Palliative Care for Urinary Tract Infections in Elderly Patients - Essay Example

?Palliative care for Urinary Tract Infections in elderly patients The aim of this paper is to critically reflect on a nursing experience in palliative care in relation urinary tract infection and dementia and demonstrate the knowledge and skills applied and acquired as a nursing student. In essence there is an attempt to document the symptoms, symptom management and existing medical regulations and standards that are associated with this medical condition and how these symptoms impact on the patient’s care that are experiencing this disease. The guiding principles that will be adopted for this reflection will be influenced by Gibbs (1988) model of medical reflection. By an extension, these principles also provide a cyclical model which will enable me to reflect upon this problem and subsequently examine my nursing practice as a founding point for further development and improvement in the nursing profession. Description In this paper I will be reflecting on an experience with a patient who was suffering from urinary tract infection, dehydration and dementia, whom I encountered during my community placement. This patient was suffering from Urinary tract infection and dehydration and had been transferred to the ward from Emergency Medical Unit (EMU). The patient was also suffering from dementia and during the handover it was mentioned that she could be both verbally and physically aggressive. It was also handed over that she had intravenous (IV) fluids prescribed and needed a cannula insertion as she had removed the one previously in place. This involved a patient who will be referred to as Mrs P, in order to maintain confidentiality and anonymity (NMC 2008). Mrs P was an elderly 79-year old woman who was suffering from dehydration and urinary tract infection. Mrs P had also been diagnosed with dementia, and was reported as being aggressive both physically and verbally. Feelings Initially when we opted to insert the cannula into the patient initially she agreed to our intentions only to turn aggressive and unmanageable, later my mentor advised the matron to insert the cannula, which she did though without the patient’s consent, as the patient shouted and almost made the whole process impossible. I was disturbed by these two related events, first, the patient’s aggressiveness and two, our forceful way to inserting the cannula into the patient. Thus these situations brought in me a need to find out more about the patient and their condition, and the consequences of the matron’s decision. When I met the patient I felt sympathetic towards her and her insistence to refusing the cannula insertion given her general condition. A mixture of thoughts crossed my mind, although I could understand why she did not want to undergo the process, but this thought was not conclusive for me as a medical student. On reflection it seemed a positive experience as it allowed me to see how people cope differently with medical conditions, and the impact it has on the patient and the entire therapeutic process. Evaluation During this experience I thought that the nursing team had built a good professional relationship with the patient and therapeutic process. The patient had plenty of time to discuss any concerns or issues that she had and any of her reasons for refusal the cannula insertion. In my mind, I had theorized that the issues that had been discussed or ought to be discussed included issues such as symptom management; how the patient is feeling is important and needs to be taken into consideration. This would also need to be discussed with her partner alone, to find out how she is feeling and to find the best medical alternative for her treatment. This is why the Visual Analogue Scale could have been helpful for monitoring the progression of the patient’s condition (Crichton 2001). Since I have used the tool before, I find it to be beneficial for effective monitoring of patient’s condition because it was a good indicator as to when we would need to adjust her analgesia using the World Health Organization (WHO) analgesic ladder (WHO, 2005). This aims to give the correct drug, correct dose, given at the correct time and proves to be inexpensive and 80-90% effective (WHO, 2005). This ensured the patient was in the least amount of pain and anxiety which enabled them to carry on with activities of daily living and cope with drug administration. At the same, therapeutic counselling would have proved handy as it provides useful insights into understanding a patient’s internal mental faculties and their attitudes towards medical equipments like the cannula, so that alternate medical options could be exploited those that are not associated with psychological distractions from the patient. Analysis The World Health Organization (1990) has defined palliative care as: “The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families.” Caring for those receiving palliative care in the hospitals requires an extraordinary commitment from the nursing team, not only human resource but also competence, compassion and focus in anticipating the needs of the patient and family. It is a complex activity involving a holistic approach, building relationships together with expert professional skills and decision making processes (Melvin 2003). Urinary Tract Infections (UTI) cause serious health problems in many patients. UTI occur as a result of bacterial infection that occurs in the kidney or bladder. If let unattended to, this condition may lead to more serious health problems more than the normal discomfort symptoms. Apart from chronic or acute kidney infections that can cause permanent kidney damage, UTIs are also responsible for causing sepsis, which in its own class is a dangerous infection of the blood stream. The elderly people experience more cases of UTIs and are therefore more susceptible to this disease. The National Health Institute (NHI) generally agree that the elderly are more prone to these diseases due to among other reasons, their reduced immune system that is often related to age and also progressive conditions that are mostly related to aging. Compared to younger persons who are able completely empty their bladders keeping less bacteria accumulation, the elderly due to already weakened muscles, more urine is thus retained in their bladders leading to a poor process of emptying their bladder and also incontinence resulting to UTIs. It has been established that there exists a direct relationship between dementia and urinary tract problems. The disease has been a major source of dementia in both the old and young people. An estimation by the Congress Office of Technology (SHC) estimates that 6.8milion are affected by dementia and another 1.8million are seriously affected. Patients who suffer from UTI display symptoms that are associated with appearance of cloudy and bloody urine, and characteristic foul smell in the urine odor; frequent urge to urinate. During the process of urination, these patients also report cases of feeling pain and a pressure feel in the lower region of the pelvis with subsequent low class fever. Other cases of sweats, shaking or chills have also been reported at night in many patients. Unfortunately, elderly persons rarely display a clear hallmark of fever symptoms since their immune system is characteristically weak and therefore unable to initiate internal response mechanisms to diseases resulting from their aging nature. It has been suggested that, the elderly do not exhibit any common symptoms to UTI and therefore their caregivers have a difficult time noticing such. According to NIH, recent studies suggest that cases of UTI are often being mistaken for that of early dementia stages since these symptoms are often associated with confusion, hallucinations, agitation, characteristic behavioral changes and poor ability to coordinate the motor processes. At times, these are the only symptoms that display for UTI in the elderly people with feeling of no pain, fever lacking, or other characteristic symptoms that clearly define UTI. Dementia is commonly understood as a collective term for symptoms that generally include decreased mental functioning that interferes with the daily life processes. More generally, one or major life functioning processes are impaired and such are associated with memory loss, poor language coordination and judgment and ability to perceive things correctly. Subsequently, these patients often lose both their ability to control their emotions and behavior, develop changes in their personality, and their abilities to handle problems become significantly reduced. For easier understanding, dementia has been classified on various classes based on the degree of the problem. These may include cortical, sub-cortical, progressive, primary and secondary. However, it should be noted that not all conditions are associated with dementia, through some conditions may resemble dementia. Such include depression, age related cognitive decline, delirium and low level cognitive impairment. It may also be difficult to characterize whether a dementia patient is suffering from UTI since most of the patients are unable to articulate fully their feelings an unable to clearly express their pain. When dementia and UTI occurrences occur in combination in a patient, it has profound effects on their physical well being, behavior changes including disorganized mental processes, disorientation with regard to time and place and apathy. NIH also suggests that, elderly people are often more susceptible to UTIs due to diabetes, use of urinary catheter, retaining urine, enlarged prostrate, bowel incontinence, kidney stones or surgery around bladder. The paperwork handed over by EMU indicated that Mrs P had a score of 2 and a body mass index under 18. Being guided by Malnutrition Universal Score Tool (MUST) chart I commenced Mrs P on a food chart and left an answer phone message for a dietician to review Mrs P and advice on diet and any supplements she may require. This was informed by the fact that Mrs P was greater than 65 years. As Mrs P is 79 years old we took the ?65 years conversion to determine her food chart (BAPEN 2003). After insertion of the cannula, we administered 1 litre of normal saline, a giving set and a Grasby pump. We checked the prescription chart again and checked Mrs P’s details on the prescription with those on her wrist band, checking name, date of birth and hospital number. We also checked it was the right drug at the right time, right dose and administered via the correct route before starting the pump (NMC 2010). However, during this process and Mrs P’s attitude, I realised just how important communication is, not only in this situation, but any situation that includes the patient, relatives, carers and multi-disciplinary team. Communication is an essential part of good nursing practice and forms the basis for building a trusting relationship that will greatly improve care and help to reduce anxiety and stress for patients, their relatives and carers (NMC 2008). Groogan (1999) acknowledges that communication is not something that people to do one another, but it is a process in which they can create a relationship by interacting with each other. From Mr. P’s' perspective, patient-focused communication can be the most important aspect of treatment, due to its capacity to exacerbate or relieve the symptoms that often accompanies dementia, with evidence of effective communication resulting in decreased anxiety, greater coping ability and adherence to treatment (Dickson 1999). Action Plan/Conclusion My reflection of this experience has taught me how complex it is caring for someone experiencing dementia. It requires a holistic approach to ensure the patient and the family receive the best possible care in accordance with the guidelines and standards, in which they must remain empowered and make informed choices regarding their care and treatment with the help of health care professionals. I now understand how complicated symptom management can be; UTI/dementia patients experience many symptoms from their condition and also side effects from their medication. Assessments are vital to ensure the appropriate treatment and management of symptoms. The importance of communication has been brought to my attention once again, in my future nursing practice I will focus on my communication skills as this is an essential part of good nursing practice and plays a vital role in the healing process. Although this was an upsetting experience it has also been a positive one as this will affect my future nursing practice a great deal as I have gained vital skills to look after those receiving palliative care. Read More