Pathophysiology And Pharmacology Of Multiple Health Concerns In A Patient

Pathophysiology Of Symptoms

The patient Mr X, an 87-year-old man, was admitted to the care facility with multiple health concerns. The name of the patient has been kept confidential as an ethical concern. The patient is a retired professor and lives with his wife who is the primary care giver. The patient had previously suffered aspiration pneumonia and APO for which he had to be admitted to the FMC. However, since his wife was not able to cope with the stress of looking after him, he had to be admitted to the aged care facility as a permanent resident. The patient has been suffering from Alzheimer disease, depression for the last few months, anxiety, type 2 diabetes mellitus, hearing loss, hypercholesterolaemia, glaucoma, stent-femoral artery, macular degeneration, TURP since the last ten years, peripheral vascular disease, chronic heart failure and chronic lower back pain. From the chief presenting conditions it is to be noted that the patient needs immediate attention and an appropriate care plan is to be outlined for the patient to achieve better health outcomes. The present paper would discuss the pathophysiology of the patient’s main signs and symptoms and explain the pharmacological interventions for these conditions. This would include the action of the durg, adverse effects, contraindications and nursing considerations. The assessments and investigations for the patient would be discussed, highlighting how these could impact on the care of plan for the patient. Lastly, recommendations would be outlined for achieving better outcomes for the patient.  Pathophysiology And Pharmacology Of Multiple Health Concerns In A Patient Essay Paper

The patient at the time of admission to the aged care facility has been presenting with multiple symptoms that required immediate actions to be taken against them. The prime patient concern is a risk of falls due to hearing loss, visual impairment and confusion, that might lead to adverse physical injury. The patient is suffering from Alzheimer’s disease that has been detected recently. According to Wimo et al., (2013, p. 15) hearing and sight loss are the two most striking complication suffered by a patient of Alzheimer’s disease, a form of dementia. A number of cross-sectional studies have pointed out that there lies an association between sensory impairments and cognitive decline in case of dementia. Such sensory impairments include hearing and visual impairment. Dementia, including Alzheimer’s disease, is one of the major disorder suffered by individuals aged 70 and above wherein a number of problems are suffered by the patient. The pathology of this disease is marked the abnormal aggregates of beta-amyloid deposited in the brain in the form of senile plaques along with neurofibrillary tangles of abnormally phosphoryated tau. Dementia leads to a number of visual problems such as colour vision loss, visual acuity loss, changes in pupillary response to mydriatics, defects eye movements, disturbances of complex optical functions such as reading and detecting objects. The decline in hearing ability is a neurological impairment due to the changes in the functioning of the brain. Risk factors for falls in older patients include both intrinsic (person-centered) and extrinsic (environmental) factors. Some of the most important intrinsic factors can involve balance impairment, hearing, cognition, muscle strength, vision, gait, and symptoms realted to depressions. Hearing dysfunctions is found to be the third most common chronic ailment in the older adults aged 65 years and above. Hearing impairment can decrease the quality of life and is independently related with difficulties in walking, functional decline, social isolation and impaired cognition. A number of research studies have highlighted hearing dysfunction in relation to fall related risks. Patients suffering from hearing impairment need increased attention for the detection and processing of auditory cues, leaving alteredattentional resources for balance control (Steinberg etal., 2015, p. 446). Vision impairment is directly linked with risk of falls. The direct and simple mechanism is that people having vision impairments do not identify environmental hazards  beyond their line of sight (Beltran et al., 2015, p. E5844-45).

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Pharmacological Interventions

Confusion and disorientation are other patient symptoms that need attention. The patient had been wanderingfrom one place toanother and have the predisposition to get lost. In addition, he had been getting into other resident’s room. These conditions present him with the increased risk of getting harmed. These conditions are related to Alzhiemr’s disease. Though short term memory of Alzhemier’s patients are lost, the long term memory of these patient links to the past life. Mrs. X’s Wandering behaviour is a result of the fact that he was a paediatric Professor and he used to wander from place to place in the hospital looking after his patients.The rationale behind such conditions is dementia that is known for giving rise to extremely difficult situations for the patient to cope up with. The main cause of the confusion and disorientation is the progressive damage to the cells of the brain due to Alzheimer’s disease. The functioning of the brain is hampered to the extent that the patient struggles to understand and perceive the environment around (Berry, 2014,p. 123). Chronic lower back pain (LBP) is the next symptom drawing the attention of the carer. Lower back pain is termed as chronic after 3 months if the normal connective tissues do not heal within this time period. A slow rate of tissue repair in the relatively avascular intervertebral disk impairs the resolution of chronic LBP. Traumatic and degenerative conditions of the spine are the common causes of chronic LBP (Arneja et al., 2016, p. 453). In the present case, the patient has been suffering from this condition that has affected his activities of daily living (ADL). The patient relies completely on his wife for daily functioning. Dementia patients have difficulties in expressing their pain. The rationale being reduced ability to communicate with others and reduced cognitive ability. As a result, they find their own ways of getting relieved  from the pain (van Kooten et al., 2017, p.523). In the present case, the patient might be wandering for getting relief from pain in the chronic back pain. Further the pain might be impairing the patient’s ability to carry out ADL. The researhers point out that pain and functional impairment is the cause of reduced ability to carry out ADL.

Based on the main signs and symptoms that the patient has been presenting, the pharmacological intervention for the patient would include Paracetamol, Mirtazapine, and Oxazepam.  Paracetamol, or acetaminophen, is a common drug used for relieving pain in patients. The drug has been recommended as the first-line treatment for low back pain. Though the drug does not generally have any adverse side effect, some patients might develop allergic reactions, severe dizziness, liver damage and trouble in breathing. Contraindications include renal impairment, acute inflammation of the liver and poor nutrition. A nurse is to check whether the patient is taking any other medication that has paracetamol as a constituent. Evaluation of therapeutic response is also essential (Lehne& Rosenthal, 2014, p. 254). Mirtazapine is a common drug indicted for treating depression in patients. The effectiveness of the drug is indicated by mood elevation. The side effects of the drug include nervousness, delusions, feelings of restlessness, drowsiness, headache, constipation, dysphagia and weakness. The contraindications for this drug include hypersensitivity to mirtazapine, acute Myocardial Infarction, infection, fever, jaundice, hematologic disease and ethanol intoxication. Patients are to be monitored for the worsening of depression by the nurse. Orthostatic hypotension is to be monitored along with the history of cerebrovascular disease (Adams & Urban, 2015, p. 57).

Assessments And Investigations

Oxazepam is the choice of drug for treating and managing anxiety in patients. The drug has hypnotic, anxiolytic, sedative, and skeletal muscle relaxant effects. The side effects of the drug include dizziness, drowsiness, vertigo, mental confusion, lethargy, skin rahs, oedema and slurred speech. Contraindications for this drug include hypersensitivity to oxazepam and other benzodiazepines and psychoses. Nursing considerations for the drug include signs of overdose. In case the patient suffers depressed daytime psychomotor function the physician is to be informed (Karch&Karch, 2016, p. 87).

Since the patient suffers from Alzheimer, a common form of dementia, it is imperative to carry out a neurological assessment for understanding the extent of cognitive function decline. The role of neurological assessment in dementia is well explained by Nielsen et al., (2016) who state that cognitive deficits arising due to dementia are different from that of age-related complications, making the neurological assessment more demanding. Patient assessment pertaining to the neurological functioning enhances the ability to clinically diagnosis the disease early in its course, as for the case of Mr X. The assessment is significant for understanding the deficits in executive functions accountable for the mental manipulation of concept information, cue-directed behaviour and problem solving skills. The test is to encompass those for reflexes, eye movement, speech, coordination, muscle strength and tone, and sensation. The assessment in the present case determined that Mr X had anxiety and confusion as the main complications arising due to dementia.

A cardiovascular assessment is imperative for a patient with dementia since heart disease is a risk factor for dementia. The rationale is that reduced cerebral blood flow (CBF) as a result of heart disease is known to worsen the vascular homeostasis of the brain. The cognitive problems faced the patient, as a result of beta- proteins and tau protein build-up are magnified as a result. Studies also indicate that dementia patients having a history of heart disease have more chances of having structural and functional cardiac abnormalities (Liu et al., 2017). Cardiovascular assessment for Mr X revealed blood pressure at 151/85 mmHg. This reading is higher than the normal value for BP at 120/80 mmHg. The heart rate was normal at 90 bpm as the normal values are 60-100 bpm. This information indicated the need for controlling blood pressure through medication and proper dietary intake.

Renal assessment is important for the patient since it helps in identifying renal impairments, monitoring disease progress and assessing baseline measurements before commencing on medications. Since the patient, in this case, needs to be administered a number of medicines for his presenting signs and symptoms, it is desirable that renal assessment is done. Based on the results of this assessment the medication regimen can be outlined (Wanner et al., 2016, p. 325). The patient in the present case has reported faecal incontinence. A thorough gastrointestinal assessment would be thus required in this case. This condition is marked by the involuntary passage of faeces or the inability to control the discharge. Assessment of the condition would enable the nurse to improve the quality of life for the patient. Since the Mr X is unable to carry out ADL by himself and has several impairments, addressing the concerns of faecal incontinence would be suitable to relieve him from associated complications.

Recommendations

The care facility did not record patient’s vital signs for 3 months even though their policy is to do monthly vital signs for each resident. Vitals signs are the main indicators of the patient’s health condition and determine the respiratory, neural,circulatory, and endocrinal functions. Vitals signs are a mechanism to communicate a patient’s condition and severity of disease. The parameters help nurses in identification of the interventions that are o be given to the patient and making decisions concerning the response of patients to treatment.In the context of care provided to elderly patients, vitals signs act as the indicators that needdistinct attention since these individuals experience in their cognitive, physiological and psychosocial health. Vitals include the physiological measurement of blood pressure, heart rate, respiratory frequency and temperature(Black, 2016, p. 264).Monitoring these parameters for Mr X is important sicne he is at high risk of altered functionality as a result of aging and dementia, considered the phase of greatest vulnerability due to comorbidities.The importance ofBGL being undertaken once weekly is also to be highlighted. For Mr X BGL is to be taken on Friday pre-meal as per doctor order as they have missed this as well since 6/6/2017. The last BGL result pre-meal on 6/6/2017 was 6.4 mmol/l while at present it is 6.1 mmol/l. BGL is to be checked once in a week for for ensuring that the level  is under control (Aleppo etal., 2017, p. 539). Some classes of oral drugs can lead to hypoglycemia or low blood sugar so regular monitoring is needed. Changes in body weight also determine BGL and confer the need of regulary monitoring BGL.Blood glucose level is to be assessed since the patient had been suffering from Type 2 diabetes. In case a patient has diabetes, it is recommended to provide the patient with a diet that meets the nutritional needs of the body as well as lowers the level of blood glucose. For the majority of healthy individuals, normal blood sugar levels are as follows: between 4.0 to 6.0 mmol/L (72 to 108 mg/dL) when fasting and up to 7.8 mmol/L (140 mg/dL) 2 hours after eating.

The mental health status of MrX was assessed by mini mental status examination (MMSE) tool. Assessment of the mental health status is important element of overall examination of a patient. It augments other forms of assessment components like the atienthistory of complaints, and helps in providing cue for a detailed assessment such as cognitive assessment or psychometric testing. Though the health history might be static, the mental status is dynamic. The mental status examination is aguide to structure data regarding the patient’s mental functioning (Pasi et al., 2015, p. 253).

Based on the patient condition and the assessment findings, a number of recommendations are outlined for addressing each of the patient concerns. Firstly, the patient must be supported to achieve optimal health and wellbeing through participation in different activities. This is to include both physical and social heath care. The patient has been suffering from dementia, and thus his cognitive functioning needs special attention. The patient can be given memory activities such as puzzles that would augment his cognitive skills for enhancing his mood and eliminating chances of social isolation; the patient needs to engage in any recreational activity. For this purpose, a professional can be helpful who would help in assisting with the activities (Butcher et al., 2013, p.214). Since the patient has impaired body functioning and chronic back pain and struggles with his ADL, appointing a physiotherapist would be noteworthy who can bring improvements in his mobility and ability to carry out activities in an independent manner.

Fall prevention is a key aspect of the care plan for the patient since the patient is at increased risk of suffering falls due to visual and hearing impairment. Firstly, an armband is to be given to the patient to wear so that other professionals can easily identify high-risk patients and act accordingly. Using a visual cue outside the door of the patient’s room would alert the carers about the risk of falls. The number of safety companions, when increased, would ensure that those who are disoriented, such as Mr X, are provided with continuous observation and monitoring for preventing falls. Bed alarms are useful so that patients can call for help at day time of the day or night. Ensuring that the bed is provided with side rails and the washroom has handrails is important. One also needs to ensure that the floors are dry and not slippery. Spills of any form are to be avoided, and the floor has to be free from any heavy furniture or any other things that might lead the patient to trip (Potter et al., 2016, p. 56).

The elements of patient care would be dietary intake, pain management, BGL assessment and observation of vital signs to detect changes in patient condition. A dietician is to be consulted who would outline the dietary chart as per the body requirements of the patient (Black, 2016, p. 57). Pain management would be possible with the administration of medications at regular intervals. BGL assessment and observation of vital signs is important to promote suitable dietary intake. A social worker would encourage the wellbeing of the patient by providing emotional support so that the patient can express his feelings. It is to be noted that the communication made with the patient has to follow the ‘5 S’ rule- Slow, Simple, Specific, Show & Smile that is effective for dementia patients (Potter et al., 2016, p. 98).

References

Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson Education.

Aleppo, G., Ruedy, K. J., Riddlesworth, T. D., Kruger, D. F., Peters, A. L., Hirsch, I., …&Rickels, M. R. (2017). REPLACE-BG: a randomized trial comparing continuous glucose monitoring with and without routine blood glucose monitoring in adults with well-controlled type 1 diabetes. Diabetes Care, 40(4), 538-545.

Arneja, A. S., Kotowich, A., Staley, D., Summers, R., &Tappia, P. S. (2016). Electromagnetic fields in the treatment of chronic lower back pain in patients with degenerative disc disease. Future science OA, 2(1).

Beltran, W. A., Cideciyan, A. V., Iwabe, S., Swider, M., Kosyk, M. S., McDaid, K., …&Boye, S. L. (2015). Successful arrest of photoreceptor and vision loss expands the therapeutic window of retinal gene therapy to later stages of disease. Proceedings of the National Academy of Sciences, 112(43), E5844-E5853.

Berry, B. (2014). Minimizing confusion and disorientation: Cognitive support work in informal dementia caregiving. Journal of aging studies, 30, 121-130.

Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health Sciences.

Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2013). Nursing Interventions Classification (NIC)-E-Book.Elsevier Health Sciences.

Karch, A. M., &Karch. (2016). Focus on nursing pharmacology. Lippincott Williams & Wilkins. Pathophysiology And Pharmacology Of Multiple Health Concerns In A Patient Essay Paper