Comprehensive Care for a Complex Geriatric Patient: A Multidimensional Approach

QUESTION

71year old male Diagnose with shortness of breath, fall, CHF, and Hypoxia,

Patient history: diabetes, Afib, hypertension, and possible dementia. Nuro Ax1, 4-liter cannula, wheezing, crackles RUQ, bundle breach block. 22 gage right arm, patient on PO, regular diet, fluid restriction 1500Ml a day, the patient has a pure wick, left leg cellulitis, stage one pressure ulcer, on the coccyx  area, chest x-ray : large heart, right lower lungs, atelectasis, pleural  fluid, pulmonary edema, aortic vascular disease , RBC low, hbg low, hct low,  patient hair unequally distributed, no upper teeth, left arn bruising, edema on the femur thighbone area, weak on the upper and lower extremity, two people transfer.

Narrate a two page note on patient care, assessment, interventions, monitoring, and educations

Priority 1

Nursing diagnosis 1……………………………………….R/T……………………………………………..as evidence by

Nursing intervention 1……………………………………………………………………………………………………………………..delegated Y/N to whom

Nursing intervention 2…………………………………………………………………………………………………………………….delegated Y/N to whom

Nursing intervention 3……………………………………………………………………………………………………………………..delegated Y/N to whom

Nursing intervention 4……………………………………………………………………………………………………………………..delegated Y/N to whom

Goals : short-term…………………………………………………………………………………………………………………………………………………

Long term………………………………………………………………………………………………………………………………………..

Priority2 

Evaluation………………………………………………………………………………………………………………………………….

Nursing diagnosis 1……………………………………….R/T……………………………………………..as evidence by

Nursing intervention 1……………………………………………………………………………………………………………………..delegated Y/N to whom

Nursing intervention 2…………………………………………………………………………………………………………………….delegated Y/N to whom

Nursing intervention 3……………………………………………………………………………………………………………………..delegated Y/N to whom

Nursing intervention 4……………………………………………………………………………………………………………………..delegated Y/N to whom

Goals : short-term…………………………………………………………………………………………………………………………………………………

Long term………………………………………………………………………………………………………………………………………..

Evaluation………………………………………………………………………………………………………………………………….

Priority 3

Nursing diagnosis 1……………………………………….R/T……………………………………………..as evidence by

Nursing intervention 1……………………………………………………………………………………………………………………..delegated Y/N to whom

Nursing intervention 2…………………………………………………………………………………………………………………….delegated Y/N to whom

Nursing intervention 3……………………………………………………………………………………………………………………..delegated Y/N to whom

Nursing intervention 4……………………………………………………………………………………………………………………..delegated Y/N to whom

Goals : short-term…………………………………………………………………………………………………………………………………………………

Long term………………………………………………………………………………………………………………………………………..

Evaluation………………………………………………………………………………………………………………………………….

ANSWER

Comprehensive Care for a Complex Geriatric Patient: A Multidimensional Approach

Introduction

Providing care for a 71-year-old male with a myriad of medical conditions presents unique challenges that demand a holistic and multifaceted approach. This two-page note outlines the patient’s assessment, interventions, monitoring strategies, and education plans across three prioritized nursing diagnoses. The patient’s complex medical history, including diabetes, CHF, hypoxia, hypertension, and possible dementia, underscores the need for tailored and vigilant care.

Priority 1: Managing Cardiovascular Health

Nursing Diagnosis: Impaired Gas Exchange related to pulmonary congestion as evidenced by wheezing, crackles in the right upper quadrant, and hypoxia.

Nursing Interventions

Administer oxygen therapy via 4-liter cannula to improve oxygenation (Delegated: RN).
Monitor oxygen saturation levels using a pulse oximeter (Delegated: PCA).
Assess breath sounds and lung sounds frequently to detect any changes (Delegated: PCA).
Collaborate with the healthcare team to adjust fluid restriction as needed to alleviate pulmonary congestion (Delegated: MD).

Goals

Short-term: Increase oxygen saturation to 95% or above within 24 hours.
Long-term: Improve lung function and reduce pulmonary congestion within one week.

Priority 2: Addressing Nutritional and Skin Health

Nursing Diagnosis: Impaired Skin Integrity related to pressure ulcer and cellulitis as evidenced by stage one pressure ulcer on the coccyx area and left leg cellulitis.

Nursing Interventions

Implement pressure-relieving measures, such as repositioning every two hours and using pressure-relieving devices (Delegated: PCA).
Monitor the pressure ulcer for signs of infection and healing progression (Delegated: PCA).
Administer prescribed antibiotics for cellulitis as per MD’s orders (Delegated: RN).
Educate the patient on the importance of proper nutrition and hydration to support wound healing (Delegated: RN).

Goals

Short-term: Prevent infection and promote healing of the pressure ulcer within one week.
Long-term: Achieve complete healing of the pressure ulcer and cellulitis within one month.

Priority 3: Cognitive and Functional Support

Nursing Diagnosis: Disturbed Thought Processes related to possible dementia and multifaceted medical conditions as evidenced by weakness, confusion, and impaired functional ability.

Nursing Interventions

Provide a safe environment by removing trip hazards and ensuring well-lit pathways (Delegated: PCA).
Collaborate with the interdisciplinary team to assess cognitive function and plan appropriate interventions (Delegated: RN, SW, OT).
Educate the patient’s family on communication strategies and the importance of engagement and mental stimulation (Delegated: RN).

Goals

Short-term: Minimize fall risks and enhance patient’s cognitive engagement within one week.
Long-term: Optimize cognitive function and ensure a safe and supportive living environment.

Conclusion

Caring for a complex geriatric patient demands a comprehensive approach that addresses the interplay of medical conditions, functional limitations, and cognitive challenges. By prioritizing cardiovascular health, addressing nutritional and skin integrity, and providing cognitive and functional support, the patient’s overall well-being is enhanced. The collaborative efforts of healthcare professionals ensure that the patient’s unique needs are met, fostering a holistic and person-centered approach to care.