Neuro Science Nursing

Introduction

Johann Silvermann is an aged widower that has been diagnosed with Parkinson’s disease and hypothyroidism four years ago and is on medications , namely, Thyroxine 100 micrograms daily, Carbidopa/Levodopa 25/100 q8h and Entacapone 200 mg q8h.Soon after his wife’s demise 12 years ago, he has been living independently. He doesn’t have any children and so is taking care of himself. He depends on the pension and hence uses it very carefully.  He makes an effort to set out for a holiday every year however, was incapable to this time owing to his distorted mobility.

He has started to suffer from mild tremors in both his hands which are making simple tasks like tying shoe laces very tough. His conditions have started to become worse and have triggered a concern to him. Since his present condition of Johann Silvermann is not good and he is in dire need of attention. This attention can be best imparted to him by a nurse who can help him out.

Nursing Care Priority One – Increased falls and injury risk   

The Functional Consequences Theory, which was developed by Miller in the 1990, acts as an outline intended for nursing evaluation and supervision of love and care for aged serene. The Functional Consequences Theory structure lends a hand to the nurse to recognize risky aspects linked with the growth of severe perplexity in the elderly. Auxiliary, it directs the growth of intrusion to diminish the consequences of this situation in this populace.

Johann Silveramann is suffering from some diseases that have put him in bad condition. He is at very high risk of suffering injury or a fall (Olanow & Schapira, 2013). The risk factors related to fall are mainly divided into two categories, namely, intrinsic and extrinsic factors(Killock, 2012).  The Intrinsic factors in favor of falls are those initiated inside the human being include low blood pressure, weakened mobility, unbalanced walk, and deprived poise due to soreness, musculoskeletal deformity, or neurologic disarray, inadequate bodily-activity endurance, foot troubles that grounds soreness or parenthesis and messed up visualization (Pan & Bai, 2014). Extrinsic factors instigate external to the personality. They take in circumstances in the substantial surroundings, such as deprived illumination, mess, a greasy ground owing to a fall, and a rough doorstep (Peev & Obretenov, 2015).

The current projection for the anticipation of falls is unsure, even though several inherent and pharmacologic issues that are linked in the midst of an improved danger of falls must be acknowledged. Several falls in the aged are almost certainly multi factorial, ensuing from the junction of more than a few inherent, pharmacologic, ecological, behavioral plus action-related reasons (Cameriere, 2013). Situational and ecological factors might be amongst for the most significant determinants of danger in older people. Physiological alterations take place with age in all limb systems. The heart output reduces, the blood force boosts up and arteriosclerosis build ups. The lungs demonstrate blight gas exchange, a decline in essential capability and sluggish expiratory gush rates. Functional amend, mainly connected to distorted motility prototype, take place within the gastrointestinal system with senescence, gastritis, and tainted hepatic medicine metabolism are familiar in the aged. Progressive augment of the blood glucose take place with time on a multi factorial basis furthermore osteoporosis is often witnessed owing to a lesser in bone mass density following the fourth decennium. The skin’s epidermis shrivels with time and owing to transformation in collagen plus elastin; the skin loses its tenor and softness. A degenerative alteration takes place in a lot of joints Furthermore, collective with the trouncing of muscle bunch, restrains aged patients’ movement (Foulis, Christie, Maynard, Kamen, & Kent-Braun, 2011). These alterations with time have a significant realistic proposition for the medical organization of aged patients.

A number of probable risk factors can be modifiable have been deliberated with respect to cognitive mutilation and dementia during late existence, but practical limits of observational study have an outcome in some inconsistency crossway study (Chatterton, 2013).

Goal(s)

The goal regarding impediment ought to be not merely to decrease falls yet to diminish wound and other consequences of falls. The danger of wound commencing a fall exist as the result of a series of threat, together with the likelihood of falling, the success of defensive answers, defense by limited distress attractions, including ecological facade, and the potency plus the resiliency of tissues and appendages.  Thus, precautionary endeavors ought to address every phase in the wound succession.

Take Action

Nursing interventions in that should be taken care at home include some factors. Since Mr. Silvermann lives alone his the home environment should be assessed for coercion to protection like litter, greasy floors, spread out rugs, hazardous stairway, and stairwells, barren entries, faint lighting, addition cords especially across the pathway, elevated beds, and pet waste matter. Patients suffering from weakening mobility, messed up visual insight, and neurological inhibited, together with dementia and added practical cognitive, arrears, continue to be at danger for damage from general hazards (Sikdar, 2013). The patient should be encouraged to make use of gait buckle and added people when ambulating. These Gait belts tend to decrease the danger of falls all through ambulation. Equipment such as motion sensitive lighting can be installed so that the pathway is easily visible to the patient when he /she get out of bed (Tveit, Rosengren, Nilsson, & Karlsson, 2014). Patients should be encouraged to wear little-heeled shoes amid good grip when ambulating. Such kinds of shoes offer the patient with an improved sense of balance and defend from unsteadiness on not smooth surfaces. The patient should be provided with a signaling device that lives alone and strolls or in danger for falls (Swift, 2015). Also since the Mr. Silvermann lives alone, a helping hand or a call device should be made available. Lastly, the patient should be provided with medical recognition wristlet for the patient at danger for damage from dementia and seizures.

Evaluate Outcomes

The possible outcomes of such interventions t Mr. Silvermann are safety behavior, acquaintance, remains liberated of falls, alteration in surroundings to diminish the occurrence of falls and also the patient shall understand the methods to put off injury.

Nursing Care Priority Two: Altered nutritional levels

Undernourishment is a recurrent and grave predicament in the aged (Stránský, 2015). the occurrence of undernourishment is growing in elderly populace and is connected with a turn down in: practical status, weakened muscle purpose, diminished bone mass index, invulnerable dysfunction, anemia, abridged cognitive function, deprived injury curing, and deferred recuperation from a surgical procedure, superior rest home readmission charges, and humanity. According to the Functional Consequences Theory  given by Miller elderly people frequently have abridged appetite and power disbursement, which, joined with a turn down in natural and physiological purpose such as abridged inclined body mass, alteration in cytokine as well as hormonal intensity, and alteration in liquid electrolyte parameter, holdup gastric draining and lessen sanity of odor and savor. Administration towards such patients requires a holistic advance, and fundamental causes for instance chronic ill health, dejection, medicine and community remoteness have got to be taken care of.

Screening of the patient is very important in recognizing and observing patients. Administration involves taking care of pathological grounds such as deprived ivories and improving the supervision of persistent diseases.

The patient has been suffering from altered nutritional levels which are also contributed by various age-related changes as sensory alteration, reduced odor discernment, enhancement in taste brink, lowering of taste feeling, gastrointestinal zone amends, earlier congestion, deferred gastric pouring, hormonal amends, augmented serum leptin, diminished serum testosterone, augmented serum cholecystokinin, amplified inflammation-arbitrated cytokines, nervous system alterations, reduced opioid receptor movement (Vestergaard, 2014).

Goal(s) 

In the supervision of Mr. Silvermann, main vital objective are to increase their dietary condition. To attain this purpose, the primary stride is to recognize the jeopardy of anorexia using geriatric appraisal tools. Affliction plans ought to be put into practice should warranty a sufficient quantity plus quality of foodstuff to bound mass trouncing due to malnutrition caused due to aging.

Take Action

Nursing interventions for the patient suffering from altered nutritional levels should be such that the altered levels of food intake are changed. Protein-energy undernourishment in elder persons is not often acknowledged and even yet further not often treated suitably. Patients are vulnerable to protein-calorie underfeeding or else protein-energy underfeeding whenever they are incapable to nourish themselves .Dietetic risk separately augmented the probability of bereavement in cognitively weaken older adults. Lofty protein supplement supported on personage requirements and capability ought to be administered. Elderly persons recognize taste as the main important part that determines their food choice. The Ability to savor although goes down in the majority of the elderly but not for every aging person. Most affected are the salt receptors, and the sweet receptors are the slightest affected. It has also been observed that music plays a vital role in the treatment of the elderly suffering from altered nutritional levels. Selection of music with a sluggish tempo, next to or beneath the human heart tempo, has typically been used to reduce ecological sound that may or else shock them. Calcium intake should also be supervised.
Milk and its products are the finest animal supply of calcium, pursued by sardines, oysters, salmon, and clams. In the milk, the calcium is pooled with lactose that tends to increase assimilation. In addition to lactose, another beneficial constituent in the milk are the osteoblasts that are needed to restructure the weakened bone matrix.

Evaluate Outcomes

The outcomes of these interventions shall be progressiveness towards weight gain, will be able to identify the nutritional requirements and fulfill those using easy resources, shall be able to understand that the adequate nourishment should be there and finally shall be free of signs of malnutrition.

Conclusion

The role of the nurse in treating Johann Silvermann is very crucial since he is suffering from some problems such as Parkinson, hyperthyroidism and now is suffering from slight tremors. The work of nurse here is to help him understand his condition and start living a life with the understanding of the fact that age tends to make the diseases worse (Beaudet & Ducharme, 2013). He needs to adjust to the conditions and live a happy life (“Parkinson disease: Patients with Parkinson disease request more research into living with the disease”, 2014). The nurse, on the other hand, needs to follow the Miller’s Functional Consequences Theory that outlines the way an elderly needs to be treated. With some priorities of the nurse towards Johann Silvermann’s disease increased falls, injury risk, and altered nutritional levels play an essential role. All of them can cause serious problems in his life and can be treated using proper outlines and technique, so as to give Johann Silvermann a superior and blissful life.

References

Beaudet, L. & Ducharme, F. (2013). Living With Moderate-Stage Parkinson Disease. Journal Of Neuroscience Nursing, 45(2), 88-95.

Beaudet, L. & Ducharme, F. (2013). Living With Moderate-Stage Parkinson Disease. Journal Of Neuroscience Nursing, 45(2), 88-95.

Cameriere, R. (2013). Age, What Age, How Old?. Anthropol, 01(03).

Chatterton, C. (2013). Practical Psychiatry of Old Age Wattis John P Curran Stephen Practical Psychiatry of Old Age 284pp £29.99 Radcliffe 9781908911988 1908911980. Nursing Older People, 25(10), 10-10.

Foulis, S., Christie, A., Maynard, L., Kamen, G., & Kent-Braun, J. (2011). Altered Force Modulation Strategies during Submaximal Contractions in Old Age. Medicine & Science In Sports & Exercise,43(Suppl 1), 923.

Killock, D. (2012). Bone: Performance of fracture risk prediction tools—old and new. Nat Rev Rheumatol, 8(4), 183-183.

Olanow, C. & Schapira, A. (2013). Therapeutic prospects for Parkinson disease. Annals Of Neurology,74(3), 337-347.

Pan, X. & Bai, J. (2014). Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review. International Journal Of Nursing Sciences, 1(4), 441-445.

Parkinson disease: Patients with Parkinson disease request more research into living with the disease. (2014). Nature Reviews Neurology, 10(6), 308-308.

Peev, P. & Obretenov, V. (2015). Painful hip in 19-months old represents an intertrochanteric fracture following a low energy injury. Bone Abstracts.

Sikdar, S. (2013). Old age psychiatry risks turning into a dementia-only service. The Psychiatrist, 37(3), 116-116.

Stránský, M. (2015). Nutrition in old age. Kontakt, 17(3), e163-e170.

Swift, C. (2015). Exercise regimens, bone health and fracture prevention in later life: evidence still needed. Age And Ageing, 44(4), 542-544.

Tveit, M., Rosengren, B., Nilsson, J., & Karlsson, M. (2014). Exercise in youth: High bone mass, large bone size, and low fracture risk in old age. Scand J Med Sci Sports, 25(4), 453-461.

Vestergaard, P. (2014). Diabetes and bone fracture: risk factors for old and young. Diabetologia, 57(10), 2007-2008.

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