Risk Factors and Interventions for Leonard's Case Study

This report focuses on identifying and describing the risk factors associated with Leonard's case study and presents best practice assessment tools and interventions to support him through a person-centered approach. It also discusses the obligations of a Registered Nurse in providing care for Leonard.

Assessment 2

Contents
Part A...............................................................................................................................................3
Introduction..................................................................................................................................3
Discussion....................................................................................................................................3
Three risk factors for Leonard..................................................................................................3
Three best practice assessment tools for Leonard....................................................................3
Conclusion...................................................................................................................................5
Part B...............................................................................................................................................5
Critical analysis of the person-centered interventions to support Leonard and obligations as a
Registered Nurse..........................................................................................................................5
References........................................................................................................................................7

Part A
Introduction
This report will focus on identifying and describing the risk factors associated with Leonard’s
case study. It will identify and critically analyze a range of interventions to support Leonard
through person-centered approach. The report will also present how the chosen interventions
relate to the obligations as a Registered Nurse.
Discussion
Three risk factors for Leonard
Hypertension- Leonard has a history of hypertension and he was hypertensive at the time of
hospital admission when he was diagnosed with Urinary Tract Infection (UTI). He also has a
history of urinary urgency. All these factors are associated with old age and Leonard is 73 years
old. Study has established a pathophysiological association between hypertension and lower
urinary tract symptoms and recommends management of comorbid clinical manifestations
simultaneously (Hwang, et al., 2015).
Declined self-care including unhealthy eating- Worsening of Leonard’s condition is also
associated with decline in his self-care. He became inactive by quitting walking and isolated
socially. He was eating microwaved prepared meal since last six months as opposed to eating
fresh vegetables from garden. Unhealthy eating and inactivity may also be the reason of his
recent weight gain. Self-neglect is observed in Leonard which is either inability or unwillingness
to attend to his personal requirements can also lead to poor hygiene. Poor hygiene is frequently
associated with various mental disorders and increased frequency of UTIs (Balentine & Stöppler,
2018).
Urinary urgency- Leonard also demonstrates a history of urinary urgency. Frequency, urgency,
dysuria, incontinence, or suprapubic tenderness are some of the established symptoms of
symptomatic UTI (Beveridge, et al., 2011).
Three best practice assessment tools for Leonard
Hypertension- Hill-Bone Adherence Scale is a comprehensive tool which can be used to examine
behavior of Leonard for three significant behavioral domains of high blood pressure management

which are decreased salt consumption, appointment maintenance and medication adherence
(Song, et al., 2011). It is used commonly to measure a patient’s non-adherence to hypertension
treatment. More the scores on the Hill-Bone Scale indicate, lower the adherence (Han, et al.,
2014). The scale has 14 items in three above mentioned subscales and each item is a four point
Likert type scale. Nurse can use this simple tool in case of Leonard to assess his self-reported
compliance level and plan suitable interventions for him. Content validity of the scale has also
been investigated through a suitable literature review and a panel of specialist. It focused on
cultural sensitivity and suitability of the tool for lower literacy level. The scale addresses the
barriers and self-efficacy however has limited generalizability.
Urinary agency- A tool to observe patients for possible symptoms prior to starting antibiotics
administration in UTI will be recommended. A bladder diary can be used in Leonard’s case to
collect data during assessment as well as evaluation. Bladder diary will collect the information
about UI episodes, all the activities linked with UI episodes, void times and volumes,
fluid intake, absorbent product usage, and bowel movement episodes. The DIAPPERS or
TOILETED mnemonics give a framework for highlighting the examination of possible causes of
transient UI. It can be utilized to differentiate among the possible causes of transient UI (Staskin
& Kelleher, 2013). Although bladder diary is not validated (Bright et al., 2011), however still
regarded as a significant tool to gather historical data required for diagnosis and management of
UI. Leonard can maintain a 7-day or 3-day bladder diary which is a reliable tool. Therefore,
nurse can make use of bladder diaries as a standard tool to examine patterns of continence
episodes.
Self-care- Self-Management Screening (SeMaS) is a brief tool that can suggest probable barriers
for self-management which must be addressed in the conversation with the service user instead
of a diagnostic tool. Nurse can use this tool to enable personalized counselling and support to
increase self-management in Leonard’s case. It comprises of a limited questions to facilitate its
usage in daily practice. Depression and anxiety are some of the common possible barriers for
self-management, and frequently remain undetected by the health care professionals (Hermanns,
et al., 2013). SeMaS may help in diagnosing these issues in Leonard’ case (Eikelenboom, et al.,
2015).

Conclusion
Leonard belongs to aged population and has a significant medical history. It is essential to
comprehensively assess his condition to identify all the possible risk factors and prioritized based
on Leonard’s needs. Then best practice assessment tools related to each identified risk factor is
evaluated to assess Leonard’s health status and interventions.
Part B
Critical analysis of the person-centered interventions to support
Leonard and obligations as a Registered Nurse
When required fluids and antibiotics are administered to Leonard in Emergency ward and he is
shifted to general wards along with resolving of her symptoms and returning of mental status
returns to baseline, various person-centered interventions are formulated for him. As per Rogers,
congruence, unconditional positive regard, and empathic understanding are the three
fundamental aspects of the person-centered approach (Rogers & Rogers, 2012).
Nurse will make Leonard understand the disease process and how the recent changes in his
lifestyle has led to deterioration of his condition. Nurse will educate him about the possible risk
factors of developing UTI and the probable complications. Nurse must ensure adequate oral
intake of fluid. Nurse will instruct Leonard regarding maintaining hand hygiene and complete
emptying of the bladder when voiding. Leonard must actively participate in self-care including
maintaining bladder diary as the chances of compliance increases with this as he will get an
immediate feedback which will lead to an increased sense of control. Nurse must carefully define
the terminologies of the diary and she should verify that Leonard not only understands the
meaning of the diary items, but also the significance of complete and regular data entry. Nurse
must identify the preferred type of diary that Leonard may want to use as it may impact his
compliance with data entry.
To maintain normal blood pressure nurse will assist and raise awareness to adhere to the
medicinal regime, implement required lifestyle changes, and arranging regular follow-up visits
with the health care professional to evaluate progress or recognize and manage any

complications of hypertension. Regular follow-up care is essential to assess his disease process
and treat it accordingly based on whether it is controlled or advanced. Nurse will take a history
and physical examination at each visit. In the care planning, nurse will emphasize on the
significance of walking or exercising so Leonard again, so that her hypertension is controlled and
his weight is maintained. The nurse will focus on the approach of prevention instead of treatment
for future improved health outcomes of Leonard. It must be focused that therapeutic regimen is
the duty of Leonard in collaboration with the nurse and other health and social care
professionals. Nurse can educate Leonard about hypertension and how to manage it, including
medications, lifestyle changes of diet, weight control, and exercise setting goal blood pressures,
and help with social support, can help Leonard achieve blood pressure regulation. Nurse can
involve his sisters in education programs to facilitate them to support Leonard’s efforts to control
hypertension. Written information about the anticipated effects and side effects of medications is
significant. When side effects occur, Leonard must understand the significance of reporting them
and to whom they should be reported.
Leonard is reluctant to accept social service assistance but nurse must make him understand the
usefulness and requirement of these services. Nurse can take help from his sisters in this process.
Person-centered care focused on developing the interventions which particularly fulfil the needs
of the client and at the same time considers his/her nature, personality, preference and choices.
Therefore, it is essential that nurse adopts an empathetic attitude while informing him of the
benefits of these services. Support services can assist him with self-care activities and cooking
which will ultimately help him in improving his overall well-being. Moreover, these services can
connect him to other community fellows and enhance his social network which will make him
more active and assist him in retaining his mental status.
Nurse can refer Leonard to support groups to enable him to develop a social network which can
motivate him to go out.
Therefore, it can concluded that persistent education and motivation are usually required to
enable Leonard to develop an acceptable plan which can help him to improve his health
outcomes and adhere to the management plan. Higher-priority goals must be focused initially.
Nurse can help him in achieving behavior change by supporting Leonard in making small
changes with every visit that progress toward his long-term goals.

References
Balentine, J. R. & Stöppler, M. C., 2018. Urinary Tract Infection (UTI) Symptoms & Causes.
[Online]
Available at:
https://www.medicinenet.com/urinary_tract_infection/article.htm#what_is_a_urinary_tract_infec
tion_uti
[Accessed 2 April 2019].
Beveridge, L. A., Davey, P. G., Phillips, G. & McMurdo, M. E., 2011. Optimal management of
urinary tract infections in older people. Clin Interv Aging, Volume 6, pp. 173-80.
Eikelenboom, N. et al., 2015. Validation of Self-Management Screening (SeMaS), a tool to
facilitate personalised counselling and support of patients with chronic diseases. BMC Fam
Pract, 16(165).
Han, H.-R., Lee, H., Commodore-Mensah, Y. & Kim, M., 2014. Development and Validation of
the Hypertension Self-Care Profile: A Practical Tool to Measure Hypertension Self-Care. J
Cardiovasc Nurs, pp. 11-20.
Hermanns, et al., 2013. Screening, evaluation and management of depression in people with
diabetes in primary care. Primary care diabetes, 7(1), pp. 1-10.
Hwang, et al., 2015. Men with Hypertension are More Likely to Have Severe Lower Urinary
Tract Symptoms and Large Prostate Volume. Low Urin Tract Symptoms, 7(1), pp. 32-6.
Song, et al., 2011. Psychometric evaluation of hill-bone medication adherence subscale. Asian
Nurs Res (Korean Soc Nurs Sci), 5(3), pp. 183-8.
Staskin & Kelleher, 2013. Patient-reported outcome assessment. In: Abrams, Cardozo, Khoury &
Wein, eds. Incontinence, 5th International Consultation on Incontinence. 5 ed. s.l.:s.n., pp. 361-
8.