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American Colege Of Rheumatology Management

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American Colege Of Rheumatology Management

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American Colege Of Rheumatology Management

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Old age is a phase in life that is quite sensitive; elderly people require comfort and care to enable them lead healthy lives without the unnecessary anxiety and worries. (AgeUK, 2015). Old age, adulthood, adolescence, childhood, and birth are the critical stages in every person’s life. Each stage is characterized by its own challenges and issues. As one proceeds from one stage to another, it reaches a point when physical strength deteriorates and so too the mental stability (Bragen, 2013). As age progresses, several medical issues occur the most common being osteoarthritis, dementia, diabetes, cardiovascular diseases, visual impairment, kidney infections, and other geriatric medical conditions.
Besides disease, other issues are interlinked with old age. A major concern among the elderly is loneliness and depression. As one ages, the relationships that one had begin to sever; children grow up and move out, souses die, friends and family move away and soon an elderly person finds that they are all alone. Depression begins to manifest even as the elderly person starts to visualize a different life from what they have been accustomed too (Mental Health America, 2017).
Description of the Patient
In this paper, the patient, Barbara Green is an 89 year old widow who has reported at the health center with multiple complaints.  The patient complains of swollen feet and enlarged joints; painful joint pains in the knees, fingers, hip, and back; joint stiffness, minimal joint movement; visual impairment; constipation; weight loss; and dizziness that occur on and off (Levett-Jones, 2013). The decrease in physical functionality has caused her to cut off socializing with her friends at the German Association, her eating habits have deteriorated; and her house keeping has reduced causing her to live in poor condition.
The physical conditions that the patient in this case has complained about and which are geriatric in nature include constipation, the visual impairment, and stiff painful joint  (Siamak, 2016, Levett-Jones, 2013). The risk factors associated with constipation include use of multiple pharmacological drugs, poor diet that is deficient in roughage and fluids; and reduced amount of physical activity (Hunter, 2016). In addition, the fact that Barbara has a visual impairment renders her at risk of physical injury. The visual impairment is most likely caused by macular degeneration (WebMd, 2016) a condition that is common among the elderly and also among the Caucasian community (Haddrill, 2016). In addition, reduced amount of activity as well as poor eating habits have been known to exacerbate the condition among the elderly (WebMd, 2016).
In this scenario, the three major illnesses that will be addressed are Osteoarthritis/Rheumatoid arthritis, Constipation, and Macular degeneration. Although Barbara is currently living a solitude life, the underlying reason behind it is not depression, rather it is as a result of reduced activity resulting from joint pain (Hunter, 2016). The inactivity has resulted in the patient developing constipation (also caused by her prescribed medication) and exacerbated macular degeneration (also caused by age) (Hunter , 2016). Based on the presentation of facts and by utilizing clinical reasoning, the optimal patient outcomes will be achieved when Barbara is able to manage her pain  (Bullock, & Hales 2013) which will in turn help her achieve her ADLs, eat healthier, become more active, and resume her normal life and restore severed relations with her German Association friends as well as her family. Eating healthier will reduce incidences of constipation and  will slow down macular degeneration. To manage her pain, Barbara will need to adhere to her medication regimen.
Cues from the patient.
Barbara reported that she lives alone in a one-storey building. She said that she experiences joint pain especially on the hip and knees which could result in limited movement. Although she did not mention it, it is probable that her housekeeping as well as other ADLs is below par because of the physical pain in her joints. It is also possible that she has resulted in eating poorly because of her inability to make healthier food purchases at the grocery due to her reduced mobility caused by her painful joints. Other than not being able to go to the grocery, her weight loss could be attributed to depression as she reported that she no longer visits with her friends at the German Association and that she is widowed.
Visual impairment is caused by macular degeneration in older patients. Macular degeneration occurs when the retinal macular wears out from ageing which causes one to lose central vision (WebMd, 2016). However, a patient is able to see using the peripheral vision. Macular degeneration can either be dry or wet with the most common being the dry macular degeneration among the elderly. (WebMd, 2016)
Constipation is a common occurrence among the elderly. There is a distinction between hospital environment constipation and that which is influenced by other external environments. The occurrence of constipation among the elderly increases with age, the older one gets the more incidences one experiences (Gandell, Straus, & Bundookwala et al., 2013). In addition, constipation can be as a result of drug interactions in the body (Hunter, 2016). Barbra is currently prescribed on slow release Paracetamol which causes slow bowel movement.
Another common medical condition among the elderly is Rheumatoid arthritis and/or osteoarthritis (Hunter, 2016). The medical condition is as a result of bone cartilage wearing out with age which causes joints to rub off against each other. The friction between the joints causes stiffness, mild to acute pain, as well as development of swollen nodes (Udell, 2017).
Assessment of the patient and interventions
Assessment of the patient showed blurred vision and a centralized blind spot in the visual filed. In addition, Hydroxychloroquine can also cause impaired vision ((Tiziani, 2014). The patient has visual impairment and is at risk of injury from poor vision. The patient may also experience challenges in her ADLs because of minimal vision. To manage the condition, the patient will be advised to wear sunglasses and avoid direct light or sunlight once she has undergone photodynamic therapy (Arnold J, Heriot W , 2007; WebMd, 2016).
The patient will be required to give details on the time of day and frequency of constipation. Symptoms to look out for include confusion, diarrhea, nausea, urinary retention, loss of appetite, and abdominal pain (Mandal, 2016). The patient is already on multiple drugs which predisposes her to constipation.(Hunter, 2016). The limited physical activity that is caused by her painful joints is another risk factor that contributes to the patient’s constipated condition.
The patient will be advised on increasing her fluid and roughage intake (Orenstein, 2016). In addition, she will be advised to adhere to her pain management medication for her joint aches. Once she is able to manage her joint pain, the patient will be able to increase her physical activity which will help ease the constipation that she is experiencing.
Assessment of the patient shows joint swelling and deformity with Heberden and Bouchad nodes in the distal and proximal joints respectively. The pain in the joints intensifies with physical activity such as walking, exercising or basic ADLs. Patient also indicated that the pain intensifies during the night when the room temperatures are low, and upon getting up after sitting or lying down.
The diagnosis is chronic pain that results from joint deterioration. Evaluation using x-rays shows joint narrowing and sclerosis in the knee, hip, and finger joints. The synovial fluid analysis showed the occurrence of both rheumatoid arthritis and osteoarthritis in the affected joints.
The patient will be advised to manage the pain through strict adherence to medication. She will also be advised to avoid strenuous activities that can trigger painful joint episodes. Heat application will be done on the affected joints. A terry clothe will be placed under the patient’s neck to relieve any pain on the cervical area as she sleeps. Simple exercises will be taught to the patient that will help reduce joint stiffness. The patient will also be advised to wear foot pain relieving shoes and support. In addition, calcium supplements will be included in her medication.
The four main goals that need to be met with regard to taking care of Barbara include:

Barbara should be able to do mild exercises on a daily basis. She will start with 10 minute exercises per day which will be increased by 5 minutes every fortnight. The goal us to ease joint stiffens and also to boost her metabolism
Barbara should be able to take short walks t the grocery store twice a week without experiencing acute pain n her knees. The goal is to get her to walk and get some fresh air, get away from the confined loneliness of her home, and to enable her make wiser and healthier food choices for her meals.
Barbara should be able to carry out her ADLs without any assistance except for joint straining duties.
The patient should adhere to her medication

The first issue that needs to be resolved is medication non-adherence. The first step is o have a conversation with the patient and educate her on the need to stick to her medication regimen, the health benefits she stands to gain from her medications, any side effects she should be on the look-out for, and how to use a medicine chart (Jimy, & Jose, 2011).
Barbara’s medication will be packaged in different colored bottles and placed in easy to reach areas. This will allow Barbra to be engaged in her own therapy. As she is suffering from visual impairment, placing the medications in places she uses often will help her in adherence. For the drugs that are to be taken before she sleeps, the bottles will be placed on her nightstand. Those that need to be taken in the morning will be placed in the toothbrush stand and those that need to be taken during or after meals will be placed on top of her refrigerator. A medication chart will also be created to enable the patient take her medicines at the right time (Jimmy et al., 2011)
Tracy will be informed on the action plan so that she is able to discuss with Barbara about her daily goals when she calls her.
Barbara will be required to purchase a water bottle and advised to fill it with water which she will be expected to drink during the course of the day.
A meal plan will be drafted by the healthcare nutritionist to help Barbra make healthier meal choices and also enable her regain her weight.
After three weeks: Barbara has gained weight of 1-2kgs
The patient has rejoined her friends in the regular meetings at the German association
As people become older, I not excluded, the things that we value become lesser and we are left with that which is most precious. The key is to expand our horizons, value more relationships, and more variety in what makes our lives rosier. When a person spends his early years establishing and strengthening many good relationships, it pays off in the sunset years as such a person will always have people around them to laugh, share, and confide in. In addition to people investment, health investment is critical. I have resolved to live healthier now so that I do not have to struggle with some of the geriatric conditions n the future.
For the overall wellness and enhanced productivity, Barbra’s care will include taking care of her physical needs through pain management and medication adherence; healthier eating and consumption of daily fluids; and regular mild exercises. For her socio-psychological health, Barbra will be able to socialize with her friends and family and get out more as she makes visits to the grocery store. Health eating and exercising will improve her mental health and decrease chances of depression occurring
AgeUK. (2015). Protecting yourself and others from abuse. Retrieved 03 09, 2017, from https://www.ageuk.org.uk/health-wellbeing/relationships-and-family/protecting-yourself/what-is-elder-abuse/
Bragen, J. (2013). The Berkley Daily Planet. Retrieved 03 09, 2017, from https://www.berkeleydailyplanet.com/issue/2013-01-03/article/40630
Bullock, S & Hales, M. (2013). Principles of Pathophysiology. NSW: Pearson Australia.
Gandell, D; Straus, S; & Bundookwala et al., (2013). Treatment of constipation in older people. CMAJ , 663-670.
Haddrill, M. (2016). What Is Age-Related Macular Degeneration? Retrieved 04 09, 2017, from All About Vision: https://www.allaboutvision.com/conditions/amd.htm
Hunter, S. (2016). Miller’s Nursing for wellness in older adults. North Ryde: Lippincott, Williams and Wilkins.
Jimmy, B & Jose, J. (2011). Patient Medication Adherance: Measures in Daily Practice. Oman Medical Journal , 155-159.
Levett-Jones. (2013). Clinical reasoning: Learning to think like a nurse. NSW: Pearson.
Mandal, A. (2016). Constipation in the Elderly. Retrieved 04 09, 2017, from News Medical : https://www.news-medical.net/health/Constipation-in-the-Elderly.aspx
Mental Health America (2017). Depression In Older Adults: More Facts. Retrieved 04 09, 2017, from Mental Health America: https://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts
Orenstein, B. (2016). How Fiber Helps Ease Constipation. Retrieved 04 09, 2017, from Everyday heakth.com: https://www.everydayhealth.com/digestive-health/fiber-and-constipation.aspx
Siamak, N. (2016). Senior Health. Retrieved 04 09, 2017, from eMedicine: https://www.emedicinehealth.com/senior_health/article_em.htm
Tiziani, A. (2014). Havard Nursing Guide to Drugs. (9th ed.). Chatswood.NSW; Mosby Elsevier.
Udell, J. (2017). Osteoarthritis. Retrieved 04 09, 2017, from American Colege of Rheumatology: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis
WebMd. (2016). Age-Related Macular Degeneration Overview. Retrieved 04 09, 2017, from WebMd: https://www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-overview#1

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