NURS 3003 Dynamics of Practice 3
1 Introduction
The underlying report is aimed at identifying the complex care needs of patient, such that care plan for the patient can be devised for three prioritized needs. The name of patient is Mrs Mary Tonkin, who is 79 years old women, who is living alone and has limited social ties. The patient has stayed for five days in hospital for treatment of Atrial Fibrillation (AF), which has resulted in dizziness and shortness of breath along with continuous episodes of fatigue in the patient. Along with AF, patient has complex history of chronic ailments. For instance, Mrs. Mary has suffered from Transient ischaemic attack in 2016, from which she has recovered and again suffered from right sided Cerebro Vascular Accident (CVA) in 2018, which requires continual assessment of neurological conditions of the patient. Other significant issues which make it compulsory to offer complex care to Mary are; Diverticulosis, Cholecystectomy (2000), Atrial fibrillation, Hypertension and Type 2 Diabetes Mellitus and Colles fracture from a fall at home with internal fixation. Based on the chronic condition of patient, the following medications are taken by her; Clopidegrol 75mg PO daily, Digoxin 125mcg PO daily – AF, Warfarin 3mg, Microzide 25mg PO daily and Metformin 500mg. The drugs taken by patient are not without side-effects and given the chronic condition of patient, in-house nursing care is recommended for the patient. The underlying report has chosen the three needs of Mrs. Mary, which require close consideration of multidisciplinary team members, such that effective care can be offered to the patient, along with monitoring for any complexity associated with medication side-effects and disease related complexities. Additionally, the role of registered nurse in provision of care services is also highlighted along with potential barriers to patient’s long term care.
2 Chronic and Complex Needs
Proper definition of both needs with separate heading
As per my understanding both complex and chronic care needs are same and interchangeably used in literature.
The complex needs of patients are also regarded as long run care needs, which might be the result of chronic health care conditions experienced by patients. The complex needs are linked with combination of multiple health conditions of patients, which might include heart stroke, diabetes, chronic brain damage, Alzheimer’s, any physical disability, multiple tissue disorder, kidney failure and many others (Schoen et al., 2011). The condition involving multiple morbidities mainly require the involvement of multiple care providers, which is mainly accompanies by community or home based care mechanism (Phillips et al., 2008). The complex care is mainly person-centered and in order to enhance its effectiveness, it needs to be equitable, multidisciplinary, data based and team based. The multidisciplinary team members are needed to encourage lifestyle changes among case, such that patient can be helped to cope up with chronic conditions (Schoen et al., 2011).
3 Justification of complex care needs of Mrs. Mary
Mrs. Mary is having complex care needs, as she is suffering from series of complex illnesses which have potential risk factors for long run wellbeing of the patient. For instance, the patient has suffered from Transient ischemic attack in 2016 and in 2018 she has suffered from cerebro vascular accident. CVA has caused hemiparesis, whereby patient is feeling weakness on left side of her body, especially leg. These kind of strokes are considered as serious, as they are followed by risk of another stroke, which is most likely during the first stroke of initial one (Hong, Abrams & Ferris, 2014). It is notable that chances of second stroke are mainly high for patients who have history of hypertension, diabetes, any heart related issue, are of older age and have suffered from Transient ischemic attack at any point in their lives (Kim, Subramaniam & Flicker, 2018). All of these risk factors are witnessed from the past medical history of Mary and thus it can be anticipated that she is at high risk of having another stroke. Therefore, she needs long term medical care based on this complex care need.
Additionally, the patient’s past medical history has also shown that Mary had conditions of Diverticulosis, Cholecystectomy, Atrial fibrillation, hypertension, diabetes and Colles fracture. All of these conditions are co-morbid and thus continuous care is needed to ensure that any severe condition can be controlled in effective way (Huyse et al., 2001). The potential risk factors for each of the medical condition are expected to be severe, as medication taken for the treatment of Mary are mainly blood thinners, which are; Warfarin and Clopidegrol. These medications put her at risk of bleeding and there is need to closely monitor the patient’s condition to avoid excessive blood thinning.
4 Prioritization of care needs for Mrs. Mary
Three needs which are identified for Mrs. Mary in order of high to low priority are as follows;
- Post stroke care and Physio Therapy to recover from Hemiparesis
- Lifestyle modification and diet changes to control diabetes
- Counseling and psychological care
5 Justification for Prioritizing care needs for Mrs. Mary
5.1 Post Stroke Care and Physio Therapy to recover from Hemiparesis
The identification of physical therapy as one of the high priority needs is based on the notion that physical weakness is highly depressing for the patient. It is notable that Mary has had suffered from Colles fracture from fall at home and hemiparesis can further increase the chances of fall. Additionally, 79 years old patient is likely to have osteoporosis which can be worsen from trips and falls. In similar way, it is addressable that Mary is taking medicines for blood thinning, and any injury from fall can lead to uncontrollable bleeding. Mobility is also important for patient for avoid condition of bed bound, such that posture changes can be encouraged and bed sours can be avoided, which are common issues followed by CVA (Hong, Abrams & Ferris, 2014). In order to recover from hemiparesis, it is highly important for Mary to get physio therapy at regular intervals. The issues of mobility, balance and coordination can be improved through physical training and exercises, such that patients can learn to balance and walk with ease.
5.2 Lifestyle modification and diet changes to control diabetes
The care for diabetes has been prioritized as second most important need of Mrs. Mary, which needs consideration of multidisciplinary team members. The reason for prioritizing it is based on the fact that patient’s HbA1C 2 months ago was 11.8, which indicates that value of blood sugar is too high for case patient. If timely care is not taken for diabetes, then it can result in severe health conditions, such as; heart stroke, eye problem, kidney failure and nerve damages among other conditions (Hickam et al., 2013). Likewise, high sugar level in older age can lead to Alzheimer’s disease. It is notable that Mrs. Mary has recently been forgetful about things and also has family history of Alzheimer’s, showing that she is at greater risk to suffer from this condition, if level of diabetes is not controlled (Herman et al., 2005). The lifestyle changes and diet changes are thus highly needed to control diabetes.
5.3 Counseling and psychological care
It is notable that Mrs. Mary has gone through hard time lately, as her husband died of chronic illness and she has left alone at the home. Her complex health condition is further an addition to her deteriorating mental health conditions, and she is a sufferer of hypertension. Patient has also suffered from cardiac arrest, which causes psychological trauma. Given her chronic health care condition and her social isolation, it is anticipated that Mrs. Mary is traumatic and she needs mental health assistance. Counseling and psychological care is also important for enhancing the will power of patient, as there is significant connection between patient’s mental health condition and success of treatment through medication (Craven & Bland, 2006). Therefore, this need also needs substantial contribution of multidisciplinary medical team.
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1 How MDT will meet these needs?
1.1 Delivery of care to recover from Hemiparesis
In order to deliver effective post stroke care, the following members of multidisciplinary team will play their role.
Role of Physiotherapist: In order to deliver best possible post stroke care to patient, firstly the services of physiotherapist are needed. The home care packages of physiotherapist are widely important in this regard, whereby physiotherapist will be needed to maintain close communication and collaboration with other stakeholders involved in care delivery of Mrs. Mary. Along with providing physiotherapy, the therapist will also help the patient with different exercises and posture building (Coleman 2003). The exercises will help Mary to strengthen her muscles, such that she can move with ease around the house. Additionally, the session to improve balance and coordination will also be delivered by the physiotherapist. It is important to mention here, that any exercise and physical therapies are beneficial when they are accompanied by healthy and nutritional diet. In order to assure that patient is taking needed diet, the coordination is needed with nutritionist who will serve Mrs. Mary with life style modification and diet changes.
Role of Nurse: In order to continue the exercise routine, the willpower of patient is highly important, which will require coordination of nurse and occupational therapist. Nurse will engage with patients through interventions to educate her on living life after stroke, in addition to assuring that medications are taken in timely manner. Additionally, she will also be monitored for any serious side effects of drugs which are being taken by her.
Role of Occupational Nurse: In addition to physical therapy the occupational nurse along with others will be responsible to offer inclusive post stroke care to Mrs. Mary (Australian Primary Healthcare Nurses Association, 2020). The vitals of patient will be checked on regular intervals to identify any changes which could be alarming to health condition of Mrs. Mary.
1.2 Care to encourage lifestyle modification and diet change
Different members of multidisciplinary team will act as a team to provide effective care to Mrs. Mary. The detail can be seen as;
Role of dietician: In order to keep control of blood sugar level of patient, the nutritionist services will be obtained, who will encourage the patients to take food which can help to control the glucose level.
Role of registered diabetic nurse: As patient is taking metformin daily, so chances of hypoglycemia could also arise. It will need the nurse to monitor HbA1C on regular intervals, along with assuring that right proportion of nutrients are given to patient to avoid any complex condition.
Diabetic Nurse Educator: The life style modification will be encouraged with assistance of diabetic nurse educator and nutritionist. The mobility of patient will be encouraged through educational interventions, as active lifestyle is recommended for patients with diabetes. This nurse will be needed to offer education and coaching to patient regarding the needed living style and diet to live a normal life with type 2 diabetes.
Role of clinical Nurse Specialist: The clinical nurse specialist can also play role in this regard, as they are trained to recognize the behavioral aspects of patients who live with chronic conditions (Productivity Commission, 2008).
Role of pharmacist: Pharmacist will assure that combined interactive effect of medications taken by patient is not adversely affecting her health.
1.3 Delivery of counseling and psychological care
The services of psychiatric, mental health nurse and therapeutic recreation specialist are important to assure that mental health needs of Mrs. Mary are addressed well. They can all work as a team to assure that total medical care and counseling can be provided to patient, who has suffered a stroke recently and also has had many chronic health conditions (Productivity Commission, 2008). For instance,
- Physician will recommend medications for treatment and control of hypertension and its related complications.
- The mental health nurse will be engaged in extensive communication with patient to assure that effect of social isolation can be overcome, along with reducing the level of anxiety and depression of patient (NSW Government, 2018).
- Additionally, the counseling sessions will be arranged by psychiatrist to discuss that how Mrs. Mary feels after stroke. The counseling will focus on suppressing depressing and negative emotions of patient, along with encouraging positive emotions and boosting will power of patient.
- Neurologist will act as highly professional care provider to protect the cognitive and mental wellbeing of patient, with hypertension. The medications provided by neurologist will be specialized and cognition focused.
- Social workers will also help Mrs. Mary to ease up her life, as she is living in social isolation. Her mental wellbeing needs social assistance, which will offered by social worker.
- Nutritionist will assure that Mrs. Marry takes nutritional food that does not cause her blood pressure to elevate beyond certain level.
In addition to the need specific care, the inclusive care program will be relied upon, which address diverse conditions of patient to assure that total care can be delivered to Mrs. Mary. For instance one significant program in this regard is ACAT (aged care assessment team), whereby aged care assessment will be arranged for the patient to continually assess the health condition of Mary (My aged care, 2020b). This assessment will be carried out under home support assessment with a Regional Assessment Service (RAS), which is provided to patient who want to live independently at home, along with receiving continual health assessment. ACAT will investigate the medical condition of patient (in the light of past medical history of Mrs. Mary), along with identifying any physical requirements of the patient ((My aged care, 2020b). Along with this, psychological needs of patient will be assessed on regular intervals and any needed support will be offered to lower the level of stress experienced by patient. The assessment of social needs will also be included in ACAT, such that panic attacks can be controlled for the patient which result from isolation from family. ACAT will seek assistance of multiple disciplinary team, who work to offer care services to Mary based on her complex care needs.
2 Role of RN in accessing services?
Mrs. Mary has been hospitalized for 5 days and after her recovery and discharge, it is the responsibility of registered nurse (RN) to explain to patient about the aged care services being provided to support the older age people (Cameron & Brownie, 2010). For instance, RN will explain to patient about ‘my aged care’, which allows the patient to give a call to service providers, such that they may be referred for face to face health investigation. The online application for assessment can also be given by patient and RN will explain the way of doing that to Mrs. Mary (My aged care. 2020a). The RN will explain that services will be provided in person and Mrs. Mary does not have to leave the home for health condition assessments and assistance (My aged care. 2020a). Additionally, patient will be informed about the option of representative or advocate, who might communicate with my aged care on behalf of Mrs. Mary. Additionally, RN will inform patient about the funding option, which include; The Commonwealth Home Support Program (CHSP) Home Care Packages (HCP), short-term care and aged care homes (My aged care. 2020a). These providers will assess the eligibility of Mrs. Mary such that services can be provided on subsidized rates and costs can be controlled for services provided to patient.
3 Potential Care Barriers
One core potential care barrier is associated with economic resources needed for my aged care. It is addressable that in order to get funding approval for ‘my aged care’ comprehensive assessment is needed and Mrs. Mary might not have technological resources and skills which are needed to initiate and follow-up the process of assessment (My aged care. 2020a). Although, her son Sam is supportive towards her mother care and gets aged care allowance, yet her wife is not happy with him and thus the role of Sam in care delivery of her mother cannot be anticipated. Therefore, the economic factor is one of the core barrier, which might intervene with assess of better care services by Mrs. Mary.
Along with this, the effective care delivery needs to be supplemented by healthy social life of the patient, such that patient can be positively reinforced to embrace care that is given to them (NSW Government, 2018). The case of Mrs. Mary shows that she is living alone and suffering from kind of social isolation. It is likely to lead towards the deteriorating mental wellness of patient and can cause depression and anxiety, which are substantial barriers in the way of effective care delivery to Mrs. Mary.
4 Issues related to Medication needs of Patient
One main issue which is linked with medication needs of patient is based on the fact that side effects are evident for all these drugs, such as;
- Warfarin (3mg daily) and Clopidegrol (75mg PO daily) are both blood thinners. The intake of this much doses on daily basis can put the patient at risk of bleeding, which could be caused by any injury or can be spontaneous through nose or mouth.
- Digoxin is also linked with different side effects, such as vomiting, nausea, headaches, as well as dizziness, which could lead to further deterioration of Mrs. Mary’s health and thus needs close monitoring of her condition.
- Likewise, intake of Microzide can cause loss of vision, which might restrict Mrs. Mary to mobilize and to perform her daily activities.
- Additionally, the patient is taking metformin (500mg PO daily), which might cause lactic acidosis, diarrhea, nausea, decreased appetite and vomiting among patients. These side-effects can further add up in worsening the complex condition of Mary and thus needs careful consideration.
5 Conclusion
The care of aged people with complex care needs is considered as one of the core priority by health care practitioners. The complex needs arise for patients who suffer from series of chronic illnesses. Mrs. Mary is also suffering from number of chronic conditions including; CVA, AF, hypertension and type 2 diabetes mellitus. Additionally, she also had Colles fracture, transient ischemic attack and diverticulosis, which are contributes in complex condition of the patient. In order to offer care to Mrs. Mary, three care needs are being identified and prioritized in the order of high to low priority. These needs include; post stroke care and Physio Therapy to recover from Hemiparesis, lifestyle modification and diet changes to control diabetes and counseling and psychological care. In order to serve these needs of Mrs. Mary, the consideration will be offered by the members of multidisciplinary team, who will coordinate and communicate with each other to ensure effective care delivery. The care activities will mainly include physiotherapy, exercises and walking sessions, posture changes, life style modification, nutrition intake, regulated diet, timely intake of medications, counseling and psychiatrist sessions among others. Additionally, the ACAT will also carry out assessment of Mrs. Mary, such that effective and timely aged care facilities can be provided to her. The registered nurse will play substantial role in this regard, by informing the patient about myagedcare services, post hospitalization of Mrs. Mary. The care barriers will also be present, including the economic and social conditions of patient, which might hinder the effective care delivery to Mrs. Mary. Finally, the medications also have some related side-effects which will be continually monitored by the MDT members.
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