In a geriatric population, some of the common diseases and conditions may appear in an atypical manner. Therefore, this population of patients requires more attention in the diagnosis and care of common conditions (Auerhahn, 2007). An example of an atypical presentation of a condition in the geriatric population is the personal experience with a patient who was later diagnosed to have End Stage Renal Disease (ESRD). The common presentation of this condition includes generalized abdominal edema with marked ascites (Flaherty, & Resnick, 2011). The patient may present with a number of typical presentations such as anemia and decreased urine output.
However, this particular patient had signs of dizziness and easy fatigability. Traces of blood were present in his stool in the form of melena. Initially, doctors thought of a malignancy, with the indication of the patient most likely having colorectal carcinoma, which may strike in the same way (Wold, 2008). Relevant investigations were done, with results showing no signs of any malignancy. An analysis of the electrolytes in blood and a urine analysis provided the answer, thus showing that the patient had ESRD. The bleeding in the rectum and gastrointestinal system was due to the loss of proteins in the urine because of renal failure.
Some of the strategies used to overcome the clinical atypical presentation include urine psychotherapy and blood electrolyte analysis. The patient was also dialyzed, with clotting factors being replaced to replenish the ones lost through the defective kidney. After these measures were taken, the patient was managed successfully for the ESRD. He was discharged home on supplements. He was also advised on the foods that he should avoid along with other measures to enable a faster return to normal functioning with the scheduled dialysis.
Dementia
Dementia is a common observation in elderly individuals, with most of the hospitalized geriatric patients exhibiting this condition (Flaherty, & Resnick, 2011). Unlike delirium, patients do not have a clouding of consciousness. However, they experience deterioration in their level of intellectual functioning with a consequential personality change, impulsive control, and memory impairment (Wold, 2008). With 2-4% of the geriatric population over the age of 65 years having dementia, it is common to come across patients with this condition. Frail elders with this condition often have memory impairment. They forget materials that they had learned besides having a decreased ability to learn new materials (Auerhahn, 2007). These elderly patients with dementia may also exhibit aphasia, apraxia, agnosia, and impaired occupational and social functioning (Flaherty, & Resnick, 2011).
The personal experience involved assessment of a frail individual who also presented with symptoms of dementia. The patient assessment care plan involved a thorough history collection. Relatives provided information about the patient and his condition. The diagnosis was based on the laboratory investigations that were done. These investigations were complemented by the brain imaging studies. After the diagnosis, the management that was established involved first admitting the patient. Adequate treatment through the administration of drugs to improve the neurotransmitters’ enhancement was later done. The patient and relatives were educated on the condition together with what they needed to do to the patient before he was discharged home. The care plan was effective, with the patient improving with time. The relatives were also able to proceed with the necessary care at home. In the future, some of the things that might be done differently include prompt diagnosis of the condition, with development of a more detailed care plan.
Shingles
Shingles is a manifestation of herpes Zoster Virus on the skin after a reactivation of a dormant prior infection. The skin wounds formed in shingles are very painful. Patients complain of a very sharp burning pain in the area of the skin and the affected surrounding areas (Flaherty, & Resnick, 2011). The consequences for this type of wounds in frail patients include unbearable pain, anxiety, and confusion. In some cases, the patient may have alterations in the cognitive ability.
An example of a patient presenting with shingle was a 68-year-old male who presented to the institution with extreme pain over a well-demarcated area of skin. He stated that all relieve medication that he had tried did not work. The pain was excruciating. The assessment of the patient involved the collection of history of the condition followed by a close examination of the area of the skin that was affected. A general assessment of the patient was also carried out, with a head-to-toe exam being done (Wold, 2008).
The investigations done included the blood sugar levels and an assessment of the immune status. The patient was managed with antiviral drugs, with a cream being applied on the wound daily. He was later advised and educated on the wound care, with the provision of the risk factors for the development of the condition. The care plan utilized in the management and care of this patient with shingles was successful. However, some of the things that could be done differently in the care of such a patient include prompt diagnosis and the provision of strong analgesics to make him comfortable (Auerhahn, 2007). Another measure can be the involvement of the family in the care of the patient.
Reference List
Auerhahn, C. (2007). GNRS: geriatric nursing review syllabus : a core curriculum in advanced practice geriatric nursing. New York, NY: American Geriatrics Society.
Flaherty, E., & Resnick, B. (2011). GNRS: geriatric nursing review syllabus: a core curriculum in advanced practice geriatric nursing. New York, NY: American Geriatrics Society.
Wold, G. (2008). Basic geriatric nursing. St. Louis, MO: Mosby Elsevier.