Patient’s diagnosing with the use of medical labels for describing the conditions of mental health conditions or the comorbid situation has negative impacts on the care delivery; professionals working with them; patient’s health and this could potentially result into the less effective care plan and treatments being delivered. The use of labels often creates a 'self-fulfilling prophecy', which could turn into the aggravated condition of the patients’ health status. This results in the less targeted interventions, treatments and health outcomes of the patients. It is important for those professionals who are working with patients with disorders such as acopia or any other psychological illness to be enormously cautious regarding the diagnostic. Despite certain benefits of the usage of diagnostic labels, there are also some disadvantages (Matsunage & Kitamura, 2016). Diagnostic labelling works as cues that can potentially activate the stereotype and stigma. The stigma that is directly linked with the diagnostic labels of Acopia or of any other psychological illness is seen to have a significant negative impact on the interactions with the health care community, interpersonal relationships, participation in clinical research, and attitudes about service utilization. Diagnostic labelling skips much important medical diagnosis. This could also result in the danger of reversible pathology. Labelling of Edith can directly influence the interventions that would be used for the patient and patient’s outcome as the patient is staying on a trolley, so there would be no proper symptoms observational chart. Simply labelling a person without any other information will create problems during the handovers and may result in interventions that do not address the important vitals of the patient (Ilgen, Eva & Rehger, 2016).
Getting pressure injuries in old age is very common as the elder people’s mobility gets reduced and being bedridden for a long time gives them pressure injuries. From the case study, it has been seen that Edith’s age is 87 years that means he comes in the category of aged people. The mobility in elderly people gets decreased because of the physiological changes that take place in their body and leads to an increase in the risk of getting a pressure injury. These physiological changes occur in all of the organ systems of the human body during ageing. These changes tend to decrease the cardiac output, augment the blood pressure, and develops arteriosclerosis develops (Jaul et al., 2018). The lungs show impaired gas exchange, a decrease in vital capacity and slower expiratory flow rates. Such age-associated physiological alterations result in lowering the threshold for pressure injury in elderly patients. It can be understood that the patient had an augment in the fragility of the connective tissue and blood vessels and a lot of fat loss and this leads to a reduced capacity of the muscle to dissipate pressure. The constant pressure on one portion of the body leads to damaging the skin. Constant pressure on the skin results in the abnormal flow of blood. Later on, this leads to the death of the cells and breakdown of the skin (Ggreenhalgh, 2019). Nurses’ role can be understood as in the prevention of the pressure injury by doing regular assessments and diminishing the potential causes that may result in the pressure injuries.
Chronic pain has been considered as a factor that keeps affecting the daily activities and quality of life of the patients. However, along with this chronic pain has also been seen to have an impact on the patient’s family and social environment. As from the case study it has been seen that the patient has been facing pain issues due to the chronic leg ulcer. The pain in such a situation is extreme and requires immediate actions that can potentially help in addressing and managing the pain issue of the patient. Patient’s chronic pain, when remaining untreated for a long time, impacts the daily activity, environment, and quality of life (Leren et al., 2020). It is seen that quick healing does not happen for pressure injuries. The environmental stressors are those that have been defined by both the voluntary as well as involuntary responses to the sensory stimuli. It has been seen that the stressors do not generally adopt the acuity or the capacities of the patient, but they tend to confront the patients on a regular basis (Hellstorm et al., 2016). Nurses play a key role in order to get the assistance that will help in assisting the patents that have been dealing with the leg ulcers. This assistance is done by providing education to the patient to stabilise the environmental factor along with protecting them from any potential risk factors.
Older adults are more vulnerable to the adverse events of drugs. Amita, 87 years old will also be considered to be more vulnerable to the adverse events of drugs. The reason behind this is that there is an increase in the frequency of the utilization of the drugs when the age is advancing. The sensitivity towards the drug effects also increases along with the prevalence of the conditions that are predisposing and can potentially increase the severity and the frequency of the adverse drug reactions.
Ageing leads to the destruction of many functions. The augmented sensitivity of elderly patients towards the drug tends to affect them and this result from the alterations in the pharmacokinetics and pharmacodynamics. There are drugs, both of the half-life as well as of the activity levels that are produced by a given dose that usually gets increases with the age, while there are some of the active drug levels and they seem to have had a greater effect the older adults. The pharmacokinetic changes entail the reduction in the hepatic and the renal clearance this results in the increased volume distribution of the drugs (Sneha et al., 2019). Nurses play a major role in the medication administration to the patient and ensure that the medication errors have been avoided and patient safety is maintained. As per the standard 4 of NSQHS standard 4, there is a need to maintain the medication safety and nurses are accountable for all the medication-related aspects (Australian Commission on Safety and Quality in Health Care, 2015).
As the ageing progresses, various age-related changes take place in all of the body systems, similarly the respiratory system also undergo such certain ageing-related changes. The respiratory system undergoes a wide range of physiological, anatomical, and immunological changes with the advancing of age. The structural changes that occur in the respiratory system include certain deformities in the chest wall as well as in the thoracic spine that potentially impairs the entire respiratory system compliance. This leads to the augment work of breathing. The dilation of the air spaces also occurs as a result of the loss of a supporting structure of lung parenchyma. Along with them the strength of the respiratory muscle gets reduced with the advancement of age and this could possibly impair the process of coughing, which is very important for the clearance of the airway. The lung function also declines by the progressive declination. There is also an increase in the alveolar dead space as a result of the ageing that tends to affect the arterial oxygen without impairing the elimination of the carbon dioxide elimination (Kim et al., 2017). As per Oliver’s condition, it could be depicted that also an increase in the alveolar dead space and this would have made some functional changes because of which he became less responsive towards the drugs. His issue of pneumonia would have been the result of the reduced ventilatory response towards hypoxia and hypercapnia. The nurses’ role in this context is to understand the age-related changes that are resulting in the impairments.
During hospitalization, it has been seen that older patients are completely bedridden in order to avoid falls and harms. However, this reduces their mobility even more than it was earlier. Enhancing the mobility in older patients has many benefits and the prime benefit among them is the reduction in the risk of pressure injuries. Not moving at all leads to the pressure injuries in the older patients however, if the mobility will be increased the chances of pressure injuries will be decreased (Boyko et al., 2018). Other than this, there are some other physiological and psychosocial benefits of increasing the mobility as it would also help in reducing the depression along with balancing the impaired functions and psychosocial dysfunction (Smart et al., 2018). As the registered nurse of Oliver, the interventions for him would be based on encouraging the patient for the incidental exercise. This would include effective therapeutic communication and motivational interviewing. Both of the interventions would be helpful in making the patient understand the significance of incidental exercise in his recovery process. The patient will be able to understand the need for this for him and what will be the consequences if the patient does not look forward to this type of exercise.
Australian Commission on Safety and Quality in Health Care. (2015). Medication safety standard. Retrieved from https://www.safetyandquality.gov.au/standards/nsqhs-standards/medication-safety-standard
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the Current Management of Pressure Ulcers. Advances in Wound Care, 7(2), 57–67. https://doi.org/10.1089/wound.2016.0697
Greenhalgh, D.G. (2019). Pressure Injury in the critically ill elderly patient. Current Geriatrics Reports, 8, 167–172. https://doi.org/10.1007/s13670-019-00289-3
Hellström, A., Nilsson, C., Nilsson, A., & Fagerström, C. (2016). Leg ulcers in older people: A national study addressing variation in diagnosis, pain and sleep disturbance. BMC Geriatrics, 16, 25. https://doi.org/10.1186/s12877-016-0198-1
Ilgen, J. S., Eva, K. W., & Regehr, G. (2016). What's in a label? Is diagnosis the start or the end of clinical reasoning?. Journal of General Internal Medicine, 31(4), 435–437. https://doi.org/10.1007/s11606-016-3592-7
Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18(1), 305. https://doi.org/10.1186/s12877-018-0997-7
Kim, J., Heise, R. L., Reynolds, A. M., & Pidaparti, R. M. (2017). Aging effects on airflow dynamics and lung function in human bronchioles. PloS One, 12(8), e0183654. https://doi.org/10.1371/journal.pone.0183654
Leren, L., Johansen, E., Eide, H., Falk, R. S., Juvet, L. K., & Ljoså, T. M. (2020). Pain in persons with chronic venous leg ulcers: A systematic review and meta-analysis. International Wound Journal, 17(2), 466–484. https://doi.org/10.1111/iwj.13296
Matsunaga, A., & Kitamura, T. (2016). The effects of symptoms, diagnostic labels, and education in psychiatry on the stigmatization towards schizophrenia: A questionnaire survey among a lay population in Japan. Mental Illness, 8(1), 6344. https://doi.org/10.4081/mi.2016.6344
Sneha, S. G., Simhadri, K., Subeesh, V. K., & Sneha, S. V. (2019). Predictors of adverse drug reactions in geriatric patients: An exploratory study among cancer patients. South Asian Journal of Cancer, 8(2), 130–133. https://doi.org/10.4103/sajc.sajc_218_18
Smart, D. A., Dermody, G., Coronado, M. E., & Wilson, M. (2018). Mobility Programs for the Hospitalized Older Adult: A Scoping Review. Gerontology & Geriatric Medicine, 4, 2333721418808146. https://doi.org/10.1177/2333721418808146
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