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Patient Assessment
Conclusion on alzheimers disease treatments
Patient Assessment
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Mrs. Andreotti is an 87 y.o female seen at home for an initial visit at the request of ARNP Garrison, I am asked to see this patient to assist with symptom management and exploration of palliative treatment options in the setting of the patient's complex medical illnesses. A review of the medical records indicates that the patient suffer from multiple medical illnesses including advanced Alzheimer's, chronic Afib manage with medications and xarelto, chronic anxiety, chronic agitation, chronic depression, and chronic hyperlipidemia.At today's visit she is accompanied by her daughter. She is awake and alert. The daughter states that the patient was recently evaluated by hospice by not admitted due to a prognosis of greater than 6 months. The
Public health officials estimate that up to 50% of all antibiotics use in the U.S is either unnecessary or in appropriate.
Question 1: a) Donna Gamble is an Aboriginal woman who lives in her hometown of Saskatoon, Saskatchewan. She is a former ward of the state and has spent a significant part of her youth inside juvenile correction centres. At a young age she started using drugs and alcohol as a form of escape and resorted to prostitution as a means of sustaining her habits. Donna has six children, all with the exception of the youngest two who were placed in the custody of child services. Donna has quit working as a prostitute and is currently on the road to recovery from years of addiction and abuse.
Rosa Lee Cunningham is a 52-year old African American female. She is 5-foot-1-inch, 145 pounds. Rosa Lee is married however, is living separately from her husband. She has eight adult children, Bobby, Richard, Ronnie, Donna (Patty), Alvin, Eric, Donald (Ducky) and one child who name she did not disclose. She bore her eldest child at age fourteen and six different men fathered her children. At Rosa Lee’s recent hospital admission to Howard University Hospital emergency room blood test revealed she is still using heroin. Though Rosa Lee recently enrolled in a drug-treatment program it does not appear that she has any intention on ending her drug usage. When asked why she no longer uses heroin she stated she doesn’t always have the resources to support her addiction. Rosa Lee is unemployed and receiving very little in government assistance. She appears to
Read the posted case study about Benita Vasquez and discuss the following questions: 1. What are the clinical causes of death in the story? a. Senora Vasquez died because of uncontrolled diabetes, Infected wound and diffusing kidneys. With not well-controlled diabetes and acquiring an infected burn wound makes it harder for the patient to get treatment. Thus with the condition of the patient and her current social status, she is unable to afford the treatment and medications needed to alleviate her suffering.
I carried out this case study on Mrs. Casey (Pseudonym), any 86 year old woman who underwent an elective left total hip replacement (THR). After the OT student studied Mrs. Casey's past medical history in her medical chart, it was noted that she had previously undergone a right THR in 2011, which had been successful and free from complications. Ms. Casey had no other significant past medical history and had been an independent and active woman before the progression of her arthritis. Ms. Casey was required to have total hip replacements carried out on both hip joints as a result of severe Osteoarthritis (OA), which lead to stiffness, pain, and an eventual decrease in mobility, affecting her quality of life and involvement in meaningful occupations.
The ethical principle of nonmaleficence demands to first do no harm and in this case protect the patient from harm since she cannot protect. Nurses must be aware in situations such as this, that they are expected to advocate for patients in a right and reasonable way. The dilemma with nonmaleficence is that Mrs. Boswell has no chance of recovery because of her increasing debilitating mental incapability and the obvious harm that outweighs the intended benefits. If the decision were to continue treatment, suffering of the patient and family would be evident. Autonomy is the right to making own decisions and freedom to choose a plan of action. When making decisions regarding treatment of another person, it is important to respect the expressed wishes of the individual. John says that his mother would want to live as long as she could, but questions arise related to her quality of life and perception of prolonged suffering by prolonging the dying process. In BOOK states that quality of life changes throughout one’s life ...
I will be evaluating the case of Angela and Adam. Angela is a white 17 year old female and Adam is her son who is 11 months old (Broderick, P., & Blewitt, P., 2015). According to Broderick, P., & Blewitt, P., (2015) Angela and her baby live with her mother, Sarah, in a small rental house in a semirural community in the Midwest. Adam’s father, Wayne, is estranged from the family due to Sarah refusing to allow him in the house however, Angela continues to see him without her mother’s permission which is very upsetting for Sarah. Angela dropped out of high school and struggles raising her son (Broderick, P., & Blewitt, P., 2015). With all that is going on in Angela and Sarah’s life right now their relationship has become strained and hostile which
Gawande’s book is very pertinent to the present day and has by many accounts sparked a national discussion on end-of-life care and how we treat our elderly. With elderly people accounting for a greater proportion of the American populace and as people start living even longer than they do now, end-of-life care will become and remain a major issue faced by doctors, patients, their families, and the healthcare system. Additionally, with our greater focus on improving patient outcomes while getting the most value for our healthcare dollars, end-of-life care is a major area that healthcare systems and hospitals will focus on, as it accounts for a large portion of their budget. As a response to the need to take care of our aging population, hospice care and palliative medicine are some of the newer specialties in the medical field that have been increasing in popularity and more research needs to be focused in these areas to better understand how to improve patient outcomes.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
It can also accompany with the necessary work of determining, if the patient is showing any variation of illness denial. (Lumbinsky MS). Most of the people they express their desire about their disease diagnosis, prognosis and condition of their illness. Shunning information is one of the valid psychological coping mechanism. Discussing the information and requesting for another diagnostic test is the key for scheduling next counselling with the patient. In the fourth step, the nurse should warn the patient, the bad news is coming soon. So the patient cannot embarrassed too much. Example;” I have one bad news for you” I am sorry to tell you that”. The nurse conveys this bad news in simple language for patient understanding. The care provider should use’sample of tissue” instead of” biopsy.” Nurse can share only small chunk of information with the patient and simultaneously assess the patient understanding level. If the patient’s prognosis is poor, tell about the pain control and symptom management. In the fifth step, nurses having greatest challenge, in managing the patient’s emotion after they heard about their bad news. The patient may show their feelings like, anger, denial ,unbelievness, and
In order to accurately meet our patient's needs, our hospital has adopted a few assumptions. While our hospital's views may conflict with our patients' views and values, we believe every human being has the right to life. However, a patient knows himself or herself best, and through this we respect our competent patients' wishes when concerning their end of life care. Our hospital will respect the decisions of competent patients to refuse treatment without which they will surely die. However, due to the finality of such a decision, we will require that a given patient undergo two psychological evaluations in order to confirm competence beyond any reasonable doubt. Furthermore, our policy aims to assure that decisions of this magnitude are not made in haste. To accomplish this goal, the hospital will require a minimum 48-hour waiting period for treatment to be withdrawn following competence verification. Thus, patients will have ample time to review and reflect over their decision in much the same manner that mandatory waiting period legislation for obtaining handguns seeks to limit ill-advised choices made in the heat of the moment.
Mrs. D. was admitted to the unit in 2011. She is 84 years old widow who was diagnosed with dementia, diabetes mellitus type II, hypertension, high cholesterol
...eeds of the adult/gerontology population, especially within the context of palliative care. As nursing continues to shift towards an evidence-based approach in health care, I am also interested in participating in the synthesis and dissemination of research-based guidelines in palliative care. UCLA’s advanced practice nursing degree program is nationally recognized and the medical center is known for its care on the adult/geriatric population. My brief tenure at UCLA has been a rewarding experience and an opportunity to continue contributing to this institution as an advanced practice nurse in palliative care would be an honor. My goal to maximize the use of this valuable, but currently underutilized resource within the acute care setting is ultimately about helping patients achieve and maintain a quality of life that is both acceptable to them and their families.
will have to make the decision on where the patient want to spend their last days, treatments
Knowing that dementia has no cure, most elderly with are concern and have requested to spend their last days with families and loved ones in their homes. Yet it is reported that their wishes are not granted and most die in hospitals or acute care centers with less trained providers that understand their illness. Bayer, A. (2006), reported a case in 2003 which occurred in london. Patients that had died with cases of dementia were not recorded or evaluated for cognitive dysfunctions(p.101). Although other forms of methods were provided such as the mechanical ventilation and central venous lines, however they were not used as frequent as they should have been. In addition, dementia patients did not receive adequate