Introduction
Mrs. C.D, my 77 years old aunt, is an African from Nigeria. She is visiting the United States for 3 months on a holiday. She is alert and aware of persons, place, and time and is verbally responsive. She is calm, friendly and very cooperative, with clear and articulate speech. She has a symmetric facial expression and has no hearing impairment. She also has a stable gait.
Historical Background
Mrs. C.D has a history of hypertension and diabetes mellitus. She is currently married with three adult children; two boys and one girl. Her first born is a 34 years old engineer and he is married with one child. The second born is a 32years old and she is a teacher, married with two children. The youngest is 28 years, who is single and is a lawyer. She is a non-smoker and takes some alcohol and wine on occasional basis. She denies the use of illicit drugs. She lives with her husband back in Africa who is financially independent. She gets emotional and psychological support from her husband, children and grandchildren that visit every month. She is a devoted Christian and attends the Catholic Church every Sunday. She is also a member of two community-based social-support groups in Africa and is one of the elders of her church. She helps to organize church activities, as well as assist in marriage counselling in her church.
Acute and Chronic Medical Issues
Mrs. C.D. has age related visual changes characterized by dry eyes, yellow sclera, clear conjunctiva and presbyopia. According to the Harvard Health Letter, as one gets old, the eyes tend to be dry (Anonymous, 2010a). This is mainly because the lacrimal and other glands become less productive. Also, with age, the lower eyelids may sag, failing to form an effective seal over the eye. Therefore, Mrs. C.D uses artificial tears for the dry eyes and wears corrective eye glasses to enable her to read, to see nearby objects and to see well at night. The Harvard Women’s Health Watch states that, “presbyopia, the most common form of visual impairment in older adults, reduces close-up vision and may create a need for corrective lenses for both near and far vision” (Anonymous, 2010b).
Mrs. C. D also prefers adequate light especially at night time because she has difficulty with peripheral vision. She also had cataract which was removed two years ago, which might have been caused by increased exposure to ultraviolet light. The dry eyes may be caused by too much exposure to sunlight as seen in Africa. Mrs. C.D’s medical history of hypertension and diabetes are also risk factors that exacerbate or interferes with her visual wellness.
The gray coloured strands of her hair has a negative impact on her self esteem as she does not feel comfortable most of the time. Thereby, she prefers to wear wigs when she’s going out to give herself a younger look. Meanwhile, her hair is evenly distributed and dense. She does not have any hearing impairment.
Mrs. C.D has a warm, brown coloured dry skin, with the skin hair evenly distributed. This decreases sweating. According to Hodgkinson, Nay & Wilson (2007), “the ageing process is associated with changes to the skin, including decreased turnover and replacement of epidermal skin cells, thinning of the subcutaneous fat layer and reduced production of protective oils causing the skin to be dry”. Therefore, use of protective cream is necessary for Mrs. C. D to maintain her skin integrity. These age-related changes could be attributed to exposure to ultraviolet radiations which diminishes the skin’s ability to protect itself against sunlight. Mrs. C.D is therefore using moisturizing cream for her dry skin and tries to avoid prolonged exposure to sunlight. She also has a few black spots on her back and a mole on her shoulder. Her nails are short and thick, growing slowly. However, she is not dehydrated. Her skin tone is fair as she does not drink enough fluids. But her oral mucosa is pink and moist.
Mrs. C.D. denies any soreness or bleeding in her mouth. She has her own teeth which are discoloured, with a few molar caries and two disfigured incisors. She does not have any difficulties when swallowing or chewing. However, she always complains of xerostomia which is part of age-related changes and may also be due to the medication she is currently taking. According to Folke, Fridlund & Paulsson (2009), “xerostomia (dry mouth) is caused by changes in quality and quantity of saliva due to poor health, certain drugs and radiation therapy. It is a common symptom, particularly among older people, and has devastating consequences with regard to oral health and general well-being”. She normally visits the dentist at least once every year and brushes her teeth twice a day.
Mrs. C.D has no allergies and eats independently at home and sometimes with family. She is able to prepare her own food when she needs to. Mrs. C.D. occasionally has difficulty with bowel movements. She experiences firm stool, sometimes due to slow motility. But she is continent in bowel and bladder. She takes Colace for her bowel regimen. She tries to drink more fluids and eat high fibre foods to enhance her bowels.Occasionally, due to age-related changes, her sense of smell and taste are not effective.
Mrs. C.D has a decreased cardiovascular function, and this is attributed to high fat diet, lack of exercise, sedentary life style and a history of hypertension. She gets tired easily, especially after short walks. She denies any chest pains or dyspnea, but reports that she feels dizzy at times. She does not have indigestion, swollen feet or ankles, but complains of frequent urination.
Mrs. C.D has a baseline temperature of 98.1 o F and does not like winter or hot summer seasons as she gets too cold or too hot. She always keeps a constant warm temperature 75 o F in her room. She is not taking any medication for cold or heat intolerance. She tries to make sure that she drinks a lot of fluids when she is outside in the hot weather to avoid dehydration.
Mrs. C.D. has no dyspnea or respiratory distress. She has been down with malaria back in Africa a couple of times, but has never been hospitalized. However, ever since she was diagnosed with diabetes and HTN at the age 58, she started to pay particular attention to her health. She had her pneumonia vaccination and annual influenza vaccine upon her visit to her doctor after she arrived in the United States.
Mrs. C.D has no limitations in movements or transfers. She is not at risk of falls and has no history of falls. She walks independently without any assistive device.
Review of Medications
Mrs. C.D is currently on the following medications: Aspirin 81mg PO daily, Metoporol 25mg PO daily, Colace 100mg PO daily, Glucophage 500mg PO daily and over the counter Multivitamin with iron 1 tab PO daily. The medication Glucophage causes her to have metallic taste in the mouth and occasional cases of indigestion. The dry mouth she complains of is a symptom of high sugar and effects of metoporol. As such, she is encouraged to drink a lot of fluids to balance the effect (Carol, 2009).
The Aspirin, an anti platelet, is for CVA prevention and it can cause GI irritation and bleeding. The Colace as a stool softener causes diarrhoea at times. The metoporol is for HTN and can lead to hypotension or orthostatic hypotension. According to Mann (2009), the elderly should always follow their doctor’s orders to take their blood pressure medications and adhere to the rules if they do not have any cognitive impairment. Mrs. C. D. is advised to always check her heart rate and blood pressure before medication. She should check her liver function test, HGA1C and cholesterol levels every 3 to 6 months. Mrs. C.D should also avoid grape fruit juice as it leads to medication toxicity. Also her complains of constipation could be as a result of effects of metoporol. The MVI with iron that she is taking will help in preventing the side effects of ASA which includes GI bleeding with decreased levels of iron, folate and Vitamin C. She is also encouraged to eat fresh fruits as a source of vitamin C.
Mrs. C.D’s Functional Status: ADL and IADL
Mrs. C.D is able to perform all of her ADLs like dressing, grooming, bathing, eating and toileting independently. This is together with her IADLs like cooking, laundry, shopping, telephoning, medications and money management. She is functionally independent with no deformity or immobility.
Mental Health and Cognitive Ability of the Client
Mrs. C.D has no cognitive impairment or memory loss. She is engaged in social activities such as church functions back in Africa. She is very jovial and hopes for a better future. She believes she is righteous. She has positive relations with people, and is very kind and willing to help those in need where she can.
Evaluation of the Client’s Living Situation
Mrs. C. D tries to maintain cleanliness in the house and participates in cooking in the house when I am cooking. Mrs. C.D is the principal of an elementary school back in Africa. She usually returns home at 4.00pm and tries to go for a walk before dinner time. She was in an emotional distress when she lost her brother shortly after her arrival to the United States and she is grieving appropriately
Recommendations to Improve Mrs. C. D’s Quality of Life
I recommend that Mrs. C.D should stick to low fat, low sodium diet due to her diabetes and hypertension. She needs to continue with her walking exercise to improve her cardiac function. She needs to drink more fluids and eat high fibre foods to avoid any constipation or straining during bowel movement. Mrs. C.D should apportion her time wisely to avoid stress and should stop her occasional consumption of alcohol. She should never forget to check her heart rate and blood pressure before taking the blood pressure medications to avoid hypotension. She should always remember to rise up from bed slowly and avoid making sudden changes in positions to avoid orthostatic hypotension. She should consult her physician when she experiences chest pains or dizziness accompanied by nausea, sweating, confusion or swollen feet and ankles. Mrs. C.D also has to check her HGA1C, her liver function test, cholesterol levels and follow up with her dental care as prescribed.
References
Anonymous. (2010a). When eyes get dry and what you can try. Harvard Health Letter, 35(12), 4-6.
Anonymous. (2010b). Studies find ways to reduce falls in older multifocal lens wearers. Harvard Women’s Health Watch, 17(12), 6-7.
Carol, A.M. (2009). Nursing for wellness in older adults. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins.
Folke, S., Fridlund, B., & Paulsson, G. (2009). Views of xerostomia among health care professionals: A qualitative study.Journal of Clinical Nursing, 18(6), 791-798. Web.
Hodgkinson, B., Nay, R., & Wilson, J. (2007). A systematic review of topical skin care in aged care facilities.Journal of Clinical Nursing, 16(1), 129-136. Web.
Mann, D. (2009). Resistant disease or resistant patient: Problems with adherence to cardiovascular medications in the elderly. Geriatrics, 64(9), 10-15.