Elderly Diagnosis Essay Example

There are three main assessments to make in this patient: 1) homeostasis; 2) oxygenation; 3) level of pain. In dealing with the issue of homeostasis, \elderly individuals present a more difficult case than a younger individual.  Indeed, in order to diagnose homeostasis in the elderly, clinicians should use a systematic approach utilizing a comprehensive history and physical examination and a few directed tests (Kugler & Hustead, 2000).  The main initial test is blood test in order to test the individual’s level of sodium- the level of sodium will be used to assess the patient’s level of hydration.  In order to check oxygenation level, an oxygen saturation level test should be initially performed to gauge the level of oxidation in the patient’s internal organs.  Finally, the clinician should assess levels of pain through interaction with the patient; although the patient’s real pain level may be obscured by declined cognitive ability (an effect of the dehydration). Elderly Diagnosis Essay Example.

As enumerated above, there are a number of technological tolls that could be used to help diagnose the patient including blood tests, oxygenation, and observation of the patient’s heart rate and blood pressure.  There are a number of technological tools that would be used to assess and treat the patient.  Initially, the patient should be treated through using intravenous therapy (to increase levels of hydration), inotropic or vasoactive drug infusions (to maximize cardiac output), and ventilator support (to raise levels of oxygen) (Rauen & Stamatos, 1997).  These are the initial technological tools that should be used to treat the patient. Finally, in order to ensure proper functioning of the GI track, enteral delivery of glutamin could also be considered (Rauen & Stamatos, 1997).

The priority of the data collection should focus on determining the state of the patient’s level of hydration, cardiac signs, and oxygenation levels.  Once those data points are gathered, further choices can be made regarding what tests to take.

There is a significant difference in treating pain between a geriatric patient who is alert versus one that is not alert.  In the case of the patient that is alert, assessing pain through a physical examination and asking of questions (on a pain scale) would be the primary methods to gather data.  There are a number of ways to assess pain in an unresponsive patient by proxy: 1) observe the patient’s behavior- although not as a good as a self-report, observing the patient’s behavior can serve as a key way to assess it; 2) attempt an analgesic trial- provide an analgesic trial and titration appropriate to the estimated intensity of pain in the purported pathology and analgesic history (Herr, Coyne, Manworren, McCaffrey, Merkel, Pelosi-Kelly & Wild 2006).

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In this situation, it is best to assume that the patient is experiencing some type of pain. Elderly Diagnosis Essay Example.  With the standing orders of either acetaminophen of morphine, this will serve as an initial pain treatment for the patient.  Pain treatment in the case of a patient experiencing multisystem failure is more complex due to the numerous etiological factors at play. In the case of multi system failure, there are two primary ways to observe the effect of pain management: 1) observe the patient’s behavior- has there been intensification in the patient’s moaning, restlessness, and grimacing.  2) Monitoring of vital signs and clinical tests- pain could be related to a number of factors, but monitoring the patient’s hydration levels and oxygenation might serve as key signposts for the patient’s pain level.  A “successful” pain intervention would likely result in a return to normality from the previous symptoms and a reversion to the patient’s mean for clinical tests.  Overall, a clinician be more attentive and use numerous standards to assess pain in geriatric patients, this is particularly the case due to cognitive difficulties that might put more weight on behavioral , clinical, and history of the patient in treating pain.

In addition to the emergency room nurse, team members should also include an internist, a geriatric doctor, and a cardiologist and pulmonary specialist just in case.

References

Rauen, C.A. & Stamatos, C.A. (1997).  Caring for Geriatric Patients with MODS. The American Journal of Nursing. 97 (5), 16BB-16GG.

Herr, K, Coyne, P.J., Manworren, R., McCaffrey, M., Merkel, S., Pelosi-Kelly, J., Wild, L. (2006).  Pain assessment in the nonverbal patient: position statement with clinical practice recommendations.  American Society for Pain Management Nursing.  7(2), 44-52.

Kugler, J.P. & Hustead T. (2000).  Hyponatremia and Hypernatremia in the elderly.  American Journal of Family Physicians. 61(12), 3623-3630. Elderly Diagnosis Essay Example.