Investigative Ophthalmology and Visual Science †MyAssignmenthelp

Question: Discuss about the Investigative Ophthalmology and Visual Science. Answer: Introduction Ageing is an inevitable, gradual and irreversible decline in an individuals level of physical and mental functioning. Some of the risk factors associated with age include persistent episodes of medical conditions, psychological instances, lifestyle, support system and the side effects of medications used. This essay will focus on the issues captured in Amalies scenario who is aged 89 years. She is born in Germany and married in Australia by a sailor who died two years ago after a tough struggle with lung cancer leaving her with the extended family. Her only social support is her daughter Tracy and her Son Dominik who stay far from her but they regularly keep in touch with her via mobile contacts and visits. Her health has been deteriorating whereby she recently developed dry macular degeneration and mobility difficulties due to osteoarthritis and rheumatoid. Functional Consequences Theory and Clinical Reasoning Cycle will be used in identifying patient nursing priorities, setting goa ls, taking actions and evaluating the outcomes. Her priority nursing priorities include nutrition, risk of falls and injuries and vision deficit. The first priority is vision. Vision is important in all daily activities. Vision deficits are commonly associated with ageing. Therefore, Amalie being 89 years old is at a high risk of vision loss associated with ageing. Vision weakens with age leading to development of macular degeneration which leads to loss of vision among old people. It damages the macula which is responsible for sharp and central vision (Satariano, Guralnik, Jackson, Marottoli, Phelan Prohaska, 2012). Macular degeneration does not completely lead to blindness but it interferes with the simple daily activities such as reading, driving, cooking, writing and fixing other things around the home compound (Satariano, Guralnik, Jackson, Marottoli, Phelan Prohaska, 2012 From the scenario, Amalie developed dry macular degeneration which led to her withdrawal from driving and other activities she was involved in. Secondly, the referral letter from her GP states that she has vision deficits. From the Scenario, Amalie has a positive medical history of Macular degeneration which largely contributes to her current history regarding her vision deficits (Rickman, Farsiu, Toth Klingeborn, 2013). Based on this information, it is clearly evident that Amalies vision is impaired and its a priority which should be considered in nursing care. According to Levett-jones clinical reasoning cycle, nurses should toughly assess the patient by taking a detailed history on age of the patient, medical and social history which is important in diagnosis and implementing care (Levett-Jones, 2013). Assessment on Amalies ability to carry out daily activities such as cooking, driving or reading should also be included to ascertain the impacts of vision deficit and to make a plan of care for Amalie. Nursing intervention should be implemented to ensure positive outcome whereby the patient should report improved vision and ability to carry out daily activities (Satariano, Guralnik, Jackson, Marottoli, Phelan Prohaska, 2012). The second priority is risk of falls and injuries. Falls pose great risk of injuries to old people. In accordance with Millers Functional Consequence theory, changes related to age require specialized nursing interventions since ageing is gradual and irreversible. Ageing is associated with reduced daily functioning due to reduced mobility, poor hearing and vision deficits (Gillespie, Robertson, Gillespie, Sherrington, Clemson Lamb, 2012). Risk factors associated with falls and injuries are categorized into four. Biological risks which include impaired gait and mobility (Hunter, 2016). Medical conditions such as osteoarthritis, hypothyroidism and rheumatoid contribute to risk of falls and a community nurse should assess this (Almeida, 2012). Environmental risks such as stairs, poor lighting, rails and uneven clutters contribute to falls and the nurse should assess them (Forsberg, Ziegert, Hult Fors, 2014). On top of this, inadequate feeding, isolation and living alone could cause health deterioration and reduced involvement in the community. In accordance with Levette-jones model of clinical reasoning, nurses need to perform a comprehensive assessment for Amalie in order to achieve positive functional consequences (Levett-Jones, 2013). Both subjective and objective data should be collected during the assessment. Objective data includes mental status whereby Amalia is too isolated, medical history and nursing diagnosis which subjective data include the environmental factors and ageing. Nursing reassurance and education are very helpful in this instance (Cameron, Gillespie, Robertson, Murray, Hill, Cumming Kerse, 2012). From the scenario, the third priority is altered nutritional patterns which is clearly evident by the fact that she has not been eating properly and she is drastically losing weight. This priority will incorporate the remaining four steps of the clinical reasoning model on top of the first four steps. Nutrition is a very important element and requirement for proper body metabolism and system functioning. In the elderly people, sufficient nutrition is important in prevention and management of any chronic illnesses that are associated with ageing. The remaining steps of the clinical reasoning cycle will be applied in this priority of altered nutritional patterns whereby the fourth step is setting goals. The four goals set regarding Amalies care are: The patient should be able to carry out daily activities such as feeding herself without assistance. Secondly, Amalie should demonstrate increased appetite and weight gain based on the nursing care provided. Thirdly, Amalie should be able t o interact with others without isolating herself. Fourthly, she should report reduced incidences of constipation throughout the nursing care (Forsberg, Ziegert, Hult Fors, 2014). Her deteriorating health condition and mobility problems made it difficult for her to perform daily living activities such as cooking leading to alteration of her feeding patterns hence altered level of nutrition. Therefore, Amalia required an assessment on nutritional intake since inadequate nutrition can result to a high risk of dehydration and malnutrition (Gallagher-Allred, Amenta, 2016). Gastrointestinal changes associated with ageing include reduced production of saliva, decreased sensation of taste and declined functioning of body organs which consequently affects the general body metabolism, digestion and absorption of nutrients in the body (Hunter, 2016). It also impacts on the ability to excrete through the kidney and delayed bowel movements leading to persisted constipation (Cameron, Gillespie, Robertson, Murray, Hill, Cumming Kerse, 2012). Ageing is also impacts on ones appetite, reduced appetite results from changes in the functioning of the oral cavity, loss of teeth, reduced taste buds and weakening of muscles in the mouth hence reducing the strength used in chewing food (Hunter, 2016). Other changes include reduced perception of thirst and decreased mastication due to the reduction in muscle strength. Growing old is also associated with reduced production of mucus that lubricates the intestinal walls for proper flow of food materials. Ageing also reduces the level of functioning of the gastrointestinal enzymes (WHO, 2015).This may lead to accumulation of food material in the gut leading to constipation due to delayed flow of food materials and egestion. All these issues leads to a high risk of development of gastrointestinal problems (Hunter, 2016). As it is stated in the scenario, Amalie is reported to have isolation behaviors which is a possible risk of alteration in level of nutrition. When one isolates himself or herself from others, he probably ends up without eating. Food could be given to her but it remains uneaten unless there is someone who aggressively follows on her to ensure that she has eaten the food. From the scenario, Amalie is becoming isolated and she does not want to involve her daughter Tracy and her son Dominik as she feels like she is bothering them (Gallagher-Allred Amenta, 2016 Amalie feels like she is a burden to her daughter who also has her family to cater for. Her son suggested for she goes to Germany to stay with him and his family where they can closely take care of him but she declined despite her gratefulness to them. Due to this isolation, she is not able to perform her daily activities and eating becomes a problem to her. Culture is a very important aspect regarding preference of food eaten by Amalie. Having come from Germany, Amalie would want her meals be prepared in accordance with her cultural preferences. Malnutrition resulting from altered nutrition leads to negative impacts such as loss of bone density, fatigue and risk of infections (Gallagher-Allred Amenta, 2016).Reducing level of functioning, depression, weight loss and anxiety also result from malnutrition (Piantadosi, 2017).Additionally, malnutrition is associated with hip fracture, risk of falls, impaired cognitive functioning and hypotension (Clegg, Young, Iliffe, Rikkert Rockwood, 2013). Appropriate nursing interventions need to be implemented to achieve the set goals. To identify the risk factors, assessment and screening tools should be applied in Amalies scenario. Furthermore, patients nutritional history, mini-nutritional assessment and physical examination are useful in identification of the risk factors (Rantanen, 2013). Physically, Amalies ability to chew and swallow and oral health should be assessed properly and proper measures be implemented (Cameron, Gillespie, Robertson, Murray, Hill, Cumming Kerse, 2012). Risks of falling, nutrition intake and weight loss should involve a dietitian in the care of the patient who can prescribe high protein and supplementation drinks to meet her nutritional needs (Rantanen, 2013). The second action regarding difficulties in cooking due to problems with mobility, vision deficit and health deterioration, nurses can offer available community agencies such as home care, meals on wheels or shopping services to ensure adequate feeding. Amalie should first be informed about these services due to her cultural preferences (Almeida, 2012). On the sixth step of the clinical reasoning cycle-taking action, one of the action that should be taken is assessment of the skin, mucous membrane, nails and hair to check for nutritional inadequacy. The patient should be reassessed to ascertain her well-being and any positive improvement (Alfaro-Lefevre, 2015). Another action is monitoringAmalies weight should be weekly monitored to ascertain weight loss or gain. The other action that should be taken is educating her about nutritional supplementation and drinks containing high proteins for maintenance of a healthy weight. Another important action is referring Amalie to a dietitian who should prescribe for her high protein and supplementation drinks for body maintenance and weight gain. Regarding isolation behaviors, the best action is referring her to a counsellor who should educate and talk to her on how to cope up with her health issues and promote socialization. Regarding the seventh step of the clinical reasoning cycle on evaluation of nursing care, Amalie should be able to cook and feed herself. She should have increased appetite and gained weight back to normal after the nursing care that will be provided (Karlsson, Magnusson, von Schewelov Rosengren, 2013). She should also be able to socialize with the community and have reduced risk of injuries and falls (Alfaro-Lefevre, 2015).Amalie also should be reporting reduced constipation after the nutritional review and management. For reflection of nursing care in this scenario, I now understand that ageing is a gradual and irreversible process and it is associated with different medical conditions and diseases which reduce the normal functioning of the old people. I understand that ageing associate with rheumatoid, macular degeneration and osteoarthritis. Additionally, I should have recommended for a nurse to provide home-based care to Amalie since she rarely leaves her house due to mobility problems. I now understand the applicability of the Clinical reasoning model and Millers Functional Consequences Theory in care of the old people. Conclusion The main aim of this essay was to give an analysis of Amalies Scenario and create a nursing plan of care using Levett-Jones Clinical Reasoning model and Millers nursing wellness for older adults. Based on the provided information, it is clear that nurses require critical thinking in order to prioritize health issues of patients and be able to accordingly implement appropriate nursing interventions to meet the set goals and ensure positive outcomes. Initially, the three main priorities of the patient were identified and vital issues were discussed together with their impacts on the well-being of the patient. Additionally, collaborative approach of health care was discussed. This approach captured the role of nurses, dietitian and the family in provision of care for the patient. 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