Homeostasis and Pain Management in the Elderly Population - Essay Example

Homeostasis and Pain Management in the Elderly Population Name Institution Affiliate Date Multisystem Failure in the Elderly Population The nursing care given to patients with multisystem failure needs a closer observation that is complex, which determines the decision for treatment and medication. This brings in the need for immediate assessment of the patient’s homeostasis, oxygenation and pain level. This would also be appropriate in the case of Mrs. Becker, 73 years old who has multisystem failure. Key Immediate Assessment Important nursing assessment that would be immediate on Mrs. Baker would involve finger oximeter readings and assessing the pain level. Immediate response to her condition would require supplementing oxygen to resolve and stabilize her breathing difficulties and control pain. Other assessment will include; lab findings, arterial blood gases, chest x-ray and electrocardiogram. Lab work would involve blood count, urinalysis and a comprehensive metabolic panel. Blood count determines the level of hemoglobin and hematocrit that has the effect of determining the capacity of oxygen supplied in the blood. Lower level of hemoglobin and hematocrit decreases oxygen level in the blood. Assessing the white blood cell count would determine if Mrs. Baker has any infection risk. If the count was high, it would indicate an infection in her body and a lower platelet count would imply that she could be at a risk for bleeding. A comprehensive metabolic panel would outline the electrolyte imbalances in the body fluid. Imbalances in the body fluid would result to cardiac arrhythmias. Higher or lower sodium levels in the body fluid would result to variations in the intravascular fluid; lower levels of the sodium ions in the body fluid could be the reason for Mrs. Baker’s confusion. A level of glucose in the blood from the comprehensive metabolic panel with extremely lower or higher levels of glucose explain her diabetic condition which in most cases could aggravate confusion and coma. Renal dysfunction is determined from the comprehensive metabolic panel, high levels of nitrogen in the compound urea or high liver enzymes indicate a reduced hepatic function. Functionality of the kidney and hydration level can be determined from urinary analysis or it can indicate presence infection on the urinary tract. Mrs. Baker’s cardiac status analysis is important to check the effectiveness of blood supply. Electrocardiogram finds out if there could be arrhythmias, if arrhythmia is present then there would be disturbances in the circulation of oxygen in the blood hence hindering effective performance of body tissues. It would be important to take a chest X-ray to find out whether there is any respiratory problem like pneumonia, pulmonary embolism atelectasis or pleural effusion. Technological Tools for Assessment Technological tools used by the nurse to assess Mrs. Baker would be electronic vital sign machine, electrocardiogram machine, pulse oximeter and digital thermometer. Her blood pressure and pulse rate would be measured using electronic vital sign machine; it is necessary to determine her hemodynamic status. A high blood pressure that is extremely high, would be a sign that she could be experiencing pain and she could experience stroke or she could suffer from cardiovascular disorders. On the other hand, if her blood pressure was low it would mean that she could suffer from shock, low blood volume and cardiovascular problems. Pulse oximeter would determine the amount of oxygen circulated in the blood system. If the reading of the oximeter is lower than normal, it indicates that the blood does not supply enough oxygen for effective tissue functioning and balanced homeostasis. If the pulse oximetry is less than 90%, it is an indication that the pulmonary system could be impaired or the cardiovascular functioning would require oxygen supplements. A digital thermometer would take her body temperature to establish whether she has any infection, indicated by a higher temperature level. Electrocardiogram would determine whether Mrs. Baker has any problems with her cardiac system, which majorly impact the heart functioning or rather the amount of oxygen supplied in the blood. A portable EKG machine provides the electrocardiogram that obtains electrical impulses sent from the expansion and contraction of the heart. Taking an X-ray would be necessary; a portable X- ray tool with a film plate placed behind her back would take the X- ray from the front towards the back. Analyzing the X-ray results would determine whether there could be bronchus blockage that could be causing her breathing difficulties. Data Collection Collecting data in Mrs. Baker’s situation needs prioritizing done in an emergency manner whereby the ABC principle to aid airway management, facilitate breathing and probably prevent hypoxia would be first. Oxygen supplementation, air suctioning and support aids in bringing back a balanced homeostatic functioning would then be established. To assess and maintain normal blood supply will require constant monitoring of blood pressure, transfusion of blood or intravenous fluid and appropriate medications to aid the circulatory system in delivering adequate oxygen to body tissues and organs. Responsive and Non- Responsive Geriatric Patients Mick and Ackerman (2004) suggests that if a patient is alert, he/she can identify where the pain is, describe it and rate the level of the pain felt. Pain is subjective, therefore; it would be good if the patient stays alert so that the information provided by the patient helps to identify an appropriate pain control method and diagnosis. In addition, it is possible to establish the cause of respiratory or cardiac problems. However, when a given patient such as Mrs. Baker passes out after the completion of a pain assessment, the nurses would then have to rely on non-verbal signs that could indicate presence of pain, such as grimacing, restlessness, moaning abnormal blood pressure and pulse rate. An alert patient is able to respond to the effectiveness of a pain management approach, he would feel satisfied by the change in pain by reporting the feedback to the primary nurse. Managing Pain in a Geriatric Patient with Multisystem Failure It will require fast and effective response to manage pain in a patient to reduce anxiety, discomfort and pain in order to let the patient feel comfortable and most importantly minimize physiological workload. Having lost consciousness and showing signs of pain such as moaning, restlessness and grimacing, Morphine 0.05mg/kg would be the best choice. When assessing patients like Mrs. Baker, a nurse needs to understand the process of aging, there is a diminished functionality of important body systems such as hepatic, renal and the cardiovascular system. Therefore, medication administered should not have adverse effects on the functionality of the body system. Effectiveness of the Pain Management If the patient has lost responsiveness, observation of cues that show the patient is relaxed and calm or has reduced moans indicates that the medication is effective. Mick and Ackerman (2004) write that physiological indicators like a stabilized blood pressure, normal pulse rate and reduced intensity of respirations indicates the effectiveness of the medication given to the patient. Important Point Learnt The most important point learnt from Mrs. Bakers scenario was the change in the level of responsiveness and the increase in breathing difficulties she experienced upon arrival at the emergency room. The emergency room nurse has to know that the case showed a deteriorating trend in Mrs. Baker’s health status and therefore the healthcare team needed to take a quick action to stabilize the condition and importantly prevent death. Collaborating medical team All those who would collaborate in giving care and treating the patient would be the primary nurse, primary physician, supporting nursing staff, consulting doctors such as the cardiologist and a nutritionist. The primary physician would examine Mrs. Baker, evaluate her medical test results and decide on the appropriate medical interventions. The consulting physician such as the cardiologist or pulmonologist would determine possible issues experienced by Mrs. Becker in her cardiac system or vascular system and derive the possible treatment to stabilize the situation. The need to bring the respiratory status of Mrs. Baker to normal level would require a respiratory therapist to monitor and adjust the oxygenation process. Mrs. Baker will need a given nutrition supplementation to aid in her condition basing on the fact that the aged population could be nutritionally challenged, the nutritionist will therefore be consulted to determine the appropriate nutrition supplementations to be given to the patient. The primary nurse would ensure that all the treatment plans of the patient are checked, all the assessment data availed, and that she evaluates the response of the patient to the medication and treatment prescribed. In addition to that, she would be required to keep the patients privacy, advocacy and dignity. In conclusion, multisystem failure experienced in older people like Mrs. Baker needs a keen understanding on the process of aging. It will help the medical team give appropriate assessment and prescription of the right medication and treatment. Such patients need a comprehensive treatment, closer monitoring and assessing to ensure that pain is effectively controlled, blood circulation and oxygenation be optimized and appropriate nutrition provided to ensure a positive performance in their health. Reference Mick, J. & Ackerman, H. (2004). Critical Care Nursing for Older Adults; Pathophysiological and Functional Considerations. Journal of Nursing Clinics of Northern America, 39 (2) 472-492 Read More