HEALTH AND ILLNESS IN THE OLDER PERSON 1

Health and Illness in the Older Person

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Institution

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Author Note
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Health and Illness in the Older Person

The case involves an 83-year old man admitted to the hospital due to a fracture resulting

from a fall at home. Also, he presents with peripheral neuropathy resulting from diabetes type 2

and atrial fibrillation which are co-morbidities to his presenting health condition. The patient

lives with his wife who was recently diagnosed with dementia and therefore this means that he

does not have a family care supporter since all his children live abroad except for one who flew

in to come and be with them. in addition, the patient showed confusion after admission which

was found out to be resulting from UTI from a recent surgical catheterization. Jack despite

having severe health issues, his wife condition has rendered him her only primary caregiver.

With his condition worsened by co-morbidities, it is close to impossible for him to provide the

necessary care to his wife.

Nursing Care Priorities

The first nursing care priority is ensuring that Jack's diabetes type 2 condition is properly

managed for proper healing of the wound resulting from the surgery made to correct the fracture.

The intervention for diabetes type 2 management will include diet planning and insulin injection.

People who have uncontrolled diabetes often have poor blood circulation which prevents

nutrients from getting to the wound for proper healing (Aminian et al., 2019). For instance, a

person with diabetes is likely to suffer from a chronic wound that may take a very long time to

heal compared to a person with normal blood sugar. In the case of Jack, the nurses should ensure

that his sugar levels are properly managed to ensure faster and proper healing of the surgical

wound. In addition, ensuring that the patients get enough protein diet to help in building and

repairing the damaged tissue by the fracture will also promote proper healing of the wound. In

healthcare facilities, it is easy for older patients to get hospital-acquired infections(HAI's). for the
HEALTH AND ILLNESS IN THE OLDER PERSON 3

case of Jack, it is likely that his immunity is compromised due to his old age and also the various

co-morbidities. Therefore, to protect the health of the patient, the nurses need to observe disease

transmission intervention, especially when dressing his wound. For instance, observing proper

hand hygiene would greatly help in safeguarding the health of the patient. Proper management of

the blood sugar will also reduce diabetic peripheral neuropathy (Farhat & Yezback, 2016). So the

first nursing care priority should be to ensure proper management of the patient diabetic

condition.

The next nursing care priority is to manage atrial fibrillation which is the irregular often

very rapid heartbeat. AF is one of the common postoperative arrhythmias and needs proper

management to safeguard the life of the patient (Enga et al., 2015). The intervention strategies

that the nurses can apply include anticoagulation therapy whereby its effects will require close

monitoring of the patient. Due to the surgical procedure to correct the fractured leg, the patient is

at high risk of developing clots which may endanger his life. The nurses, therefore, need to

consider administering anticoagulants to prevent the formation of clots after the surgery (Frazer,

2016). For patients with diabetes, anticoagulant therapies recommended include warfarin and

non-vitamin K oral anticoagulants. The nurses will need to closely monitor the patient since anti-

coagulants are likely to cause severe bleeding in case one is bruised and also nose bleeding

among other side effects. However, the benefits of anticoagulants for this case outweigh the side

effects and thus the nurses should consider it as a priority.

The third priority for nursing care is to manage the urinary tract infection that has

confused the patient. Sometimes confusion among older adults can be mistaken for old age and

thus hinder some from seeking medical help for serious health issues such as UTI (Akram et al.,

2020). Stereotypes in society concerning old age can hinder the proper delivery of patient care
HEALTH AND ILLNESS IN THE OLDER PERSON 4

since one is likely to get misdiagnosed. Patients in old like Jack have delayed in seeking medical

assistance for serious conditions since they are stereotyped to normal symptoms of old age that

do not need any intervention. It is likely that if Jack did not visit the hospital due to a fracture, his

mental confusion could be attributed to old age. Jack had undergone a surgical catheterization

which could have led to the UTI. Without a proper assessment of the patient, likely, one may not

be diagnosed with UTI if they only showed confusion is the major symptom (Godbole, Cerruto

& Chavada, 2020). The nursing intervention, in this case, is to ensure the removal and

reinstallation of another catheter together with the provision of antibiotic treatment as advised by

the doctor to clear the UTI. Nurses can also ensure timely replacement of the catheter to prevent

recurring cases of UTI on the patient.

Evaluation

In managing type 2 diabetes for Jack the intervention includes diet planning and insulin

injection. The care priority is to manage the sugar levels hence promoting proper healing of the

surgical wound on the fracture site (Farhat & Yezback, 2016). The intervention timeframe was 5

days where it was expected to start showing improvement. In evaluating the effectiveness of the

intervention, a record of the blood sugar readings was used which were compared to identify if

the condition was getting better. Having a steady reading of the blood glucose level will indicate

effective management of diabetes (Strain et al., 2018). Also, when diabetes is properly managed,

the surgical wound will likely show positive signs of healing. Therefore, daily monitoring and

recording of the wound progress and also the overall healing of the patient was recorded to

identify if there is an improvement based on the intervention. management of diabetes type 2 for

Jack was effective which also promoted proper healing of the wound and also reduced the

symptoms of peripheral neuropathy.

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The second priority is the management of atrial fibrillation hence preventing blood clots

may be life-threatening to patients who have undergone surgery. After surgery, patients with

atrial fibrillation are at increased chance of getting blood clots which are life-threatening and

therefore the condition requires proper management (Enga et al., 2015). The time is taken to

ascertain the success is 6 days since atrial fibrillation resolves within 7 days for complicated

cases and others within 24 hours. The intervention used is the administration of anticoagulants

where in this case it's the warfarin. The intervention timeline chosen was 1 month since for a

diabetic patient, it may take longer for the wound to heal and thus the patient is at prolonged risk

of developing these clots such as thromboembolism and deep vein thrombosis. The evaluation

tool used in determining the effectiveness of this intervention the cardiac function test was used.

The function test involves an electrocardiogram (EKG) which is used in checking the hearts

rhythm and electrical activity (Frazer, 2016). The cardiac function test results will be recorded

and compared from time to time to see the effectiveness of the intervention. at the end of the

seven days, the cardiac function test showed normal heart rhythm and electric functioning.

The patients were diagnosed with UTI where the presenting symptom was confusion. The

UTI resulted after post-catheterization and the intervention was to provide antibiotics for

treatment and also replace the catheter on a timely basis. Antibiotics would help in managing the

current UTI and replacing the catheter reduces the reoccurrence of the UTI (Godbole et al.,

2020). The Time taken to ascertain the effectiveness of the treatment is 7 days since most UTIs

are clear with treatment within the first one week. In evaluating the effectiveness of the treatment

a urinalysis test was done on the seventh day of treatment to identify if the bacteria causing UTI

has cleared. The treatment was effective since the last urinalysis test showed no signs of
HEALTH AND ILLNESS IN THE OLDER PERSON 6

infection, however, the patient requires frequent catheter replacement to reduce the chances of

the UTI reoccurring.

Conclusion

Nursing care plans focus on improving the patient's overall health. Jack an 83-year old

patient has multiple health complications which require proper management hence promoting

healing. For instance, the patient is diabetic and has a fracture that required surgery. In

promoting the healing of the surgical area, the patient requires proper management of his

diabetic condition since diabetes hinders proper healing of wounds. Also, the patient suffers from

atrial fibrillation which increases the chances of developing deep vein thrombosis or

thromboembolism after surgery. Therefore, in nursing care, the patient needs anticoagulants to

prevent the formation of these life-threatening blood clots. Proper management of the patient

condition led to improved overall health as indicated in the evaluation.

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References

Akram, F., Shafi, H., Wilkinson, S. P., Fang, Y. L., Ng, K., Gokhale, R. S., & Lin, H. O. M.

(2020). A suggested approach to the diagnosis of urinary tract infection and empiric use

of antibiotics among hospitalized older adults with acute confusion and or underlying

cognitive and communication deficits. Australasian Medical Journal (Online), 13(10),

229-233. https://doi.org/10.1002/jppr.1650

Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., ... &

Nissen, S. E. (2019). Association of metabolic surgery with major adverse cardiovascular

outcomes in patients with type 2 diabetes and obesity. Jama, 322(13), 1271-1282.

10.1001/jama.2019.14231

Enga, K. F., Rye‐Holmboe, I., Hald, E. M., Løchen, M. L., Mathiesen, E. B., Njølstad, I., ... &

Hansen, J. B. (2015). Atrial fibrillation and future risk of venous thromboembolism: the

Tromsø study. Journal of Thrombosis and Haemostasis, 13(1), 10-16.

https://dx.doi.org/10.1111/jth.12762

Strain, W. D., Hope, S. V., Green, A., Kar, P., Valabhji, J., & Sinclair, A. J. (2018). Type 2

diabetes mellitus in older people: a brief statement of key principles of modern-day

management including the assessment of frailty. A national collaborative stakeholder

initiative. Diabetic Medicine, 35(7), 838-845. https://doi.org/10.1111/dme.13644

Farhat, N. M., & Yezback, K. L. (2016). Treatment of diabetic peripheral neuropathy. The

Journal for Nurse Practitioners, 12(10), 660-666.

https://dx.doi.org/10.1016/j.nurpra.2016.07.030
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Godbole, G. P., Cerruto, N., & Chavada, R. (2020). Principles of assessment and management of

urinary tract infections in older adults. Journal of Pharmacy Practice and

Research, 50(3), 276-283. https://doi.org/10.1002/jppr.1650

Frazer, C. (2016). Atrial fibrillation. MedSurg Nursing, 25 (2), 125.

http://link.galegroup.com.libraryproxy.griffith.edu.au/apps/doc/A452585836/HRCA?

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