults including changes in activities of nodal fibers and conductive fibers increasing the risk of atrial fibrillation. It is one of the most common forms of arrhythmia characterized by rapid and unorganized activity of atrium leading to production of impulses at a rate of 300 to 600 beats per minute. With time, the atria stretch and thus their probability to fibrillate increases manifold. Along with this, fibrous tissue grows on the wall of atrium acting as a barrier in effective conduction of impulses and causing them to move spirally in place of going straight. In case of Loretta the changes are observed over the time are a Reduction in heart rate due to fibrous and fat deposition and loss of few cells in SA node, Reduction in amount of blood in chambers of heart may occur due to thickening of walls especially of left ventricle but most of the time it is compensated. Deposition of ageing pigment makes the valves stiffer and murmurs heard. Increase in chest wall thickness may reduces heart rate strength and blood flow to lungs and increases work load on the heart. AF may be of two types; paroxysmal atrial fibrillation (PSAF) and persistent AF (PAF), both types become permanent with time (Fang, et al.2007).
There occur many changes in the physiology and pathology of blood vessels as age advances which affect cardiovascular system. They do not necessarily lead to increase in chances of diseases in ageing. In some people, these changes have no clinical implication but in patients like Mrs Loretta there may be consequences. They become susceptible to many cardiac related disorders and diseases. The cardiac load increases and chances of conditions like angina, fibrillation, flutter, anaemia, atherosclerosis, raised BP, hypotension, vascular diseases, and varicose veins increases. Following are the elaboration of changes in CVS due to ageing (Anaesth, 2000). Plaque formation due to thickening of artery wall and Chances of wear and tear increases and nutrients, wastes and gaseous exchange across blood vessels reduces with age. Similarly orthostatic hypotension and dizziness is observed due to decrease in sensitivity of baroreceptors. Hypertension is seen commonly in adults due to thickening of aorta. Left ventricular hypertrophy and increase in cardiac work load occurs due to it (Safar, 1990).
Since patient Mrs Loretta is suffering from cardiac disorders and hypertension she would need following assessments on a regular basis with each examination. Patient is an 82 year old women by name Loretta and she is suffering from hypertension and congestive heart failure. Her current medication include Carvedilol 6.25mg PO Mane, Furosemide 40mg PO BD, Amlodipine 5mg Daily, Aspirin 100mg Daily, Perindopril 2.5mg BD, Ibuprofen 400mg TDS, Tramadol 100mg BD, Citalopram 20mg Daily.
ECG or Electrocardiogrpah is one of the basic assessment test which needs to be done for patient Mrs Loretta to assess all the waves of cardiac system and their coordination with each other. ECG will also provide information on conduction of fibres in heart which manages the rhythm of movement of chambers. In atrial fibrillation, the sinoatrial node becomes ineffective in directing the heartbeat and the heartbeats start generating from multiple locations in atria leading to very rapid beating of heart that may have extremely dangerous effects. This condition varies from person to person by being asymptomatic in few people to showing major symptoms in others (Janice and Celia, 2004),
Other assessment would be Blood Pressure record of Mrs Loretta on a regular basis to assess her hypertension patterns and rise in the pressure over the period of time.
Patient can also be assessed for platelet count through a complete CBC which would also assess presence of any cardiac enzyme in blood to rule out myocardial infarction.
Kidney function test would also be helpful as patient has a previous history of congestive heart failure and hypertension.
According to Abate And Chandalia, (2007) Medical science is always wondering why certain people are more prone to heart diseases, diabetes or obesity than other with no apparent reason at all. With similar diet and similar level of exercises some people are prone to accumulate fat than other, why such phenomenon exists. It is believed by many experts that there might be some genetic predisposition as well as developmental impact on the origin of these diseases.
First thing which is recommended for Mrs Loretta is regular exercise in mild form to keep herself mobile, functioning and out of total bed rest. It has been proved that doing regular exercise has multiple benefits on overall health of a person along with preventing many cardiovascular diseases as well. One major benefit that has been reported with regular exercise is vasodilatation in conduit arteries and large resistance arteries induced by an improvised endothelium mediated flow (Schächinger, ET AL, 2000). This vasodilatation has also been reported in pulmonary artery.
Second thing recommended for Mrs Loretta is to bring herself for regular examination and keep a record of her fluid intake and output. This will allow her to keep a tab on her vitals and also assess her fluid volume rise or fall. She would also be recommended to stick to her medication regime without fail. In CVS old age people, adherence to medication is very important because even one dose missed can cause serious impairment. Regular blood pressure and pulse measurement need to be done in these patients by nurses. Diet management and exercises are under their supervision. As a nurse it can be said that old age patients are very susceptible to the mental trauma so a geriatric nurse has to keep a track of patient’s mental status regularly and monitor cognitive skills from time to time. The nurse has to take care of all these problems and make sure that patient understands the old age diseases and accepts it. They keep patient educated about personal safety and hygiene. Nurses should be good communicator and counsellor. They need to manage health care delivery system and understand all new treatment modalities for better application on the patients (Paul et al. 2008).
Kuo, D.Z., (2012), Family-Centered Care: Current Applications and Future Directions in Pediatric Health Care, Maternal and Child Health Journal, vol.16, no.2, pp.297-305
Bridges, et al (2010) “Older people’s and relatives’ experiences in acute care settings: Systematic review and synthesis of qualitative studies, International Journal of Nursing Studies 47 (2010) 89–107
Safar M. (1990) Ageing and its effects on cardiovascular system: Centre de Diagnostic, Hospital Broussaia, Paris, France Drugs.;39 Suppl1:1-8
Anaesth, J. (2000) The aged cardiovascular risk patients..Department of anaesthesia, University Hospital Freiburg.Germany PriebeNov;85(5);763-766)
Kamanth S, (2002): Atrial fibrillation in the elderly: Anticoagulation strategies and indications in the very elderly. Am J Geriatr Cardiol 2002;11:357–364.
Fang MC, Chen J, Rich MW (2007) Atrial fibrillation in the elderly. Am J Med 2007;120:481–487
Schächinger V, Britten MB, Zeiher A. (2000) Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease.Circulation. 2000;101:1899–906.
Abate, N. And Chandalia, M. (2007) “Ethnicity, Type 2 Diabetes, and Migrant Asian Indians,” Indian Journal of Medical Research 125 (2007): 251–258. Medline
Janice, R. E. and Celia L H., (2004), Nursing in today's world: Trends, issues & management Lippincott Williams & Wilkins, pp. 190-193.
Paul A., et al. (2008) Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital Territory’ Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 251–261