JOCK (75y/o)

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JOCK (75y/o) by Mind Map: JOCK (75y/o)

1. Diagnosis + Medications

1.1. Leg ulcers: both legs

1.2. Advanced congestive cardiac failure

1.2.1. Medication: Frusemide 40mg mane

1.2.1.1. Loop diuretic for treatment of cardiac failure and oedema

1.3. Shortness of breath on exertion

1.4. Bilateral leg swelling

1.4.1. excess fluid volume

1.4.1.1. relieve overfluid syndrome

1.4.1.1.1. monitor fluids

1.5. Hypertension

1.5.1. Medication: Metaprolol 40mg mane

1.5.1.1. Selective B1 receptor blocker - treatment for hypertension

1.6. Limited mobility

1.7. Dietary supplements

1.7.1. Slow K: 1 tablet mane

1.7.1.1. Potassium-chloride - electrolyte replenishment

1.7.2. Multivitamin: 1 tablet mane

2. Providing health services to assist patient with ADL'S: such as meals-on-wheels, assistance with grocery shopping or house cleaning, OT to place handle bars around house where there is increased risk of falls to increase ability to ambulate.

3. Functional Consequences: Observable effects of actions, risk factors and age related changes that influence the quality of life or day-to-day activities of the older adult

3.1. +tve

3.1.1. Those that facilitate the highest level of functioning, the least dependency, and the best quality of life

3.1.1.1. Maturity and wisdom

3.1.1.2. Family support through the nephew

3.2. -tve

3.2.1. Those that interfere with the older adult's functioning or quality of life

3.2.1.1. Pain resulting from chronic leg ulcers

3.2.1.2. Limited mobility

3.2.1.2.1. Unable to access adequate nutrition

3.2.1.2.2. Social isolation

3.2.1.2.3. Falls risk

4. Community Healthcare Centre

4.1. Assessment Process

4.1.1. Diet and Nutrition

4.1.1.1. Traditional Vietnamese foods, 'careful' with diet. Recently changed with increased western foods from nephews influence.

4.1.1.1.1. Unable to do the grocery shopping due to decreased mobility, nephew taken over this activity.

4.1.1.2. Medication to increase nutritional intake

4.1.2. ACAT/ACAS (Aged Care Assessment Team/Aged Care Assesment Service - in Victoria)

4.1.2.1. Packages: Many services put together into a bundle to help individual needs in the community

4.1.2.1.1. CACP (community aged care package): Low care at the patients home, assistance with ADL's.

4.1.2.1.2. EACH (Extended aged care at home): High care treatment at the patients home, for people who need more help than care provided in the above package.

4.1.2.1.3. EACH-D (extended aged care at home for dementia): Highest level care for those who experience difficulties in daily life because of behavioral and/or psychological differences.

4.1.2.1.4. HACC (Home and community care): Assists patients to continue to live independently at home by providing support for them to participate in social activities, maintaining social contacts and supporting independence in ALD's and essential activites such as banking and shopping.

4.1.2.1.5. CDC (Consumer Directed Care) Packaged care: Gives patient and carer a greater say of treatment options in their home.

4.1.2.2. Who: ACAT/ACAS is run by all three levels of government (federal, state and local - excluding victoria which is state and local only) and is built up of a team of healthcare professionals, those involved specifically to individual patient needs will be the assessors. ACAT/S is available to all Australian citizens and those aged over 75 free of charge or government subsidised, Australian residence and those under 75 years will have altered access and services provided.

4.1.2.3. What: A government funded service that undergoes comprehensive assessments and establishes the patient's needs, their eligibility and assess how well the patient is able to cope with ADL's and forms together a 'package' to support independence.

4.1.2.4. How: If ACAT/S assessments are required; health professionals can evaluate the patient and then refer them for an assessment, ACAT/S will then meet with the patient (and family/caregiver(s)) to discuss their needs and from there visit at the patient's home to assess the patient holistically. The ACAT/S assessment will then have evaluated and determined patient needs and provide a suitable 'package' and options for the patient to consider. These assessments are valid for a 12 month period.

4.1.3. Physical Exams/Assessments

4.1.3.1. Conducted by health professionals at community healthcare centre

4.1.3.1.1. Nutritional intake assessment

4.1.3.1.2. Fluid chart: to measure intake and output for dietary needs and also effectiveness of medication.

4.1.3.1.3. Wound care: assessment of leg ulcers for improvement or deterioration, effectiveness of preventative strategies and intervention methods

4.1.3.1.4. Vital signs: observing blood pressure for hypertension and oxygen levels and respirations from shortness of breath.

4.1.3.1.5. Falls risk assessment: Due to hypertension and cardiac failure, SOBOE, medication adverse effects, leg pain from ulcers and oedema, decreased mobility

4.2. Evaluations

4.2.1. Interventions: actions by nurses or other healthcare professionals

4.2.1.1. Referals: ACAT/S, OT

4.2.1.2. Implementing medications to assist with biological/physical health conditions

4.3. Purpose

4.3.1. Aim: for patients to actively participate in their healthcare, promote prevention of lifestyle related diseases, coordinate with other healthcare facilities and professionals to create patient centred care.

4.3.2. Services/Resources: Counselling and support, health promotion, medical/dental and nursing services, aged care services, specialised programs (maternity, drug/alcohol, disability or mental health)

4.3.3. Role: Provide health promotion and disease management and prevention, increase general well-being among communities and elevate pressure from acute health services

4.4. Nurse

4.4.1. Role

4.4.1.1. Assessment

4.4.1.1.1. Take part in and undergo assessments on patient

4.4.1.2. Care/Advocacy

4.4.1.2.1. Empathetic and passionate for patients and community, treating patient holistically and being involved in treatment interventions

4.4.1.3. Colaboration

4.4.1.3.1. Working in a multidisciplinary team to achieve best patient-centred individualised care

4.4.1.4. Referral

4.4.1.4.1. Referral of health issues on to appropriate services/professionals - such as ACAT/S, OT, meals-on-wheels services

4.4.1.5. Health promotion

4.4.1.5.1. Inform and educate patients and the community about what it means to be 'healthy' and its importance, education about prevention of illness and disease, overall aim to increase general well-being.

4.4.1.6. Research/educaiton

4.4.1.6.1. Conducting research into specific conditions to further knowledge and treatment options, general health research to remain well informed and updated with the latest technologies and treatment options, practicing clinical reasoning and ethical obligations.

5. Age Related Changes: Inevitable, progressive and irreversible that occur during late adulthood and are independent of extrinsic or pathologic conditions

5.1. Specific to patient

5.1.1. +tve

5.1.1.1. Increased wisdom and maturity

5.1.1.2. Identifying that having his legs in a dependant position causes more pain and avoidance of this increases his comfort levels

5.1.2. -tve

5.1.2.1. Limited mobility

5.1.2.2. Experiencing the emotional toll of death

5.1.2.3. Hypertension

5.1.2.4. Social iscolation

5.1.2.4.1. Leaving the workforce (market gardener)

5.1.2.5. Impaired circulatory system

5.1.2.5.1. Development of chronic ulcers

5.1.2.6. Respiratory system decline

5.1.2.6.1. Shortness breath on exertion

6. Relationships/connectedness :These connectedness interventions promote wellness in older adults. A holistic perspective focuses on the potential of every person to experience wellness by achieving higher levels of psychological or spiritual functioning.

6.1. Metaphysical connectedness

6.1.1. teaching about guided imagery, journaling activities, and activities that increase self-esteem and a sense of optimism.

6.2. Biological connectedness

6.2.1. facilitating participation in congregate meals, doing group exercises to music.

6.2.1.1. Matt(nephew)

6.2.1.1.1. cook or buy traditional Vietnamese food for Jock

6.2.1.1.2. do some exercise with Jock in the park nearby.

6.2.1.2. wife & son(deceased)

6.2.1.2.1. According to the traditional etiquette mourning the death of his wife and son.

6.3. Spiritual connectedness

6.3.1. arranging transportation to local church services or making referrals to faith-based groups.

6.4. Environmental connectedness

6.4.1. encouraging and facilitating activities in nature, referring for transportation resources.

6.4.1.1. encourage the relationship with neighborhood, join in their activities.

6.5. connectedness to Society

6.5.1. providing information about support resources, helping older adults develop contingency plans for emergencies.

6.5.1.1. emergency contact person (Matt)

6.5.1.2. keep neighbor’s contact detail in case he needs help in emergency.

6.5.1.3. Encourage Jock go to local church every week with carer or nephew

6.5.1.4. ACAT/ACAS (aged care assessment team/aged care assessment service) can provide assistance with ADL’s for Jock. Such as CACP (community aged care package) can provide care at Jock’s home, or CDC (consumer directed care) packaged care can figure out a best treatment solution for Jock in his home.

7. Theoretical Perspectives on Ageing

7.1. Wear and Tear Theories

7.1.1. Definition:The wear and tear theory of aging believes that the effects of aging are caused by damage done to cells and body systems over time. Essentially, these systems "wear out" due to use. Once they wear out, they can no longer function correctly.

7.1.1.1. Decreased mobility and sensory impairment eg. Eyesight

7.2. Cross-linkage Theory

7.2.1. With age, proteins, DNA and other structural molecules develop abnormal bonds or cross-links to one another. These abnormal bonds decrease the mobility or elasticity of proteins. These damaged proteins, accumulate in the cells and create problems.

7.3. Free Radical Theory

7.3.1. Defence and repair mechanisms become less effective with age because of increased oxidative burden or inhibited repair/removal systems.

7.3.1.1. Jock's leg ulcers are chronic and have a prolonged healing process

7.4. Neuroendocrine and Immunity Theories

7.4.1. Age related diminished function of the immune system that increases the susceptibility of older people to disease. Patient has ulcers on both legs. Because the skin loses underlying fat layers and oil glands, causing wrinkles and reduced elasticity.There is increased susceptibility to cold, bruising and bedsores in the elderly. Assess client's nutritional status. Refer for a nutritional consult, and/or institute dietary supplements as necessary.

7.4.1.1. Immune system decrease, aged appearance, bed sores...in this case ulcers

7.5. Genetic Theories

7.5.1. The genetic theory of aging believes that lifespan is largely determined by the genes we inherit. According to the theory, our potential age is primarily determined at the moment of conception. Some genes are beneficial and enhance longevity. But some genes are harmful, like those that increase the risk cancer. Some gene mutations are inherited, too, and may shorten lifespan.

7.6. Apoptosis

7.6.1. Apoptosis is a non-inflammatory, gene-driven, normal developmental process that occurs continuously throughout life. This process is characterised by cell shrinkage and maintenance of membrane integrity. When apoptosis is properly regulated, it is beneficial because it helps maintain a balance between cells that should be retained and those that should be eliminated.

7.7. Kilojoules/Calorie Restriction Theories

7.7.1. Reducing kilojoule intake by between 30% and 40% is the one intervention that dramatically increases life span. Severe kilojoule restriction without malnutrition has beneficial effects in animals. This research has not been applied to human.

8. Risk Factors: Conditions that increase the vulnerability of older adults to negative functional consequences

8.1. Specific to patient

8.1.1. Chronic venous insufficiency

8.1.1.1. Bilateral leg swelling

8.1.2. Age

8.1.2.1. less efficient of peripheral circulation

8.1.2.1.1. leg ulcers

8.1.3. Prolonged bed rest

8.1.3.1. Pressure sores

8.1.3.1.1. Damage to the skin

8.1.4. Pain

8.1.4.1. Limited mobility

8.1.4.1.1. Leg ulcers

8.1.4.2. Shortness of breath on exertion

8.1.4.2.1. Leg ulcers

8.1.5. Diseases are not healing

8.1.5.1. Stress

8.1.5.1.1. Increase blood pressure

8.1.6. Hypertension

8.1.6.1. Advanced congestive cardiac failure

8.1.7. Unfavourite food

8.1.7.1. Poor appetite

8.1.7.1.1. Imbalance nutrition intake

8.1.8. Loss of family

8.1.8.1. Grief

8.1.9. Advanced congestive cardiac failure

8.1.9.1. Shortness of breath on exertion

8.2. Preventions/Interventions

8.2.1. Mild exercise and regular position changes should be recommended. Patient’s education against further potential ulcers development should be discussed . Negotiate with families how to boost patient’ appetite. E.g. Traditional and various vietnamese food. The importance of hygiene. For example: keep the infected area dry and clean and apply some dermis cream to body after shower. Keep the feet elevated as much as possible . Increase social life with people from same background

9. Psychosocial

9.1. Environmental: Affects patients level of functioning and quality of life, comfortability and can interfere with well-being, creating increasesd risk factors.

9.1.1. Cultural

9.1.1.1. Vietnamese: Came to Australia from vietnam as 'boat people'

9.1.1.2. Dietary differences: Prefers traditional foods

9.1.1.3. Non-english speaking background: English as second language.

9.1.1.3.1. Possible problems with health literacy

9.1.1.3.2. Possible difficulties in social/societal situations

9.1.2. Occupational: Worked as a market gardener until decline in his health

9.1.3. Home: Lives on the top floor in a block of units with nephew, Matt.

9.1.4. Affects patients level of functioning and quality of life, comfortability and can interfere with well-being, creating increasesd risk factors.

9.2. Cognitive

9.2.1. Patient Dignity: A self concept state of worthiness, honour and respect

9.2.2. Coping Skills

9.2.2.1. Death

9.2.2.1.1. Refers to wife: 'that kind of love only comes once', experienced death of wife and unborn son.

9.2.2.2. ADL's

9.2.2.2.1. Decreased ability to ambulate down stairs of his building due to leg pain from ulcers and oedema. Increased difficulty with daily tasks due to SOBOE and possibly hypertension.

9.2.2.3. Pain

9.2.2.3.1. States there have been increased pain with leg ulcers and pain electorates when legs are in a dependant position. Possible chest pain due to cardiac failure.

9.2.2.4. Mobility

9.2.2.4.1. Declined mobility due to age related changes/wear and tear, also from leg pain (ulcer and oedema), less inclined to walk down/up stairs of building and run errands

9.2.3. Mental Capacity + Wisdom

9.2.3.1. Ability to speak Vietnamese and English

9.2.3.2. Sociological age: involves roles and behaviours of how Jock responds to society.

9.2.3.2.1. Uncle and house member to Matt, Vietnamese australian member of society - decreased contribution through work due to decrease in health

9.2.3.3. Psychological age: Jock's ability to adapt to environmental demands.

9.2.3.3.1. Adapted: death of wife, moving to Australia, living with nephew, no longer working, decreased physical functioning.

9.2.4. Spiritual

9.2.4.1. Believes that the love he felt with Minnie only comes once.

9.2.4.2. Vietnamese traditions/beliefs

9.3. Family and Caregivers

9.3.1. Matt (Nephew)

9.3.1.1. Positive functional consequences: Increased social contact, assistance with ADL'S, emotional support.

9.3.1.2. Negative functional consequences: Lack of understanding with diet - changed to western style foods.

9.3.1.2.1. Interventions: Community service for preprepared meals or grocery shopping assistance

9.3.2. Minnie (Wife)

9.3.2.1. Deceased: Over 30 years ago from childbirth complications, unborn child (boy), did not survive.