ANSWER
Taking Care of a Patient Over 65: A Clinical Experience
I got the chance to provide care for a 72-year-old man patient this week as a student nurse practitioner. The patient’s primary complaint was worsening shortness of breath (SOB) over the previous two weeks. Important insights into handling complicated elderly cases, such as comprehensive evaluations, differential diagnoses, and health promotion initiatives, were gained from this interaction.
Obstacles and Achievements
Challenges:
Polypharmacy: Because the patient was taking several drugs for long-term illnesses, it was difficult to ascertain if the SOB was caused by drug interactions, side effects, or an aggravation of preexisting diseases.
Barriers to Communication: Since the patient had a mild hearing loss, accommodations were necessary to guarantee clear communication and comprehension throughout the evaluation.
Achievements:
Developing a Relationship: Using written documents, speaking clearly, and actively include the patient in the care plan helped me build a trustworthy relationship despite the communication difficulties.
Comprehensive Assessment: In order to create a comprehensive and customised care plan, I carried out a complete evaluation that addressed both acute and chronic health concerns.
Signs and Symptoms of Assessment (S&S):
Chief Complaint: SOB has gotten worse over the past two weeks.
Related Symptoms: Fatigue, sporadic dry cough, and mild chest tightness. denies recent weight loss, chills, or fever.
Medical History: Osteoarthritis, chronic obstructive pulmonary disease (COPD), hypertension, and hyperlipidemia.
Social History: I used to smoke forty packs a year, but I stopped ten years ago. denies using illegal drugs or alcohol.
Physical Examination:
Vital Signs: Temperature: 98.4°F; SpO2: 92% on room air; BP: 134/78 mmHg; HR: 92 bpm; RR: 22/min.
Respiratory: There is slight wheezing and diminished breath sounds on both sides, especially at the bases.
S1/S2 regular without murmurs in the cardiovascular system.
General: Seems worn out but not in any serious pain.
Additional Systems: No clubbing of the fingers, jugular vein distension, or edoema.
Care Plan
1. Diagnostic Examination:
The purpose of the Pulmonary Function Test (PFT) is to assess lung function and possible exacerbations of COPD.
Chest X-ray: To rule out heart failure, lung masses, or pneumonia.
BNP Levels: To determine whether cardiac failure is a possibility.
To rule out infection or anaemia, perform a complete blood count (CBC).
2. Therapy with bronchodilators: prescribed albuterol, a short-acting bronchodilator, to treat acute symptoms.
Inhaled Corticosteroids: To guarantee sufficient symptom control, the correct approach for the current inhaler (fluticasone/salmeterol) was reviewed.
Through oxygen therapy, the patient was taught the value of oxygen monitoring and was given prescriptions for extra oxygen to be used during physical activity if their SpO2 fell below 88%.
3. Patient education: counselling on quitting smoking and reaffirming the significance of sustained abstinence.
To enhance respiratory function, pulmonary rehabilitation exercises were encouraged.
Differential Diagnoses
Exacerbation of COPD:
Justification: This diagnosis is supported by a history of COPD, wheezing, shortness of breath, and reduced breath sounds.
Congestive Heart Failure (CHF): Justification: Although edoema and jugular vein distension make CHF less likely, SOB and exhaustion may indicate CHF. BNP analysis will aid in differentiation.
Pneumonia: Justification: Although a persistent cough and SOB may be signs of pneumonia, this is less likely when there is no fever, chills, or productive cough.
Intervention for Health Promotion
Immunisation: Pneumococcal and influenza vaccinations are advised to lower the risk of respiratory infections.
Exercise: To enhance lung capacity and general cardiovascular health, low-impact aerobic workouts are encouraged.
Dietary Changes: To control comorbid disorders including hypertension and hyperlipidemia, a heart-healthy diet was recommended.
Knowledge Acquired
The significance of adjusting care to the particular requirements of senior citizens was reaffirmed by this experience. I discovered how to:
To distinguish between the overlapping symptoms of acute and chronic diseases, perform comprehensive evaluations.
Give patient education top priority, especially when it comes to managing chronic conditions like COPD.
Acknowledge the importance of health promotion in lowering older individuals’ risk of problems.
Current Guidelines’ Support
Chronic Obstructive Lung Disease Global Initiative (GOLD) Rules: suggests using bronchodilators and inhaled corticosteroids to treat flare-ups of COPD (GOLD, 2023).
In order to prevent respiratory issues in older persons, the Centres for Disease Control and Prevention (CDC) emphasises the significance of pneumococcal immunisation (CDC, 2022).
The Centres for Disease Control and Prevention are cited. (2022). Pneumococcal vaccination: Essential information for all. Vaccines: https://www.cdc.gov
GOLD stands for the Global Initiative for Chronic Obstructive Lung Disease. (2023). worldwide approach to COPD diagnosis, treatment, and prevention. The URL https://goldcopd.org
This case highlighted the value of evidence-based treatment and offered a thorough learning experience in evaluating and caring for an elderly patient. If you require further information, please let me know!
QUESTION
Describe your clinical experience for this week as a student nurse practitioner caring for a patient older than 65 years old
- Did you face any challenges, any success? If so, what were they?
- Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
- Mention the health promotion intervention for this patient.
- What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
- Support your plan of care with the current peer-reviewed research guidelines.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.