Models and Frameworks for Adult Care - Essay Example

Introduction: This assignment is based on the problems of an adult who is 40 years old businessman. He was admitted to the surgical division for the treatment of acute pain and mobility issues. This patient was restless and complaining several other pains like abdominal pain etc. He was facing discomfort below the costal portion. In this assignment the exact nature of each problem, with important causes and symptoms, are discussed so that careful diagnosis can be carried out further. Assessment and diagnosis of both the problems are carried out using Roper-Logan-Tierney model. Furthermore care plan is constructed adopting holistic approach for each problem. Moreover, it is also explained how various interventions work together for the achievement of final goals. Mr. A, who is 37 years old adult, was facing acute back pain because of his daily activities. He was a businessman who used to sit for several hours. This was the basic reason why Mr. A was facing acute low back pain. John Popp has defined low back pain in his book named A Guide to the Primary Care of Neurological Disorder as an acute problem affecting the population all around the world. This problem is considered the most common cause of disability in the individuals at the age of 40 years and plus. The reasons behind acute low back pain may differ from one individual to another. It may occur spontaneously or because of trauma event. In an online publication put forward by Baylor College of Medicine, acute low back problems are defined as the situation when activities and daily lifestyle routine limits due to lower back problem or the symptoms less than of 4 weeks. Mr. A was also facing difficulties in carrying out daily activities in a normal way. However, it is a fact that acute low back pain is diagnosable. About 90% of patients of acute low back problems recover within 1 month. Furthermore, Low back pain can be divided into different categories. For example, none radiating, radiating, loss of motor functions, spinal fractures and infections. Mr. A was losing motor functions and developed internal infections because of acute low back pain issue. Peter A. Rives, MD., Alan B. Douglass, MD. 2004 divided low back pain into acute and chronic conditions. Mr. A was passing through acute low back pain issue. The website of European Guidelines for the Management of Acute Nonspecific Low Back Pain in Primary Care defines acute low back pain as duration of pain less than 6 weeks. While low back pain is defined as a pain or discomfort below the costal portion, with or without the legs. SCOTT KINKADE, M.D., M.S.P.H., AAFP describe that Acute low back pain with or without sciatic is limited and has no serious pathology. For most of the patients, meditations, assurance and some advices are sufficient. It is defined as the pain which occurs in region between the lower rib and the thighs and that is less than the six weeks. Acute low back pain refers a situation that is not a chronic and its onset is recent and sudden. (James M. Cox, 1999). Mr. A was passing through the same circumstances. His pain was severe and sudden. However, it was not a chronic condition. An article, Back Pain published on Back.com describes that Acute back pain is a pain which is sharp or dull, felt in the lower part of the back. Acute back pain is usually constant, but ranging on the severity. Common Causes of Low Back pain: The cause of this acute condition to the patient included Lumber Strain, Nerve irritation and several other bone and joints conditions like arthritis and injuries. These are also considered the common causes of acute low back pain mentioned by MedicineNet.com. Symptoms of acute low back: An article named Acute Low Back Problems in Adult Patients: Diagnosis, Management and Treatment Guidelines published on the site of Baylor College of Medicine describes serious spinal conditions like tumor and infections, fractures and neurological issues as the common symptoms of acute low back pain. The patient discussed here was also facing the same difficulties and symptoms. Goal of Care: There should always be a proper and rational goal of care while treating any patient. For example in this case where you are working with a patient having pain or mobility issues, you should formulate a rational goal before any treatment. Here in case of a patient suffering through severe pain it is very important to minimize his dependency and provide him an independent living. The reason behind the goal is that this is the only way a person can work and live a happy and healthy life further. Assessing and Diagnosing the Problem of Low Back Pain An initial assessment is taken when the patient contacts with the health care professional. This assessment determines and refers the patients to the other referral services. The assessment needs to take the history of the patient and the physical examination. Using Roper-Logan-Tierney Model, it is very important to understand the living conditions of the patient. History: While describing history of the diagnosis Peter A. Rives, MD and Alan B. Douglass, MD mentioned that the making of the diagnosis starts with the thorough history. Taking information is important and necessary for the diagnosis, and gives the perception that whether it is a non-specific low back pain, root nerve infection, chronic, or a serious pathology. So, in the case discussed here, we may find that patient is a businessman who used to sit most of his time. His daily activity and exercise level is very low. These conditions created pain, weakness, stiffness and numbness in his back and legs which further caused serious pain issues. Now the conditions are severe. It is also important to note here that in initial stages the pain issue limits the daily activities of the patient. Later on the patient found it difficult to walk and stand for long time. As far as location of the pain and symptoms are concerned, the patient feels extreme conditions in lower back and thighs. Pain is usually sudden and for short time. However, sometimes the conditions are severe and it takes long to recover. The patient found sore muscles just because of constant back pain. Some more conditions and symptoms are discussed here before any further diagnosis and care plan. These are faced by the patient. Red Flags: The following conditions are termed as “red flags”. Red flags are the criteria which characteristics for serious problems. Examination and laboratory tests are not indicated for acute low back pain, in the absence of Red flags. 1 Infection: fever, drug use, urinary tract infection. 2 Fracture: trauma, osteoporosis. 3 Neurological Deficit: motor weakness, disturbance of bladder control or the disturbance of bowl control. 4 Tumor: history of cancer, loss of weight, fever, pain. 5 Inflammation: stiffness, especially in the morning. 6 Systematically unwell If any of these elements are present then further investigation may be required to exclude the serious condition e.g. cancer, infection etc. Yellow Flags: It is mentioned in European Guidelines for the Management of Acute Nonspecific Low Back Pain in Primary Care that Yellow flags indicates psychological factors that can have an impact on behaviors, expectations of recovery from back pain. Yellow flags are the factors that may increase the risk of developing pain and long term disability and pain. Proper identification of yellow flags may lead to the appropriate cognitive, behavioral and social management. The purpose of assessing yellow flags is to identify that how a health care professional can have a potential of monitoring and intervention during the care program. Yellow flags include fears, social withdrawal, avoid activities and home and work environment concerns. Patients with any severe conditions always pass through these factors time to time. However, in careful treatment, it is very important to minimize the risk associated with these factors. Otherwise the conditions would be severe and patient might take long to recover. Finally, the health care professional done physical examination, general observation, regional back pain examination and neurological screening to understand the exact nature of the problem. He also tested the strength of muscles and ability of the patient to walk. Circumferential Measurements of calf and thighs and ankle and knee reflexes are also measured to identify the risk of breakage. Sensory Examination including the testing of light touch or pressure in the medial portion, dorsal and lateral is carried out as well. Other important components of the physical examination of low back pain that are carried out in this case include: 1 Palpation of bones, joints, hip and pelvis 2 Range of motion, extension with rotation 3 Special tests of abdomen, rectal and pelvic exam Laboratory X-rays and Imaging: Robert J. Flaherty, MD. And the writings of National Institute of Neurological Disorders and Strokes describe that Laboratory X-rays and imaging includes conventional X-rays, MRI, CT scan, and CT dystrophy, Ultrasound imaging, electro diagnostic procedure, Discography. This imaging should not be done during the first week but it should be done one month after the symptoms. The patient should be educated about the risks and benefits of the imaging. Imaging is necessary to confirm about the infectious disease as the cause of patient. Nursing Care Plan for Acute Pain: While explaining the care and treatment, Steven J Atlas, MD, MPH and Richard A Deyo describe those patients with acute low back pain need quite different care from different types of health care professionals and practitioners. Low back pain is cared and managed by many different health care takers e.g. general practitioners, family practitioners, physicians, orthopedics, and neurological surgeons. Firstly, care plan always require some pain management technique. So, the nurse should always perform a comprehensive evaluation of the pain. This will include all necessary details like location of pain, characteristics, duration, onset, quality, frequency, intensity and severity. After the assessment of pain, it is very important to evaluate and consider all the cultural influences. It is also very important to reduce all those factors that can increase Mr. A’s pain experiences. These factors might include fatigue, fear and monotony. Nurse should be well equipped with the use of non pharmacologic techniques. These techniques include music therapy, massage, distraction and relaxation. It is very essential to work with these techniques with Mr. A before, after and during pain. Actually these techniques are pain relief measures. Nurse should also medicate the patient according to the recommendation of doctor. However, carefully assess the hazards of sedation. At the end nurse should evaluate the effectiveness of all the pain control measures given to the patient or used in the cure of Mr. A’s pain experiences. Evaluation: Nurse should evaluate the drug, dosage and frequency of analgesic recommended. She should carefully determine the analgesic that might be narcotics, non narcotics and NSAID. This all depend on the type and severity of the pain. Here in the case of Mr. A, nurse should give narcotics to the patient to give relief from sudden pain. However, type and dosage must be according to the prescription of the doctor or health care professional. It is also important to make Mr. A, well aware about the safety precautions while using narcotics. Sometimes in the above mentioned case, Acute Pain, patients are given medication before the happening of severe pain. However, nurse should evaluate the effectiveness of medication on Mr. A, This should be especially done after the initial dosage of the medication. Carefully examine any odd symptoms and signs of the medication e.g. respiratory depression, vomiting, nausea, constipation and dryness. If there would occur any odd symptoms to Mr. A, document them in a proper way. Put into practice the actions to minimize the risk of any odd happening further that might be gastric irritation or constipation. Nursing Intervention and Care Therapies: There are many things that a nurse can do for such patients. Simple Relaxation Therapies: First of all consider Mr. A’s abilities and willingness to participate in different strategies. For example he may feel inconvenient with one relaxation strategy than another. It is very important to understand his willingness and abilities before going through any strategy. Encourage the patient to produce relaxing behaviors like yawning, deep breathing and peaceful imaging. It is also important to create healthy and peaceful environment for the patient because in acute pain as Mr. A, is passing through, any disturbance may severe the conditions. It is also essential to offer comfortable and relaxing temperature to the patients. Dim lights are always preferred in that case because these are relaxing and comforting. So, practice these relaxing techniques with the patient and document his condition and response to these therapies. MOBILITY PROBLEM As mentioned above the case of Mr. A, who is facing severe pain issues, it is important to note that acute pain, causes several other problems to the patient. The patient also feels it quite difficult to move without dependency. Chris Wright describes that mobility is a comparative condition. If a person is bound to the bed and he is well aware that it’s difficult or sometime unable to get up and move around the house then he is suffering from mobility issues. Robert Wood Johnson Foundation. Lisa I. Iezzoni, M.D., M.Sc. further explain that mobility difficulties are not only the problem of old age. May adults who don’t live in nursing homes, or don’t have nay disability, they even say that they have some difficulty in walking. Those people who have mobility problems are more likely to be obese and fat. This is the same case with Mr. A, who has very low activity level and his back pain further deteriorated his overall health. He is a businessman who used to sit for several hours and this is the reason why he is facing mobility issues as well. His mobility issues further lead him to anxiety and depression. Individuals with Mobility Impairment published on Access e learning mentions that a study shows that the mobility impairment is the second major problem among adults. Causes of Mobility Impairment: Mr. A was facing mobility issues because of several reasons. First of all his low activity level caused the issue of Cerebral Palsy. Mr. A is feeling it difficult to control and coordinate his muscle movements. Some of his muscles get stiffed which cause difficulty in walking. Muscular Sclerosis is another neurological condition in patient. This condition includes lack of balance, paralysis and fatigue in patient. Severe conditions caused by mobility impairment and pain issues further cause muscular dystrophy and heart defects in the patient. Nursing Intervention: In an online publication Defining and Classifying Nursing Interventions Joanne C. McCloskey, PhD, RN, FAAN., Gloria M. Bulechek describe that Nursing interventions are the actions which are taken by nurse. So, in this case several individualized and standardized methods will be adopted to give maximum ease to the patient. Assessment: Assessment starts with the thorough history of the patient. Taking information is important and necessary to diagnose the problem. History must be taken in a consistent and careful manner. The physician should specifically ask the patient about the age, cause of the problem, previous treatment, and pain etc. In the case of Mr. A, we can see that pain, muscle weakness and fatigue are the major symptoms. And these are the symptoms that are further causing interference in the normal mobility. Furthermore, we can see that Mr. A is not accessing and performing daily activities effectively. Now, the patient is completely dependent on his attendants because of multiple causes occurred. In initial stages, Mr. A was just passing through temporary pain and immobility. Later on the conditions became severe and cause muscle weakness, skin breakdown and depression in the patient. Now swelling, temperature and redness over shoulders, hips, heels and ankles are the common symptoms all the time. Care Plan: Care plan is always carried out up to the diagnosis of the patient’s problem. In the case of Mr. A, who is not only facing mobility issues but also going through severe pain issues, it is very important to introduce exercises and other activities that encourage mobility and positioning and alignment. So, in this case care plan should be devised in a way that can offer maximum ease to the patient. Patient’s history is always important for the health care professional. His further diagnosis all depends on this history. So, the nurse should assess the diet pattern for the patient through which the patient can lose his weight. Obesity and weight are the prior components that can deteriorate the situations. It is also important to offer satisfactory and healthy environment to the patient. The patient should be emotionally satisfied. The nurse should also assess mobility aids like wheel chairs and walkers to assist the patient. Encourage the patient to move as long as he can. Nurse should encourage the slow movements of the patient to minimize the risk of dependency. In the case of Mr. A, important tests must be carried out to identify and determine the problem in the right way. These tests may include imaging and X-rays. Medinfo website describes in its article Neurological Examination that the examiner also needs to check and examine the reflexes of the patient. Before starting any examination, the patient should be sitting in a relaxed and proper position. Reflexes should be recorded as well. Before any medication, determine the willingness of patient. It is also important for the nurse to discuss individual needs before adopting any mobility aid. Do not go for anything that may be against the will of patient. Evaluation (Outcomes): Margaret McDonnell., Jan Hentgen., Naiicy Holland., Phyllis Weisel Loevison., explained in their online publications that taking evaluation is an essential part of the treatment. Evaluation is held for judging the outcomes of the initial assessment and treatment. Patient with mobility impaired have different causes, and these problems have different type of treatments. For different types of intervention and treatments, the following outcomes are evaluated: 1 Ambulation or walking 2 Joint movement 3 Mobility level and range 4 Range of motion, slow or fast The expected outcomes of the treatment and care plan are; So, in the case of Mr. A, it is important to note that the patient should perform physical activities independently, using the devices or without any device and the patient should maintain or increase strength of limbs and any other part of the body. After medication, care plan and treatment, carefully examine the patient has improved, there is a change in the mobility of the patient or either there is a decline in the mobility of the patient. If we give careful measures to Mr. A, we may find that the patient will start recovering after few months. After 8 months having a nursing intervention, the patient is able to move within a range of motion and is able to increase the strength and function of the affected body parts. The patient’s own believe that he is going to be recovering very soon and getting back to the daily routine life, is the main and important indicator of the recovery. Psychological, social and emotional factors should be covered and controlled at the early age of illness or mobility problems. These factors influence the treatments and rehabilitation of the patient. These factors can increase the anxiety, behavior problems and depression. The patients start to demonstrate the safety in mobility. The Patient starts to understand the effect of medication in relation with mobility. The patients understand and recognize the need for appropriate devices for mobility. The patient starts to maintain a maximum level of functioning. Conclusion: Finally, we can conclude that pain and mobility are not only the issues of old age. Our daily activities and experiences play a great role in any issue occurred. However, different kinds of pain and mobility issues require different kind of treatment. History and physical examination are very important to cure the patient effectively. Treatment and remedies are always based on careful assessment of the patient. Finally, the evaluation is taken to reassess the problem of the patient and to determine and identify the improvement in the patients. Moreover, if we offer appropriate care plans to the patient, we can minimize the risk of problems. References: 1. A. John, Popp., 2007. A Guide to the Primary Care of Neurological Disorder. 2nd ed. New York: Thieme Medical Publishers, Inc. 2. Baylor College of Medicine. November 2002. Acute Low Back Problems in Adult Patients: Diagnosis, Management and Treatment Guidelines. [Internet] Houston, Texas (Published 2002) Available at: http://www.wyeth.com/resources/hcp/shared/docs/baylortreatmentguidlelines.pdf [Accessed 26 May 2010]. 3. Peter A. Rives, MD., Alan B. Douglass, MD. Journal of the American Board of Family Medicine, JABFM. 2004. 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