Care Needs for Elderly Patient with Abdominal Pain

In this essay I will introduce my patient Mrs. Jones followed by her case study. After I have briefly analyzed the case study and identified Mrs. Jones care needs, I will pick and focus on one specific care need which from my perspective is key in this case study and discuss how it fits in with the rest of the patient’s needs with supporting information. Next, I will introduce the nursing process and explain why I am using this as a framework for my care. Throughout Mrs. Jones assessment I will use the nursing process to demonstrate how to meet patients’ specific care need chosen. This will lead to plan of care which myself and Mrs. Jones will have chosen and identifying what I would like to achieve from this assessment. Principles of implementation of plan and evaluation will be discussed, considerations outlined when implementing a plan, followed by a conclusion and references.

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Mrs. Jones is a 78-year-old lady. In the last week she has been experiencing pain in her abdomen. She has not had her bowels open for the last 4 days. Mrs. Jones has lost her appetite and as a result has not been eating or drinking as much as she would normally. Mrs. Jones is living at home by herself and throughout the years has developed many care needs. According to (Abdi et al., 2019) almost 50% of the remaining lives of people aged 65 and over are affected by long-term physical or mental health conditions therefore requiring support and help with at least one Activity of Daily Living (ADL).  The abdomen pain which Mrs. Jones is experiencing can have a big impact on Mrs. Jones life as its causing discomfort and restricting Mrs. Jones from carrying out several daily tasks. Mrs. Jones diet is disrupted due to loss of appetite meaning she is not eating or drinking therefore not reaching daily calorie intake, not receiving enough nutrition to help keep body healthy and receives a minimal fluid intake suggesting dehydration. According to Mrs. Jones she has not opened her bowels for the last 4 days indicating constipation. After identifying Mrs. Jones care needs, one specific care need I have chosen is constipation. It is my belief that this care need is the primary source of other care needs identified for Mrs. Jones therefore I will look at this more in depth throughout this essay. Gallagher and O’Mahony, (2009) have stated that constipation gets more frequent with age and often is caused by many factors which contribute to constipation. The most common factors according to Nhs.uk (2019) are as following; diet- not eating enough fibre and consuming minimal fluid intake, lack of mobility- long periods sitting down, lack of exercise, and side effects of medication. In Mrs. Jones case the abdomen pain experienced is a side effect of constipation which is caused by factors such as insufficient diet and reduced mobility due to her age. These factors influence Mrs. Jones bowel performance and consequently need to be improved to meet the main care need identified.

The nursing process (APIE) was started in 1958, based on a theory developed by a nurse Ida Jean Orlando. The nursing process is defined as a repeatable process which can be learnt step by step and a decision making approach to care using the fundamental principles and promoting critical thinking, patient-centered approaches to care, goal-oriented tasks and evidence-based practice recommendations (Toney-Butler and Thayer, 2019). According to Yura and Walsh (1969) this theory is believed to be the core and essence of nursing as it is central to all nursing actions, can be applied to any setting, within any frame or reference, any concept, theory or philosophy. This theory works as an approach to patient’s care and comprises of four steps followed in a sequence known as assessment- what the patient’s/client’s needs are, planning- how these needs can best be met, implementation- the plan of care, and lastly evaluation- how effective the care has been. Yura and Walsh (1967) have expressed their beliefs stating that the nursing process is designed to be evidence based, allow provision of care based on the individual patient’s needs, allow for documentation of patient care and progress. Time is essential for the four stages of nursing process to gain as much information as possible to deliver quality care to patients. A study conducted by Abdelkader and Othman (2017) discovered that “lack of knowledge, high patient nurse ratio/workload, and lack of educating, training and motivating factors affected the application of the nursing process”. It is vital to recognize these factors by individual staff providing care and anyone who plays a role in the setting to deliver quality care to patients by devoting sufficient time to the application of nursing process and raising an awareness and knowledge in the workplace. I am using the nursing process as a framework for my care on this occasion because I believe it will help me to deliver high quality of essential care to my patient, focusing on person centered care and it will enable continuity of care as planned after the implementation. The nursing process will help me not only identify problems but also strengths of my patient in the first stage, the assessment stage.

Assessment in nursing according to Kozier et al., (2008) is “the systematic and continuous collection, organization, validation and documentation of data (information)”. Assessing is a continuous process carried out throughout all stages of the nursing process focusing on patient’s response to health problem. The assessment should include the patients perceived needs, health problems, values and lifestyles (Kozier et al., 2008). Before starting to assess Mrs. Jones I will introduce myself and explain that the purpose and aim of the assessment which is to collect data relevant to Mrs. Jones care need – constipation, make diagnosis from data collected, identify any risks and complications that can occur if constipation is not treated and develop plan of care to improve Mrs. Jones health. I will then gain a consent from Mrs. Jones in order to start the assessment. The assessment will be carried out in a well-lit moderate-sized room with relatively small amount of noise and minimal interruptions where others can’t see or hear Mrs. Jones. The NMC Code (2015) states “As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately.”  The setting the assessment will be carried out in on Mrs. Jones will provide full confidentially and privacy and will help communicate effectively one to one gaining most relevant data to the care need and then use this data to implement the most effective plan of care for Mrs. Jones. It is important to provide person-centered care therefore considerations need to be made at the time of the assessment if Mrs. Jones is fit for the assessment. For example, if Mrs. Jones is anxious, in any pain or discomfort information gathered may not be as accurate. After considerations are made an interview and focused examination will take place to gain most specific data. Two different data collection types used in this assessment will be subjective- verbal communication with the patient, and objective- observation and examination. At the beginning of interview, it is important to set a kind tone and good body language to gain trust from Mrs. Jones and show compassion. Throughout the interview I will use listening skills, speak clearly using simple language so Mrs. Jones understands me, and I will clarify any points she may not understand. Questions asked Mrs. Jones will vary between closed questions with answer yes or no and open-ended questions giving Mrs. Jones freedom to answer. Closed questions will help understand more about the chosen care need while open-ended questions help understand about Mrs. Jones lifestyle and values and how they can be improved. Focusing on the chosen care need, questions asked would be “What is the normal pattern of opening bowels”,” Was there anything in it?”, “Any pain/frequency of pain?”, “Weight loss/appetite?”, “Any problems before constipation?”, “How often is fluid intake and urine output?”, “Any medications being taken”. To understand more about Mrs. Jones lifestyle and values questions asked include; “How mobile is Mrs. Jones?”, “Any interests in sports or any other hobbies?”, “How does Mrs. Jones socialize outside the house?”, “Does she have family support?”, “Can she cope around the house with activities of daily living?” ,” Does she feel she is meeting all her religious needs?”. Followed by a focused examination of Mrs. Jones I will examine the abdomen area where Mrs. Jones is experiencing pain, look for any abnormalities such as change in shape, any bruising, scars. Look at the condition of Mrs. Jones skin colour, any breakdowns or dry skin/lips. Once the interview with Mrs. Jones was over and examinations were done, I analyzed the data gathered and decided that constipation she is experiencing is due to lack of exercise/mobility and insufficient nutrition and fluid intake. According to Marie Curie (2019) there are many causes for constipation such as medication which can have side effects and one of them is constipation, changes in diet and the amount of food intake can contribute to opening your bowels more often or less, not drinking enough fluid can make the stool harder and more difficult to pass causing constipation and being less active due to lack of energy can also stimulate the bowel function. Constipation has its own risks and can be acute and chronic if present for at least 3 months in the last 6 months, therefore it is vital to treat constipation (NICE, 2017).

After having a discussion with Mrs. Jones, we both have agreed on three 3 goals to be achieved within a specific time frame. Hamilton and Price (2013) have advised that SMART goals should be identified which are Specific, Measurable, Achievable, Realistic and Timely. First goal to be achieved as both agreed is opening of bowels in the next 48 hours by using laxatives which will stimulate evacuation of the bowels. Second goal chosen is increasing Mrs. Jones appetite. This can be done by exposing Mrs. Jones to a bigger variety of food and help in the kitchen to prepare food. Lastly, third goal we have chosen is help Mrs. Jones be pain-free and this can be achieved by a combination of factors such as medication.

Implementation of plan is important for Mrs. Jones as it will help her follow plan of care and achieve all three goals. According to Olsen (2019) implementation is the process that turns strategies and plans to life and into actions in order to accomplish strategic objectives and goals.

When implementing a plan, commitment and excellent communication skills play a big part when proceeding with the plan. It is important to encourage Mrs. Jones with carrying out daily tasks such as cooking her meals, drinking more water and mobilizing to speed up the process of achieving goals. Decisions must be made with Mrs. Jones and her preferences to give her a sense of independence and respect. Some things that we might choose when implementing a plan for the patient they might not like therefore the outcome wouldn’t be as effective as if the patient decided themselves how they want to implement the plan to their lifestyle. Every time Mrs. Jones is visited by a support worker a re-assessment should be carried out to see how Mrs. Jones is responding to the care delivered and if any new issues have developed.

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Evaluation is the last part of the nursing process. Hogston (2011) states that evaluation is an “opportunity to review the entire process and determine whether the assessment was accurate and complete, the diagnosis correct, the goals realistic and achievable, and the prescribed actions appropriate.” As we know in the nursing process assessment is the most important part of the process. Evaluation is the next most important part after assessment to evaluate has the care been achieved. Evaluation for Mrs. Jones should occur every time the care is being implemented and reassessment of plan of care (Yildirim and Ozkahraman, 2011).

To conclude, I have introduced and identified Mrs. Jones care needs. Introduced the nursing process and explained why I would used this as a framework for my care. I have demonstrated how to use this model to meet my patients specific care need chosen. Created plan of care and had a discussion about implementation of plan and evaluation ending with a conclusion and references.

References

• Abdelkader, F. and Othman, W. (2017). Factors Affecting Implementation of Nursing Process: Nurses’ Perspective. IOSR Journal of Nursing and Health Science, 06(03), pp.76-82.
• Abdi, S., Spann, A., Borilovic, J., de Witte, L. and Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, [online] 19(1). Available at: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1189-9.
• nhs.uk. (2019). Constipation. [online] Available at: https://www.nhs.uk/conditions/constipation/ [Accessed 21 Aug. 2019].
• Constipation, d. (2019). Constipation, diarrhoea and bowel problems. [online] Marie Curie. Available at: https://www.mariecurie.org.uk/help/support/terminal-illness/manage-symptoms/bowel-problems [Accessed 24 Jul. 2019].
• Gallagher, P. and O’Mahony, D. (2009). Constipation in old age. Best Practice & Research Clinical Gastroenterology, 23(6), pp.875-887.
• Hamilton P & Price T (2013) The Nursing Process, Holistic Assessment and Baseline Observations. In: Brooker C, Waugh A (eds) Nursing Practice: Fundamentals of Holistic Care. Mosby Elsevier, London. 303-336.
• Hogston R (2011) Managing Nursing Care. In: Foundations of Nursing Practice: Themes, Concepts and Frameworks. 4th ed. Palgrave Macmillan: London. pp. 2-21
• Kozier, B., Erb, G., Snyder, S., Lake, R. and Harvey, S. (2008). Fundamentals of nursing : concepts,process and practice. 8th ed. Pearson education limited.
• Cks.nice.org.uk. (2017). NICE Clinical Knowledge Summaries Constipation. [online] Available at: https://cks.nice.org.uk/constipation.
• Olsen, E. (2019). Strategic Implementation. [online] OnStrategy. Available at: https://onstrategyhq.com/resources/strategic-implementation/ [Accessed 25 Jul. 2019].
• Nmc.org.uk. (2015). The Code: Professional standarts of practice and behaviour for nurses, midwives and nursing associates. [online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.
• Toney-Butler, T. and Thayer, J. (2019). Nursing Process. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499937/ [Accessed 17 Jul. 2019].
• Yildirim B Ozkahraman S (2011) Critical Thinking in Nursing Process and Education. International Journal of Humanities and Social Science. Vol. 1 No. 13 pp. 257-262.
• Yura, H. and Walsh, M. (1969). The nursing process. Washington, D.C.: Catholic Univ. of America Press.