Why Are Elderly Individuals at Risk of Nutritional Deficiency - Essay Example

Case Study Why is Mr Barrett considered to be ‘high risk’? Mr Barrett is considered high-risk because of two main things. First, he is elderly and, therefore, there are issues related to response to medication and psychological problems. Secondly, the patient has comorbid diabetes and anaemia (Rix & Bates 2007). The two diseases will definitely disturb the nutrition aspect of therapy. 2. What other information would you need if you were caring for Mr Barrett pre-operatively? Besides this information, the patient’s use of drugs and the kind of medication he is on must be obtained. This will help to guide the timing of the surgery, drugs to use and care to be taken. In addition, family history should be obtained in order to plan for care and discharge with the involvement of the family and the home caregivers (Dodds et al. 2001). Further, the spiritual pattern should be sought and addressed. 3. What other assessments are needed at this stage? At this stage, vital signs assessment must be done at least two-hourly to monitor the patient. Investigations on the blood grouping and cross-match should be done and safe blood for transfusion kept in wait. In addition, diabetes management and monitoring need to be done throughout the care. 4. Why are sodium phosphate bowel preparations such as Fleet Preps and Pico Preps used with extreme caution in older people? Sodium phosphate preparations often lead to adverse electrolyte imbalances which can be injurious to the health of the elderly (Mc Laughlin et al. 2010). 5. From what you know about Mr Barrett’s history, surgery, signs and symptoms (as well as your knowledge about fluid balance): Outline your rationales: Mr Barrett is oliguric and tachycardic Oliguria post-operatively results from a continuation of the factors causing the diminution of urinary flow before operation. Tachycardia can result from the effects of the anaesthetic drugs. Mr Barrett is hypotensive and afebrile. Hypotension results from reduced fluid intake through surgery. The patient is afebrile because of the invasive operation which reduces core temperatures. 6. Explain the rationales 1 Mr Barrett could go into shock. Continued hypotension will result to hypovolemic shock. 2 Mr Barrett could develop acute kidney injury. Oliguria will result to accumulation of toxic substances leading to renal complications, 3 Mr Barrett could die. The complications of shock, hypovolemia and kidney failure is life threatening. 4 Mr Barrett could become hypoxic. Tachycardia will lead to ineffective tissue oxygenation. 7. explain your rationale with Mr Barret Hypovolemia and dehydration Reduced oral intake of fluid and possible excessive bleeding during surgery result to dehydration. Hypervolemia may be as a result third spacing of fluid from the interstitial space. 8. What is the different between hypervolemia and dehydration? Hypervolemia refers to an increase in the fluid volume within the blood and lymphatic vessels. Dehydration, on the other hand, refers to a reduced fluid volume in the interstitial space (extravascular) fluid (Allison & Lobo 2004). 9. Identify four factors (at least) that led to Mr Barrett’s deterioration? Comorbid diabetes led to ineffective nutrition before surgery. An advance in age led to poor response to surgery and treatment. Psychological stress with broken marriage and loneliness negatively affected the prognosis. The Sodium phosphate preparations used before surgery led to electrolyte imbalance and possible the cause of oliguria and hypervolemia. 10. Describe causes and consequences of the third-space fluid shift. Electrolyte imbalance caused by Sodium phosphate preparations caused a fluid shift. This meant that the blood volume increased and tissue fluid was displaced. The consequences of this are that tissues became dehydrated and toxic substances including free radicals accumulated to cause cell death. Further, the increased blood volume led to cardiac overload. 11. Provide rationales to support the evidence For Mr Barrett to be normotensive with urine output at least 30-40 mL per hour within the next 24 hours. This will lead to expulsion of excess fluid and reduce hypervolemia and cardiac overload. 12. Provide your rationale and evidence to support your choice: Mr Barrett’s fluid status has improved slightly but still requires careful monitoring. You will need to contact the doctor again if further improvement is not seen in the next four hours. The patient condition is likely to reverse within a few minutes. Continuous monitoring and review are necessary (Pope et al. 2006). Respond to the following questions with reference to Mr Barrett. 13. How could Mr Barrett’s deterioration have been prevented? Avoiding the Sodium phosphate preparations before surgery. 14. What have you learned from the scenario that you can apply to your future practice? Comprehensive history taking and assessment is necessary for proper care. Further, continuous monitoring, consultation, and assessment is crucial. 15. Why are older post-operative people at risk of fluid and electrolyte imbalance? This is because they are more likely to have a renal failure that limits the balancing function of the kidney (Yee & Rabinstein 2010). Further, the older adults are predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress (Brownie 2006). 16. What actions should nurses take to promote kidney health in the community and in healthcare contexts? The nurse should ensure continuous monitoring of intake and output. This will be followed by the proper use of drugs such as diuretics to increase urine output. In the community, promoting health screening and creating community awareness is important. 17. What actions will you take in clinical practice to identify people at risk of kidney disease? I would ensure that all patients have actively monitored input-output. Further, encouraging patients to report any change in urine output and performance of urinalysis on the suspected cases is crucial (Dodds et al. 2001). References Allison, S.P. & Lobo, D.N., 2004. Fluid and electrolytes in the elderly. Current opinion in clinical nutrition and metabolic care, 7, pp.27–33. Brownie, S., 2006. Why are elderly individuals at risk of nutritional deficiency? International Journal of Nursing Practice, 12, pp.110–118. Dodds, C. et al., 2001. Pre-operative assessment of the elderly. Continuing Education in Anaesthesia Critical Care & Pain, 1, pp.181–184. Mc Laughlin, P. et al., 2010. Bowel preparation in CT colonography: electrolyte and renal function disturbances in the frail and elderly patient. European Radiology, 20, pp.604–612. Pope, D. et al., 2006. Pre-operative assessment of cancer in the elderly (PACE): A comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surgical Oncology, 15, pp.189–197. Rix, T.E. & Bates, T., 2007. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery. World journal of emergency surgery : WJES, 2, p.16. Yee, A.H. & Rabinstein, A.A., 2010. Neurologic Presentations of Acid-Base Imbalance, Electrolyte Abnormalities, and Endocrine Emergencies. Neurologic Clinics, 28, pp.1–16. Read More