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The nurses need to assess their patients to get the detail of their patients to avoid any mishaps. The nurses take time to educate the patients and the caretaker to understand the care of diagnosis and vital information such as diet, past medical histories, allergies associated with the medication, nutritional history, BMI, current health status to review the patient's physiology, anatomy and habitual status that can lead to complex medical conditions. The nurses have to understand the patients and improve their standards of care with wellness strategies and one-on-one discussion. Nurses should be trained with role-based instrumentation so that they can expertise and use their academic knowledge to that of the patients. The innovative methods to introduce the pioneering spirit to embody the patient informative with logical importance of the foundation's care for assessment for the nurses.
Figure 1: Picker's concept of patient-centred care needed to be included in the assessment process of the patients
(Source: The Eight Principles of Patient-Centered Care · Oneview, 2021)
Nurse assessment and care planning are dependent on the collection and analysis of suitable data that helps in the identification of problems of the patients. The concept of health assessment culminates the use of integrating pathways of care and helps in the application of frameworks and models to help in the assessment of the patients. The effective use of integrated care pathways is a common technique used by nurses. The Eshun-Smith model comprehensively explains the specific assessment planning procedures to indulge in care planning for different kinds of patients starting from old to aged patients. The main area of focus in patient assessment is to implement strategies to devise care plans according to the need of the patients. The planning methods can be ad hoc planning, SOAP planning, and structured formalized planning are introduced.
Figure 2: Represents the illustration of patient assessment by a nurse
(Source: Toney-Butler and Unison-Pace, 2021)
The assessment and evaluation of care developed helps in the appraisal of the nurses and helps in maintaining compatibility within the controlled situation. The decision-making approach is developed with the evaluation procedures that are done with person-hood care techniques.
The essay helps in providing an assessment of two patients JoBrown and Micheal Thomas with a description of their chronology of health history, current history of history, their living conditions, methods and assessment tools, potential problems of the patient assessment with the knowledge of anatomy and physiology. The essay discusses health assessment of 13 years old and 82 years old to look into the paradigm shift in the assessment care management of nurses.
PATIENT 1:JO BROWN
Introduction to patient
Name of Patient: Jo Brown
Date of Birth: 12.07.2006
Age:13 years old
Residential Address: 7B High Street, Chesterfield, S45 6GH
Hospital number: 6536737
The child has no prior health conditions and allergies are not known. He is under no current medication. He had a normal delivery and the immunization care was not completed and he was admitted to the hospital for dental extraction at the age of 5 and 7 years old. He is assessed by physicians 26 times but he is not provisioned under any GP.
Jo has a height of 136 cm and weighs 32 kilograms. The BMI is below the 25th centile. Jo is speaking odd words and he is struggling to swallow his food. There is no recession observed in him and his blood pressure is 90bpm. He has flushed cheeks that are pale. He is reluctant to mobilize and he does not require any kind of support to mobilize. There are clear demarcation and cold extremities. His temperature is 39.9oC. He is rushed to the emergency department of the hospital as he is not registered with any GP. He does not show troubled breathing and judging from his physical evidence it can be inferred that these are a condition of mental health that the children are suffering from some kind of depression or trauma. There are no other signs of physical problems after the assessment process.
Jo Brown has been living under such conditions because of his family's condition and he has 4 other siblings (7 years twin brothers, 3year old, and 1-year-old). Jo has her living with this condition because of the condition of neglect and they pretend to get attention from his parents. The trouble of swallowing may be persistent because he does not want to intentionally eat his food and he might want attention from his parents (Sun, 2018). There might be a probability that he is suffering from psychological dysphagia (Gosaet al. 2020).
It is seen that psychological dysphagia hampers social opportunities and it helps in poor mealtime for small children like Jo. This provides a disturbed relation with other kids at the school and this hampers the health and confidence of the child. This is the condition he is living with since he is neglected by his parents as their parents have 4other kids and his parents do not have time to register with the general physician. This might indicate the social condition and economic condition of Jo's family. Patients with psychological dysphagia become separated and slowly are excluded from the other children and they become very anxious and distressed during the time of the meal (Horton et al. 2018). This in turn negatively affects the patient. Their dignity, self-esteem is harmed with the exhibition of Jo's ability to maintain the personal relationship with his friends and patents and the healthy lifestyle of the child is harmed (Umayet al. 2020).
The patients like Jo are displaying the symptoms of conductive depression and if their condition is denied their social, psychological, and physical crux decreases with time (Howells et al. 2021). They seem to become fragile, and start losing self-confidence and they start to have lima cited social life and they tend to self-isolate themselves. The method of assessing the child is highly dependent on the convenience of the parents. The appointment had to be fixed with the child psychologist and already clearly the medical needs of the child and look into what are the troubles that he is facing indicating his personal information, medical history, and nutritional history. The boy is agile (Hsinget al. 2019). For the assessment, it is important to identify the symptoms and provide the solutions offered to the parents. There are many psychological problems and questions are asked by the psychiatrist is that the child can covalently answer the doctor is that his condition can be spoken and he will be involved in his treatment as he is psychologically inconsistent and he might be doing this due to the parental pressure as they neglect him because of too many kids and their social-economization (Kassaet al. 2019). The doctors must be well informed with the knowledge of his requirement so the methodological psychological assessment is to be done so that the child can have a normal childhood without any problems in his life (Krishnan and Goswami, 2018).
The assessment of methods will include:
The potential problem of patient assessment is that the patient and the mother are not clear with the conditions the child is going through and they are not able to decide what the problems of the child are. The child Jo is not talking properly in the format of his mother and there is no previous history of this kind of medical treatment (Lee et al. 2019). This will help in the understanding of the potential problem of the patients but if the patients are not opening their problems due to fear and not understanding conditions might seem a problem to the patients. The evaluation process and problem of disclosing the clinical and psychological condition of the children should be manifested based on the clinical approach (Pizzorni, 2017). The doctors can predict what the problems the child is facing are and why is the condition that he has prevalent of his age. The socio-economic and fundamentals of his health condition are to be considered so that the psychologist and psychiatrist will be able to predict the conditions of the child and what is the reason why he is behaving in that particular manner. The quiet child and their psychological development of speaking in front of the parents become difficult and they are in a state of denial and sense of mistrust among the children is relevant in this condition (Jackson et al. 2019).
In infancy and childhood, children show unparalleled cognitive and physical growth. When the children reach their linear and potential neurological growth, they sufficiently consume food with safety. Psychological Dysphagia in the children population has a detrimental effect on their physical and mental health (Halfpenny et al. 2020). Due to depression and panic-stricken conditions in the children, it is observed that swallowing becomes difficult and the extremities have lower temperatures than the rest of the body. The involuntary activity of swallowing might become problematic. Only 1% of the children suffer from dysphagia if they have a traumatic brain injury, cerebral palsy, and airway malfunction but the case of Jo is different from the conditions. His condition is more mentally associated (Cooney et al. 2018).
Figure 3: Physical condition of dysphagia with a comparison between suckling phase and eating and drinking phase
(Source: Arslan et al. 2017)
The condition Jo is to be taken care of with effective counselling and parents should be involved with his life so that he will be able to open himself up and the depression will slowly be relieved with adequate love and care as he needs attention at the moment. The nurses involved with his treatment should help to cope with the mechanism with the establishment of plywood activities in his care schedule. He must be given the space to open himself up so that he can illustrate his goal in childhood and get himself registered to a General physician so that care becomes more systematic and methodological in approach (Arslan et al. 2017). The approach of patient care should be based on person-hood care where the patients will be able to open themselves up and understand their physical and discuss their mental health with their doctors and parents. The conditions should be treated with entire counselling scheduling without any drug obit if there is any injury in the swallowing process then the drugs will be described otherwise, he should be treated with care and proper understanding so that attention-seeking conditions might not arise in the future. The personhood approach will help him to cope up with his personal development and psychological growth like a normal childhood. The severity of depression is to be controlled so that the child does not go into the clinical state of depression where he might reach the tendency of hurting himself (Robertson et al. 2018).
PATIENT 2: MICHEAL THOMAS
Introduction to patient
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Name of Patient: Michael Thomas
Date of Birth: 01.02. 1937
Age: 82 years old
Residential Address: 121 Lime Grove, Oxshott, K12 8DF
Hospital number: 1266877373
Brief Chronology of health history
The brief history of medical records shows that Thomas has hypertension and the condition is controlled with medication. He has benign prostatic hyperplasia and it is controlled with medication. He is normally fit and a good person.
Current health condition
He is admitted to the hospital as he has confusion and a neighbour found him in the garden behaving erratically. He is passing very little amount of urine and while he reached the hospital, he passed a small hard amount of faces. The condition of his skin is dry and thin. He has significantly reduced weight as his clothes appear to be loose. His current medication includes Bendroflumethiazide 2.5 mg OD, Oxybutynin 3mg OD and Lisinopril 30 mg OD. There are no indications of current allergic conditions. The baseline observations show that respiration is at 16, oxygen saturation at 97%, blood pressure 168/90, pulse rate is 98, he seems confused and the temperature of his body is 37.7oC with the reading of NEWS2 value at 4. He has a height of 1.58 weighs 48 kg, BMI is at 19 and MUST value 2.
One activity of living and rationale for the choice
From the analysis of the report of Thomas, it is seen that he has been living off the donations of comorbidity and he does not have family members or care assistance at home. He is mentally not stable as he is not able to decipher his physical surroundings and he might have the problems of forgetfulness that has set in with age (Goel et al. 2020). There was no one to live with him and take care of him because of his old age and he has been living with the complications but everything is under controlled medication (Chaisinget al. 2020).
The report does not show any kind of assistance that he has received in the past. The medications and the personhood care are not received by him in the due process and he is slowly living with comorbidity of old age such as hypertension, renal diseases as that are not diagnosed but from the picture of his urine and faecal matter, it can be deciphered. There was no prior education about the diseases. The oxygenation saturation is low and it clearly shows that the protein SpO2 is low. The comorbidities were not treated so he has been living under such conditions (Safarudinet al. 2020).
The method and tools to assess the patient will include the examination of his blood sample with the indication of his Full count blood toxicology has to be done. The blood serum should be looked for creatinine and urea sampling so that the renal condition of Mr. Thomas can be implicated from the study so that the treatment for his renal condition can begin (Chowdhury et al. 2020). The echocardiogram tests have to be conducted to look into the homeostatic ability of the cardiac vascular systems to be examined. There has to be the implementation of oxygen therapy so that the patient can breathe with high oxygen levels in the blood as from the scenario it is well coordinated that his lung functioning is not good. This shows that he is on stage 4 COPD syndrome (Hong et al. 2020).
The renal condition and implementation of dialysis can be advised to him with the approach of personhood care approach. The conditions of his comorbidity of renal disease and severe type of COPD are causing the erraticness in him and a state of confusion. This is included with the forgetfulness that begins with old age (Unger et al. 2020).
The potential problem of the patient's assessment that his overall history and the chronological order of his state of physical and mental conditions are not explained in the report that includes his medical conditions. The assessment should be confined to the understanding of his blood sugar level and hypertension (Chaising and Temdee, 2020). The causes of the medication and other description of the patient information is not provided. The neighbor has to take care of Mr. Thomas because of this erratic behavior and the possibility of such behavior is because of the oxygen contained in the body and his body (Benetoset al. 2019).
There is no clear projection of why he is losing weight and the mental care of the patient is not accurately done over time. This has profound implications on the patients with the governance of lack of care he receives ( Antzaet al. 2018).The medications are given in control with the indication of controlled for but there were no recent reports done to show the physiological conditions and loss of homeostasis in the body. Mr. Th.omas has not received any medication treatment to show the balance of his body homeostasis and the blood oxygenation level with the conference of his physical state that shows he is losing weight significantly (Bakar et al. 2020).
With age, it is observed in the elderly patients that the cognitive ability is reduced due to the formation of protein aggregates in the brain, and as the oxygen saturation level is low, there is no proper functioning of the blood-renal systems that mostly occurs with patients who are living with the comorbidity conditions of hypertension and diabetes (Ristaniaet al. 2017). Diabetes has affected the glomerular count filtration of the person and it is mostly seen because the kidney is not able to ultra filtrate in the body of the patient (Astarani and Wahyuningsih, 2018). The blood saturation is reduced in thethe heaviness of blood content. There is an immediate need for dialysis but the counting mechanism of the blood is to be checked with proper physiological and anatomical set up of the person with the convenience of systematic medical care. The control of the diseases is to be combined with the treatment of his medication and person-hood care that can be received in the conditioning of his body physiology (Charles et al. 2017).
The assessment process of the patient will include the verification of his blood test, test for his creatinine and urea content in the body is to be assayed with the education of SpO2 and SpO1 proteins to indicate the need for oxygen therapy. The regular dialysis regime is to be introduced with the personhood care in treating the patient (Woodham et al. 2018). This will particular to the common symptoms that the patients are receiving with the proper assessment and care Mr. Thomas will be able to comprehend the surroundings around him with basic understanding. The care should include palliative measures with the community-based treatment to make the patient understand his conditions; the capacitation of the patient's health quality is to be essentially measured to demonstrate the requirement of his body. The care measures will then include a person-good measure with 24*7 care provided to the patient (Padmanabhan, and Azam, 2019). The nutritional diet is to be refined with the inclusion of routine exercise (Azzannabillah, 2020).
The mental status of the patients is to be elevated with the nursing staff who will take care of the patient through this pertinent journey of his life where prevention of the disease might not be the condition (Luo et al. 2018). The patient is to be given proper care and attention so that he can deal with the pain management and management of his psychological heal and emotional attributes. Elderly patients tend to get whimsical when they don't understand the reason for their medical complications with the effectiveness of the necessary medication that is required with the counselling and practice of sustainable management practice of the patients (Boffaet al. 2019).
Looking into the case of Jo Brown, the clinical manifestation of the child is inferred as psychological dysphagia. The nursing technique that is convenient for the child is personhood-treatment with the involvement of the parents. Jo Brown's case and the knowledge of anatomy are based on the interference that can be drawn from various sources as he does not have any previous records of his conditions. The management of his disease has to be done from his end and the proliferation of his mental state should be based on the changing circumstances at his house and providing him with a basic livelihood that is adequately required for the psychological and systematic developmental growth of the children choose a Nursing assignment.
The environmental conditions and social state of the boy have to be balanced and proper care administration has to be provided ai that he can comprehend his surrounding with the acknowledgement of his parents the lives of children, it is a decorum to provide him with a basic livelihood that will help him to cope up with his surrounding and according to the concepts of Piaget, it is necessary to help with the operant conditioning so that he can nurture himself with the parental love to built his mechanism of living and empathy that will protect from his creative intelligence and help in the development of metacognitive abilities.
Looking into the conditions of Mr. Thomas it is seen that he has a complication of breathing disorder, cardiac and renal confirms that is causing him to behave erratically and there is a demonstration of medications so that he can live a safe and secure life till the last day of his life. This is indicative of the tactical phenomenological approach that is to be considered by the nurses and the doctors who are responsible for his health. The community-based approach of counselling will allow Mr. Thomas to administer the newer conditions of life and he will be able to engage with patients of his age so that it could give him a better perspective of medication scheduling and regime of his medical conditions (Shukuriet al. 2019).
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