Faecal Incontinence and Constipation †Free Samples to Students

Question: Discuss about the Faecal Incontinence and Constipation. Answer: Introduction The assignment deals with the case study of Ron (88, M) experiencing cough, headache, and fever since 8 days. The purpose of the assignment is to discuss the factors to be considered for conducting the health assessment for Ron. Further, it covers risk assessments needed for the patient supporting with rationale. The assignment discusses the implications of hospitalisation on the patient and his family and intends to high light the ways to overcome them. Based on the case study, the nursing care plan is developed using NANDA guidelines. These include nursing diagnosis, goals, and nursing interventions appropriate for Ron. Factors when considering the health assessment data There is a need of past medical history and need to know the physiological conditions. Past medication history is needed as certain medications are risk factors for constipation. For instance, the use of statins and antimuscarinics are known to be associated with clinical constipation. Past medical history is required to know the factors that may cause infection, or probability of other chronic illnesses such as COPD and others. Poor mental health can be the risk factor for older adults. Smoking, alcohols or drug abuse stress, anxiety and depression can lead to chronic conditions. Mental health and the cognitive ability (Confusion, and delirium) are the factors to be considered during the health assessment as they are contributors of may complicated illnesses (Iqbal, Gupta, Venkatarao, 2015). Social history is the other factors to be considered in the health assessment. Social isolation in old age leads to poor mental and physical health. Since Ron is restricted to home with decreased gait and mobility, he may be at risk of decreasing physical and mental health. In addition, Ron does not have his wife with him and hence he may be lacking the emotional support needed at this age. Social isolation leads to loneliness and depression at old age. It is necessary to know the family members support and other important people in the life of Ron. Further economic factors need to be considered to determine the care plan accordingly. Financial barrier may hamper the diagnosis and care process (Jarvis, 2015) Other factor to consider for risk is age. Ron is 88 years old and with aging alteration in mobility is evident. It is due to the decreasing muscle function, strength and loss of muscle mass and decrease gait. The decrease in gait is evident in Ron. Age is the risk factor for various chronic illnesses (Bickley Szilagyi, 2012). In addition there is need to consider the gender issues as there is a difference in the health reacted behaviour between men and women. Some patient may prefer to talk about health issue to same sex person. Knowing the patients culture and ethnicity is important as health belies vireos in different culture and may hamper the health assessment process. Language may act as barrier to health assessment, therefore it is required to know the language preferred by Ron and if he needs medical interpreter (Jarvis, 2015) Risk assessments and Rationale Fall risk assessment- Since Ron is needs assistance with activities of daily living as he has an unsteady gait and walks with the 4-wheelie walker; there is an increased risk of fall. Fall leads to complicated outcomes such as serious injury such as fracture, decline in functional status, admission in hospitals, and increased use of medical service, and death from injury. Most elderly people develop a fear of falling after a fall. Thus, it is necessary to assess the risk of fall or near falls in the case of Ron (Aranda-Gallardo, et al., 2013) Risk assessment for pressure ulcer- Ron is at high risk of pressure ulcer. Patients who are bound to bed or wheelchair are at high risk of developing pressure ulcer. These are more likely to occur at hips, buttocks, and sacrum. The risk of pressure ulcer needs to be assessed as it is difficult to treat. Pressure ulcers significantly hamper the patients quality of life and thus early identifying the conditions that may lead to this condition will help prevent(Chou, et al., 2013). Mental state assessment includes risk assessment for geriatric depression and cognitive impairment. The rationale for selecting this assessment is high prevalence of depression among older adults. Depression decreases the quality of life as it commonly accompanies complicating medical illnesses. Ron is 88 years old and lives with his daughter. He is dependent on her physically and may be at risk of depression. His depression can be due to social isolation for being mostly restricted to house (Conradsson, et al., 2013). Pneumonia risk assessment- The symptom commonly presented in pneumonia are fever, headache, cough, tachypnoea, increased confusion, loss of appetite, breathlessness and wheezing. These symptoms are also evident in Ron and hence it s necessary to identify if he is at risk of pneumonia. The vital signs of the patient include pulse 105, BP 125/70, respiratory rate 28, and temperature 37.8. Ron has not open bowels since four days and symptoms similar to this are found in pneumonia (Iinuma, et al., 2015). Implications of hospitalisations Illness hampers the quality of life and decreases the self-esteem of any patient. In this situation, the knowledge of body image and self identity can affect care. Ron may feel stressed about frailty and decreasing physical strength. Greater attention to body image can hamper the delivery of care. Many elderly patients after the illness and hospital admission may feel themselves as less attractive. Hospitalisation and illness are accompanied with dietary changes and social isolation and loneliness. The psychological implications of the illness and bed rest are worse. In addition to functional decline, the patients may feel anxious and depressed caused by feeling of dependency. Ron may experience a sudden change in the mental function. As Ron is dependent on his daughter for activities of daily living and emotional support, he may feel the loss of autonomy. He may not be able to participate in clinical decision-making and may have fear of compromising his preferences and values. The p atient may also feel a loss of respect and dignity. Hospitalisation of the household member leads to psychological distress among other members in the family due to uncertainty of the health outcomes (Bello, et al., 2014). The patient may feel homesickness and boredom, as he is mainly restricted to house due to poor mobility. The illness may affect the education of the other in the house such as grandchildren. It may influence the household responsibilities of Rons daughter and her husband. Admission to hospital involves financial burden. Depending on the length of the hospital stay, the financial difficulties may increase. If the socioeconomic status of the family is low then the illness is an added burden on the family. Ron may also feel like burden on the family (Berman, et al., 2014). Nurse can deliver patient centred care where the patients values, beliefs and preferences will be considered. Nurse can reduce the psychological implications in Ron by giving motivational session and involving him in clinical decision-making. It will reduce the anxiety, depression and poor self-image. By following the ethical principles of beneficence, non-maleficence and social justice, it is possible to overcome the psychological implications on Ron and his family (Berman, et al., 2014). Nursing process Nursing Diagnosis Goal Intervention Rationale Evaluation Risk of ineffective airway clearance and infection related to respiratory tract as evident from persistent fever, and cough since 8 days in the patient and high respiratory rate (North American Nursing Diagnosis Association., 2015) To reduce the infection like symptoms such as fever and headache and promote airway clearance in-patient which will be evidenced by decreased cough, tachypnoea and respiratory rate. Conduct lung assessment for breath sound and coarse crackles. Note cough for efficacy and coordinate with the respiratory therapist (Ghosh, OKelly, Roberts, Barker, Swift, 2016). The presence of coarse crackles during the late inspiration is indicative of fluid in airway. Airway obstruction can be confirmed by wheezing (Gatford Phillips, 2016). The patient demonstrates effective coughing, decrease in fever. The patient will demonstrate normal vital signs. No sign of tachypnea after the intervention Time- 48-72 hours Give medication as prescribed by the physician for fever and cough. These may include antibiotics, bronchodilators, mucolytic agents and monitor for side effects and effectiveness (Ghosh, OKelly, Roberts, Barker, Swift, 2016) A variety of medications are available to that treats the specific problem. Most of them may promote airway clearance. It may decrease the airway resistance (Bullock Manias, 2013). Educate the patient on coughing, deep breathing and splinting techniques and proper use of the medication and inhalers. The breathing technique that will be taught to the patient is to take deep breath, and hold for two seconds followed by coughing two to three times in succession(Ghosh, OKelly, Roberts, Barker, Swift, 2016). It is important for the patient to know the proper technique and underlying principle for keeping airway clean. An ineffective coughing leads to compromised airway clearance Patient education is necessary as understanding the prescription will promote the safe and effective administration of medication (Tiziani, 2017). Impaired elimination and exchange due to risk for constipation as evident from the stool retention for 4 days in Ron (North American Nursing Diagnosis Association., 2015) To improve the bowel movement of the patient and relief from discomfort due to unopened bowels. Encourage the patient to increase the fluid intake unless cardiac limitations (Ghosh, O'Kelly, Roberts, Barker, Swift, 2016) Adequate fluid amount is required to keep the faecal mass soft (Coggrave, Norton, Cody, 2014) The patient has improved bowel frequency that is normal at this age The patient demonstrates relive from discomfort. The patient learns the measure that treats constipation The patient maintain normal diet. Time- 48 hours Suggest balanced diet to the patient that consists of adequate fresh fruits, fibres, vegetables and grains (Ghosh, O'Kelly, Roberts, Barker, Swift, 2016) One should not have around 20 grams of fibres per day as it adds bulk to the stool and a makes the defecation process easier (Coggrave, Norton, Cody, 2014) The patient can be administered with laxative (Ghosh, O'Kelly, Roberts, Barker, Swift, 2016) Laxative irritate the bowel mucosa and causes rapid propulsion of the small intestine contents (Moini, 2015) Impaired safety due to risk of fall and injury as evident from decreased gait and mobility (North American Nursing Diagnosis Association., 2015) Improve patient safety by preventing fall, so the patient will be free of fall during his hospitalisation 1.During every shift the patient should asses the fall score of Ron and the nurse must screen Ron for stability and mobility skills(sit to stand, supine to sit, walking and turning around) (Zwar, et al., 2016) Fall scores helps to determine the risk of falling in the patient. Depending on the score preventive measures can be taught to the client. Screening will help to determine methods to ensure safety (Cangany, Back, Hamilton-Kelly, Altman, Lacey, 2015) The patient demonstrates safety behaviour in two weeks of time The patient has the knowledge of fall and fall prevention techniques Time -24-72 hours2. Nurse should keep the patients bed in the lowest position all the time and modify the environment such as removing tables and chairs in the path(Zwar, et al., 2016). n case the patient wakes up at night to drink water or toilet, lower bed positioning will reduce his risk of fall. It is necessary to remove obstacles in the patients path such as chairs and tables or any other object to avoid accident and fall or injury. It is evident from literature that majority of falls are related to toileting. Therefore it is necessary that path to washroom is clear (Cangany, Back, Hamilton-Kelly, Altman, Lacey, 2015) 3. Ron should be given yellow fall risk bracelet and yellow socks so that other nurses and staff will be aware of his delicate situation (Zwar, et al., 2016) Yellow bracelet and socks act as alert for other nursing staff. It will increase their vigilance and they will be greatly obliged to watch for falls (Cangany, Back, Hamilton-Kelly, Altman, Lacey, 2015) Conclusion The paper comprehensively discusses the factors that are to be considered for the health assessment of Ron. The risk assessment appropriate for the case study are highlighted and the implications of hospitalisation on the patient is discussed. Illness hampers the quality of life and decreases the self-esteem of any patient. It significantly hampers the mental wellbeing of the family members. The nursing process presented in this paper comprises of diagnosis and goals that are based on the NANDA principles. 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