Influence of Vaccines on Elderly Adults

The provided texts focus on the effects of influenza vaccination on elderly individuals. Several studies are presented, including a randomized trial comparing adjuvanted and non-adjuvanted trivalent seasonal influenza vaccines, analyzing their impact on symptoms and overall efficacy in older adults. Other papers delve into the role of innate immunity against influenza virus infection and the clinical practice guidelines for managing hypertension, which is often prevalent in elderly populations.

Running head: MEDICAL ASSESSMENT
Medical Assessment
Name of Student
Name of University
Author Note

1MEDICAL ASSESSMENT
Assessment 1: Patient Assessment
The patient, Jim is an elderly 58 year old male who seems to be undernourished
suggestive of underprivileged living condition. He seems to have elevated body temperature
indicating feverish conditions along with inflammation and oedema in tonsils, ear and pharynx.
He is having incessant clear nasal and muscle pain all of which suggests flu like clinical
symptoms (Essen et al., 2014). The discharge sample is sent to the microbiological lab for
diagnosis and the results have yet to arrive. The patient’s heart rate is marginally elevated to 105
beats per minute (BPM) and respiratory rate (RR) is also seemingly normal, 18 respirations per
minute (RPM). The breathing of the patient is still difficult with bilateral wheezing with no
crackles visible in lungs, so no symptoms of bronchitis are observed. The cardiac output of the
patient has come down to threshold value and no sings or murmuring or gallops is observed. The
blood pressure of the patient is very high, 158/86mmHg, this could be due to hypertension,
which the patient seems to have a previous history of, but does not take medication in spite of
being previously prescribed (Bromfield & Muntner, 2013). Although the patient came in the day
before with chest pain, muscle soreness, fatigue and malaise which seemed to have been
controlled down but the patient still has rhinorrhea and muscle tenderness. The neurological test
of the patient seems to be positive; Jim seems alert and oriented and is responding to the
parameters of Glasgow Coma Scale (GCS) properly. The patient seems to be sweaty, which
could be due to his hypertensive habit. After his hospitalization, oseltamivir is commenced to on
suspicion of influenza (Dobson et al., 2015). Jim used be a vigorous smoker but due to his poor
economic conditions, he cannot afford much cigarette, but still smokes 5-10 sticker per day.

2MEDICAL ASSESSMENT
Assessment 2: Care Planning

3MEDICAL ASSESSMENT
Nursing problem: Risk of spread of infection
Underlying cause or reason: Influenza is a highly contagious virus spread via airborne
droplets and direct contact. Immuno-compromised patients in the hospital setting are at
higher risk of contracting disease resulting in adverse events.
Goal of care Nursing
interventions/actions
Rationale Indicators your plan is
working
To prevent
and control
the spread of
influenzawithi
n the
healthcare
facility and
the
community.
Assessment of
respiratory status,
depth, accessory
muscle usage and
breathing pattern.
Auscultation of the
lung field to check for
wheezing, crackles and
any other breath or
heart related sounds.
Infection may cause
bronchial swelling,
mucous
accumulation in air
sacs which causes
narrowing of air
passage which leads
to distress while
breathing. Care has
to be taken so that
the infection does not
spread further and
Patient is expected to
show signs of stability
and achieve
homeostasis.
The respiratory passage
of the patient should be
cleared.
The patient is expected
to have clear breathing
without any obstruction

4MEDICAL ASSESSMENT
Monitor patient for
coughing symptoms,
sputum generation and
note the amount.
Position patient in such
a way that they can get
air, as in Fowler’s
position.
Change patient
position every couple
of hours.
Administer
bronchodilators if
necessary.
Perform postural
draining if necessary
Administer or
encourage more fluid
cause more
complication, since
the patient is already
suffering from
hypertension.
If any breathing
sound is observed
like wheezing in case
of the patient, then it
means that the air
passage is blocked.
This may cause
edema and
bronchospasmic
symptoms in the
patient (Lionakis et
al., 2012).
If mucous colour is
yellow or greenish
then it can be
confirmed that the
sounds and optimal gas
exchange will seem to
take place.
The mucous secretion
will stop.
The headache and
muscle tenderness will
decrease.
The feverish symptoms
will go away and
normal body
temperatures will be
observed.

5MEDICAL ASSESSMENT
intake.
Commence deep
breathing exercises.
Make sure that the
patient is in
comfortable
conditions.
Keep the patient in
isolation, since this a
very contagious
diseases (Ang et al.,
2010).
Instruct the patient to
be careful about his
hygiene and wash
hands with in contact
with his own mucous.
Administer detailed
patient is undergoing
pathogen infection
(Iwasaki & Pillai,
2014).
Fowler’s position
help the patient
achieve maximum
spreading of lung
tissues to increase air
intake (Cicolini,
Gagliardi & Ballone,
2010).
The pulmonary
secretions can be
removed if the
positions are
changed.
Bronchodilators
smoothen the
muscles and helps in

6MEDICAL ASSESSMENT
antibiotic treatment as
soon as the reports
from microbiology lab
arrive.
decreasing spasms
and improve
ventilation (Lionakis
et al., 2012).
.
Draining the posture
helps in clearing out
the mucous by the
help of gravity and
moves the secretions
so that they can be
expelled out from the
body(Cicolini,
Gagliardi & Ballone,
2010).
Expanding the lungs
helps in better
breathing and
movement of the

7MEDICAL ASSESSMENT
mucous.
Deep breathing also
helps moving the
mucous as well as
helping the patient
overcome any
possible anxiety.
Keeping the patient
in an isolated
condition will ensure
that other patients in
the ward do not get
infected by the
pathogen.
Washing hands will
ensure that the
nursing staff as well
as doctors do not get
affected from the

8MEDICAL ASSESSMENT
patient.

9MEDICAL ASSESSMENT
Nursing problem: Self care deficit
Underlying cause or reason: The patient is homeless, living below poverty conditions
where sanitation is very low.
Goal of care Nursing
interventions/actions
Rationale Indicators your plan is
working
Provide
medication
for his
hypertensive
condition and
teach patient
about
smoking
He needs to be made
aware of the ill hazards
of smoking in his
condition to improve
his health. Jim needs to
be convinced to take
medication for his
hypertension condition
and made aware of the
repercussions of
avoiding it.
Smoking will induce
his hypertensive
condition and the
progression might
cause cancer
The hypertension
symptoms will
decrease.

10MEDICAL ASSESSMENT
Nursing problem: Risk of imbalanced fluid volume
Underlying cause or reason: The febrile condition followed by influenza infection, has
rendered the patient to lose a lot of fluid. His current living conditions also do not allow
him to stay hydrated.
Goal of care Nursing
interventions/actions
Rationale Indicators your plan is
working
Restore fluid
and ionic
balance to
maintain
homeostasis
Examination needs to
be conducted for
checking the
electrolytes in urine.
Commence saline
water through
intravenous
Intake of fluid helps
diluting the mucous
and easy expulsion
from the nasal cavity
(Guppy et al., 2011).
The result of the
electrolyte analysis
Reduction of sweating
in the patient. The
patient will seem less
stressful.

11MEDICAL ASSESSMENT
administration. will determine the
ionic balance of the
patient’ body and
suggestive kidney
failure can be
detected (Greenway,
Liu, Yu, & Gupta,
2011).

12MEDICAL ASSESSMENT
Nursing problem: Chronic Hypertension
Underlying cause or reason: this a chronic disease developed genetically, but the
condition is induced due to his smoking.
Goal of care Nursing
interventions/actions
Rationale Indicators your plan is
working
Immediate
commenceme
nt of
medication
for
hypertension
to stop any
further
progression
of the
condition,
Lactate level in
circulatory system and
investigate the cause of
wheezing breaths.
Provide comfortable
surroundings for the
patient and calm them
down. Assess the
reason of fatigue.
Hypertension
conditions often lead
to the development
of severe cardiac
problems like
vasoconstriction,
ischemic heart
disease as well as
ventricular rigidity.
Depending on the
The chest X ray will
determine the cause of
wheezing.
The patient will show
better sign of
treatment.
The reports might
suggest lack of oxygen
on the extremities.

13MEDICAL ASSESSMENT
this may lead
to cardiac
arrest
(Weber et al.,
2014).
Check for peripheral
nerve pulses.
Assess heart tones and
breathing sign.
Check for signs of
cardiac
decompensation.
chest X ray,
commence necessary
measures to control
the hypertension
(Fuchs et al., 2014).
The arterial blood
gas levels will
determine, whether
the patient is
undergoing
asymptomatic
internal stress in the
cardiac cavity
(Alhamad et al.,
2014)..
Sweatiness might be
resultant of lack of
blood in skin
periphery.
Relaxed surrounding
will help the patient
develop less
sympathetic
stimulation.
The administration of
anti hypertensive drugs
like, diuretics helps
controlling the less
complicated version of
wither stage one or two
level hypertension. The
patient should feel less
tired and his breathing
should come down to
normal. The sweatiness
on his skin should also
be lowered.

14MEDICAL ASSESSMENT
Nursing problem: Nutrition deficit
Underlying cause or reason: very low economic condition
Goal of care Nursing
interventions/actions
Rationale Indicators your plan is
working
Commence
proper
nutrition
intake
Provide a proper diet
plan and maintain the
regular dietary intake
to maintain the weight
Loss of weight will
enhance his
condition even more
and causes weakness
as well as
compromise his
immune system.
Weight gain and
observed healthy
conditions.

15MEDICAL ASSESSMENT
Assessment 3: Medication management
Jim is currently undergoing medication for the suspicion of influenza, he is prescribed,
oseltamivir 75mg BD oral tablets, paracetamol 4/24 and fluvax IM stat-dose. Oseltamivir is an
inhibitor of neuraminidase for influenza virus, given to patients with symptoms of influenza like
Jim, but it is not an alternative to influenza vaccine (Dobson et al., 2015). This is a pro-drug from
which is converted to its active state by the esterase enzymes in the liver. Paracetamol is given to
Jim to ease his muscle and joint soreness and add some relief to his headache (Jefferies et al.,
2016). Jim was also administered with the seasonal flu vaccine separately to ensure that the
infection does not reoccur for the season. It has to be made sure that Jim does not show any signs
of allergic reaction to any of the administered medication. Although, he only has allergy towards
meat of chicken and no known medication, strict monitoring after every couple of hours is
recommended. If any symptoms like, nausea, oedema or inflammation on skin or distress, a
practitioner should be informed and alternative medication should be commenced (Alomar,
2014). Jim has a known medical history of hypertension, but does not take any medication to
improve his condition. A practitioner should be consulted to provide Jim, some diuretic and
angiotensin converting enzyme inhibitor to lower his BP (Weber et al., 2014). These drugs
increase urine production to excrete salts and ions quickly and relax the muscle of blood vessels
to reduce the pressure of blood in the respiratory cavity.
Assessment 4: Patient teaching
It is important to teach patient regarding the ill effects of their condition and include them
in the care plan. This technique is clinically termed as patient engagement. The given case study
is about a homeless man, so it is a little difficult for him to understand the clinical aspect of his

16MEDICAL ASSESSMENT
condition so it is advisable to provide basic recommendations to reduce his health risk. The
patient teaching plan should be performed keeping the patient’s social-economic condition in
mind and should be focussed on their current need. Jim is a known smoker with hypertension
condition that causes high blood pressure in his respiratory cavity which could lead to more
severe issues. Counselling sessions can be arranged for him if any symptoms of addiction are
observed. Rehabilitations centres can be contacted who provide free treatments of nicotine
addiction. Jim does not take any hypertension medication; he needs to be convinced to receive
those medications regularly. Jim can be referred to welfare organization where free of cost
medication is offered. Nutrition is a big factor that comes into play in Jim’s health; he lives under
condition where poverty is an issue, so he needs as much nutrition as he can get to keep his
system from declining. It is important to teach Jim about the effects for malnutrition in his
condition, for which he needs to be convinced to take minimum nutrition he finds. Jim also needs
to be taught the importance of annual flu vaccines. Jim can be referred to free vaccinisation
centres for the betterment of his health.
Assessment 5: Clinical Judgement and Patient Handover
Part A
The patient’s condition seems to have worsened and is shivering in distress. His fever has
increased and he is asking for blankets. The thermostat needs to be adjusted to prvide
comfortable environment. Medication commencement for hypertension as well as febrile
condition. Ooxygen saturation is also low, so using nebulizers to achieve 99% Spo2.
Part B
Identification Jim, a 58 year old homeless elderly male

17MEDICAL ASSESSMENT
Situation The patient was admitted a day before with chest
pain, difficulty in breathing, distress and feverish
symptoms. The patient’s pharynx and tonsils
seemed to be inflamed and sweatiness including
headache as well as muscle and joints tenderness.
The patient also had continuous nasal discharge,
suggesting influenza.
Observation The patient’s heart beat, oxygen saturation and
respiratory rate are marginally normal. Fever is still
going on with high blood pressure. The patient
seems sweaty and distressed which suggests
hypertension.
Background The patient is a known smoker having 5-10
cigarettes every day. The patient also has a medical
history of hypertension for which he does not take
any medication. Living in such poor conditions, he
is undernourished and reduced body mass. The
microbiology reports are yet to arrive.
Agreed plan Jim has been administered with oseltamivir 45mg
orally, paracetamol 4/24 and Influenza vaccination-
Fluvax for the season.
Read back Check for any signs and symptoms of allergic
reaction to any of the commenced drugs. Check the
X-ray and microbiology reports. Check for