Essay on Health & Illness in Older People

Case Summary

This assessment will construct a care plan for the patient Jane Smith, a 66 year old retired female accountant who exhibited symptoms of cardiac arrest, as detailed in Assignment 1. The patient exhibits the comorbidities of hypertension and sarcopenic obesity. This assignment will outline three care priorities of cardiovascular health, hypertension and obesity, and discuss nursing interventions and evaluation strategies to monitor the effectiveness of the care plan.

Care priority, nursing intervention and evaluation strategy 1

The first care priority should involve the monitoring of the patient’s cardiovascular health, in order to reduce the risk of a repeated myocardial infarction. The relevant nursing intervention for this care priority should involve the monitoring of the patient’s vital signs at each follow-up visit, such as heart rate, rhythm, patient’s blood pressure and vital signs, and the recording of symptoms such as heart palpitations, difficulty in breathing, or chest pains. Relevant cardiac medications, such as antiplatelet agents, angiotensin receptor blockers and anticoagulants, should be prescribed in accordance with a physician’s recommendations in order to manage potential cardiovascular blockages. The evaluation strategies for this intervention would involve the monitoring of the patient’s vital signs and medication regime over the next 6 months of follow up visits, in order to regularly track and assess the patient’s condition. The patient should exhibit a stable blood pressure, heart rate and absence of symptoms for the intervention to be certified successful. To monitor this intervention, a healthcare monitoring system similar to that proposed by Park et al (2017) could be implemented, which would flag out risks both during and outside of check-ups based on the patient’s vital signs, such as an elevated blood rate or dysrhythmia. Checkups should also monitor the presence of hemodynamic variation, electrocardiogram changes, arrhythmias, heart murmurs, dyspnea, and heart murmurs, as potential symptoms for resurgence of heart disease. (Tan et al, 2020) For example, dyspnea may be linked to low cardiac output and potential heart failure, while dysrhythmias may indicate further issues such as acidosis or hypoxia.

Care priority, nursing intervention and evaluation strategy 2

The second care priority should be the management of the patient’s hypertension. This would involve both community-based nursing interventions to encourage greater physical activity and community engagement, and prescription and strong adherence to antihypertensive medications. As discussed by Tan et al (2019), community-based nursing interventions are evidence-based options that have been shown to improve the outcomes for elderly individuals with risk factors for cardiovascular disease, which included home visits and community building initiatives by nurses for elderly patients. (Tan et al, 2019) The target patients exhibited ideal blood pressure targets for hypertensive patients. This is supported by Oh & Park (2017), community-led interventions such as community health centers, senior centers and welfare centers can also enable greater health literacy for hypertensive patients, by providing them with greater tools to manage their hypertension on their own through physical activity and dietary regime changes. (Oh & Park, 2017) To monitor this intervention, the patient’s blood pressure should be lower than 130/80 mmHg over the long term, which would indicate a mitigation or improvement of the patient’s hypertensive condition over time. The patient’s adherence to the medication regime should also be monitored, given that non-adherence to prescribed medication among the elderly is an issue demonstrated by Jankowska-Polańska et al (2016).

Care priority, nursing intervention and evaluation strategy 3

The final care priority should involve the mitigation of the patient’s sarcopenic obesity and a reduction in the patient’s weight. The relevant nursing intervention would involve a nutrition and exercise programme, which would prescribe moderate aerobic and anaerobic regimes, coupled with a low-carbohydrate, high-fibre diet. A study by Shen et al (2016) on elderly Chinese patients, who were administered an 8-week nutrition and exercise trial, showed that this intervention reduced sarcopenic obesity in elderly, with participants exhibiting lower body fat and higher muscle mass percentages over time. The evaluation strategy for this intervention involves assessing the patient’s body fat and muscle mass percentage over the intervention, while also assessing the patient’s level of fatigue, heart rate and blood pressure to ensure that the intervention is conducted at a sustainable pace. As Wleklik et al (2018) observed, nutritional requirements for elderly heart failure patients should be systematically assessed for signs of malnutrition and deficiency, given the high mortality risk for malnourished heart failure patients, 80% of which die or are rehospitalized within 12 months. A comprehensive blood assay and physiological examination is thus key to assessing the viability of this intervention.

References

Berendsen, A. A., Kang, J. H., van de Rest, O., Feskens, E. J., de Groot, L. C., & Grodstein, F. (2017). The dietary approaches to stop hypertension diet, cognitive function, and cognitive decline in American older women. Journal of the American Medical Directors Association, 18(5), 427-432. https://doi.org/10.1016/j.jamda.2016.11.026

Jankowska-Polańska, B., Dudek, K., Szymanska-Chabowska, A., & Uchmanowicz, I. (2016). The influence of frailty syndrome on medication adherence among elderly patients with hypertension. Clinical interventions in aging, 11, 1781.

Oh, J. H., & Park, E. (2017). The impact of health literacy on self-care behaviors among hypertensive elderly. Korean Journal of Health Education and Promotion, 34(1), 35-45. https://doi.org/10.14367/kjhep.2017.34.1.35.

Park, S. J., Subramaniyam, M., Hong, S., & Kim, D. (2017, July). Service Based Healthcare Monitoring System for the Elderly-Physical Activity and Exercise. In International Conference on Applied Human Factors and Ergonomics (pp. 337-342). Springer, Cham.

Rost, C. (2017). The Influence of a Nursing Intervention upon the Self-Efficacy of Medication Management within Urban Pittsburgh’s Hypertensive African-American Elderly Community (Doctoral dissertation, Carlow University).

Shen, S. S., Chu, J. J., Cheng, L., Zeng, X. K., He, T., Xu, L. Y., & Chen, X. J. (2016). Effects of a nutrition plus exercise programme on physical function in sarcopenic obese elderly people: study protocol for a randomised controlled trial. BMJ open, 6(9).

Tan, S. M., Han, E., Quek, R. Y. C., Singh, S. R., Gea‐Sánchez, M., & Legido‐Quigley, H. (2020). A systematic review of community nursing interventions focusing on improving outcomes for individuals exhibiting risk factors of cardiovascular disease. Journal of advanced nursing, 76(1), 47-61. https://doi.org/10.1111/jan.14218.

Wleklik, M., Uchmanowicz, I., Jankowska-Polańska, B., Andreae, C., & Regulska-Ilow, B. (2018). The role of nutritional status in elderly patients with heart failure. The journal of nutrition, health & aging, 22(5), 581-588.