: a) Compare acute pain to chronic pain. b) What other types of pain may be experienced by older people? c) How could you help an older client explain their type of pain?
Acute pain is sharp and begins suddenly. It signals about the disease or the body injuries and disappears after the appropriate treatment. Acute pain lasts for a moment or in severe case for weeks and months till the full recovery. Chronic pain may last even for years and the reasons sometimes may be unknown. As a rule chronic pain is the result of the old trauma, injury, untreated acute pain or infection. Chronic pain is felt when the pain signals remain active in the nervous system for a long time and is not as sharp as acute pain but very annoying.
The neuropathic type of pain occurs when the nervous system does not work properly and gives the brain false signals of the unexcitable injury and is common among the older people. Russel Portenoy explains it “some older people mistakenly think that pain is an unavoidable part of aging” (Portenoy, 2007).
For the better pain explanation the type of pain (throbbing, sharp, dull, and burning) should be established with its frequency. It is important to ask a patient about the environment and activity triggers of the pain occurrence.
9. Using the 6 factors below; differentiate the two conditions of the dementia and delirium. a) onset b)Duration c) Orientation d) Memory e)thoughts f)Mood
“Delirium is sometimes called ‘acute confusion’; it begins suddenly and is often caused by an illness” (AGDHA, Delirium, 2012), when dementia is constant confusion caused by mental disorder and aged forgetfulness. Delirium is more treatable than dementia. Delirium onset is acute when early dementia onset is hard to diagnose. Delirium duration may vary from a moment to few days, in severe cases – months, when dementia duration lasts for years and scores of the years. Till the late stages of dementia, the patients have no problems with orientation, when the delirium patients are vastly disoriented. Delirium influences on recent and immediate memory, dementia thus influences the recent memory and new learning of the sick person. The judgments of a delirium patient are very often impaired, when the judgments of a dementia patient may be vastly impaired within the disease. The dementia patients are depressed all the time, when the delirium patients have fluctuating mood characterized by periodical irritable, depressed and normal stages.
10. Choose one of the focused assessment tools listed below. Discuss the purpose of the tool and briefly outline how to accurately complete the tool. Falls assessment Tool
The Fall Risk Assessment Tool identifies possible risk factors and formulates an individual management plan for targeted patients’ care planning. The FRAT predicts, who is most likely to fall, provides a focus point for the collation of fall risk relevant information and allows the targeting of the preventable stages with the identification of the individual fall risk factors.
“The FRAT is intended as a nurse administrated tool, to be completed within 24 hours of admission” Australian Government Department of Health and Ageing published (ADHA, 2003). The first stage of the FRAT completing is filling of the corresponding protocol to provide a fall risk score. The second stage is the risk factor checklist completing. The information for it should be given by the caregiver or family member. It is good to posses this information before the stage one task is done. The third stage is action plan making. On the left side there are listed problems on the right strategies to minimize the risk of each problem. Appropriate strategies should be transferred to the effective plan. If the FRAT identified high risk score (16-20) the Fall Alert Protocol should be done.
11. Orem’s theory. a) Using the Orem’s theory identify the 4 components of self care b)
List four nursing interventions that you could implement to assist the older person to adjust to their self-care deficits.
According to Dorotea Orem the self care includes the 4 components: self care itself, self care agency, therapeutic self care and self care requisites. A person maintains his everyday life demands with the self care. Self care agency is the ability for involving in self care, which develops with the personal physical and inner development. Therapeutic self care lies in using necessary methods and operation in order to assure good self feeling. Self care requisites are actions for self care providing. Orem divided them into universal, developmental and health deviation.
Self care deficits demand nursing. Orem distinguished 5 methods of the nurse helping. To assist the older person I would choose supporting the patient, guiding the patient, promoting the personal patient’s development to make his or hers life easier and acting for the patients methods, because they may ensure the patient’s comfort and treatment progress.
12. Forms of Restraint: a) What are the three types of restraints? b) For each type, identify one action which demonstrates how this restraint could be applied: c) Identify three restraint alternatives which could be used in aged care practice.
There are three types of restraints. Physical restraints (the control over the one’s movements and behoviour with the physical barriers such as straightjacket or hands and legs bed fixation); chemical restraints (the usage of the medicaments such as sedatives and tranquilizers to calm the persons) and environmental restraints (modifying of the patient’s surrounding to control the movements and actions, for example a locked door or mostly empty room).
To avoid these restraints’ use their alternatives such as constant caregiver or nurse presence, the qualified psychologist consultations, the social group work participation and the validation method’s tricks may be used in aged care practice.
13. Elder Abuse: You are caring for Mrs. Grey in her home. She is a 78yr old lady. Recently you have seen a change in her behaviour. She is withdrawn and quite anxious. You notice bruising on her arm and she holds onto her handbag all the time. You ask her what is making her upset. She starts to cry and says her grandson is coming around of an evening and asking for money, and if she does not give it to him he grabs her bag and takes it off her.
a) List the types of elder abuse and provide examples for each type b) List the risk factors for elder abuse c) Describe signs of elder abuse d) What are your legal and ethical responsibilities as an EEN in this case?
Among the types of elder abuse there is physical abuse, which is evident with the injuries, bruises and impairment and caused by the physical force such as force feeding, beating, pushing; sexual abuse is regarded as non-consent sexual contact with the elder person, it may be as unwanted touching as all types of sexual assault or forcing. Emotional or psychological abuse is verbal or non-verbal hurt which depress a patient and often is caused by the family members’ non-acceptance, ignoring, misunderstanding and hard-heartedness. Neglect is the ignoring of the caregiver’s obligations and occurs when a patient is not supplied with the food and water and all necessary hygiene and medicine care procedures are consciously omitted by the caregiver. Abandonment is the desertion of the older person by the responsible caregiver. Financial or material exploitation is the illegal and improper use of the older savings and fund. The examples are signature forging, cashing of the checks and money stealing. Self neglect is done by the older himself and is characterized by the conscious refusing of eating, drinking and elementary caring of himself.
The risk factors of the elder abuse are caregiver’s exhausting, depression and inability to force the stress, the lack of the family help and professional support. The frequent arguing between the patient and the caregiver, the body bruises and injuries, crashed personal things of the elder person such as the glasses and changes in the patient personality sign the elder abuse, any case of which should be spoken up and appropriate departments and services should be immediately informed to provide the necessary intervention and ensure the patient welfare.
14. Explain your understanding of how Aged Care is funded in Australia.
The Aged Care in Australia is supplied with the help of the Aged Funded Instrument. Australian Government Department of Health and Care informs that the Aged Funded Instrument was founded on 20 of March 2008 and on the 1of July changes of its organization were made. The new program Living Longer Living Better envisages “matching funding to care needs, funding outcomes for providers, documentation and administrative arrangements, design issues, including the roles of health professionals; and alignment with other elements of the health and aged care system” (AGDHC, 2012), what should provide better conveniences and more sureness for the elder inhabitants of Australia. The introduction of the new program confirms on the government larger attention to the Aged Care organization and funding.
15. Who is ACAT and what is there role?
ACAT is Aged Care Assessment Team which is supported by the government and aims at older people helping. The workers of ACAT will help the one to find a person for products buying, house cleaning and any type of the help doing. To access the Home Community Program and the National Respite for Cares Program service the one should get ACAT assessment which works out the level of the one’s inability and proposes appropriate service program. ACAT plays important role in the government-funded services providing for elder people, what makes their life safer and more confident and in some way control care programs. According to Aged Care Act the one has right to be informed and involved about the decisions of his care and may appeal the assessment in the case of disagreeing.
References
Australian Government Department of Health and Ageing (2012).Aged Care in Australia. Retrieved from: http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.
nsf/content/being+assessed-1
Australian Government Department of Health and Ageing (2003). Assessment Tools. Retrieved from: http://www.health.gov.au/internet/publications/publishing.nsf
/Content/CA25774C001857CACA2571AB0010BCD5/$File/07assessmenttools.pdf
Australian Government Department of Health and Ageing (2012) Delirium. Retrieved from:
http://www.health.gov.au/internet/publications/publishing.nsf/Content/palliative-agedcare-comm-familybkt-toc~palliative-agedcare-comm-familybkt-3~palliative-agedcare-comm-familybkt-3-manage~palliative-agedcare-comm-familybkt-3-delirium
Australian Government Department of Health and ageing (2012). New Funding Model for Residential Aged Care. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-review
NCEA (2012). Major types of elder abuse. Retrieved from:
http://www.ncea.aoa.gov/Main_Site/FAQ/Basics/Types_Of_Abuse.aspx
Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc.
Portenoy K. R. (August 2007). Overview of pain. The Merck Manual. Home Health Book Retrieved from:
http://www.merckmanuals.com/home/brain_spinal_cord_and_nerve_disorders/pain/overview_of_pain.html
The Joanna Briggs Institute (2002). Physical Restraint – Part 2: Minimalization in Acute and Residential Care Facilities, volume 6, issue 4.
