Case Study: Health and Illness in the Older Person - Analysis and Plan

This report presents a detailed case study of a 65-year-old Indigenous Australian, Jack, who is diagnosed with chronic obstructive pulmonary disease (COPD) and type 2 diabetes. The report begins by outlining the purpose of the case study, which is to analyze real-world health problems and inform effective decision-making for patient care. It identifies Jack's co-morbidities and discusses how these conditions impact his functional status. The report then examines environmental changes affecting older individuals, specifically focusing on governmental policies and their impact on healthcare access for Indigenous Australians. Part 2 of the report details a comprehensive care plan, including three key care priorities: managing COPD, controlling blood sugar levels for diabetes, and addressing the patient's overweight condition. For each priority, the report provides evidence-based nursing interventions and evaluation criteria to assess the effectiveness of the care plan. The interventions include positioning, fluid intake, medication management, and dietary adjustments tailored to Jack's specific needs. The evaluation methods involve monitoring symptoms, blood sugar levels, and weight, ensuring a holistic approach to patient care.

Health & Illness In The
Older Person

Table of Contents
INTRODUCTION...........................................................................................................................3
PART 1............................................................................................................................................3
Purpose of case study.............................................................................................................3
Identify the person..................................................................................................................3
Discuss two co-morbidities that impact their functional status..............................................3
Examine specific and recent environmental change impacting on older person....................4
PART 2............................................................................................................................................4
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................10

INTRODUCTION
Health refers to a state of physical, emotional, mental and social well being of an
individual. It can be considered as a condition in which any kind of disease, infection or
infirmity is absent (Hastings, 2019). The present report will cover two parts separately in which
part 1 consist case study of an older person having two co-morbidities and part 2 includes three
care priorities and effective nursing interventions along with evaluation.
PART 1
Purpose of case study
The purpose of formulating a case study is to analyse actual problems in order to make
appropriate decision making for treating the same. It can be considered as a record of
information about the patient that can be kept for future purposes. However, formulation of a
case study facilitate to provide an example which is helpful to understand about effectiveness of
suitable models, theories and concepts that can be applied in specific case to gain better
outcomes.

Identify the person
Jack is 65 years old who is an Aboriginal and Torres Strait Islander (Indigenous
Australian) belongs to having a problem of chronic obstructive pulmonary disease (COPD) and
diabetes type 2. He is overweight and blood pressure has been examined to be high. He has
admitted in the emergency department due to condition of shortness of breath and primary
examination by nursing staff results into increased sugar level and high blood pressure
(Pedersen, Meyer and Uhrenfeldt, 2017). He complains about shortness of breath, wheezing,
cough and lack of energy. Jack seems to be weak due to fatigue and frequent colds that make
him more uneasy and uncomfortable.
Discuss two co-morbidities that impact their functional status
The main health problem is chronic obstructive pulmonary disease (COPD) can be
described as a condition of chronic inflammatory lung disease that is responsible for causing
obstructed flow to lungs. It consist symptoms including shortness of breathing, wheezing, chest
tightness, sore throat, sputum (coughing up a lot of gunk), blue lips or fingernails, fatigue,
frequent colds, swollen feet, ankles & legs etc. The second co-morbidity is diabetes type 2 refers
to a chronic condition which impacts the metabolizes sugar that is known as an important source
of fuel for human body. This health problems occurs when insulin is not used in right way and
people with diabetes type 2 are known to be with insulin resistance. It includes number of
symptoms like peeing a lot, blurry vision, being very thirsty, tingling or numbness in hand or
feet, feeling worn out, wounds do not heal, come back of yeast infections and being cranky.
Moreover, both of these health issue create difficulty for Jack to live comfortable and develop
other relevant issues as well.
Examine specific and recent environmental change impacting on older person
The recent change in strategies of government that are observed in new rules &
regulations in favour of improving lives of Indigenous Australians in country. It consist the rule
of removing factor of discrimination from every sector and provide equal opportunities that helps
to make their lives stable (Marengoni and et. al., 2016). However, this recent change in
government rules impacts positively on condition of Jack because care professionals will not
avoid him and immediately provide appropriate treatment for his well being. Previously,
indigenous Australians faced discrimination while seeking for health care facilities which create
complications in their condition but not this situations is improved due to government

regulations. Moreover, Jack can gain better quality of medical facilities and strong attention of
care practitioners like other citizens of country which facilitate him to overcome with the health
issue very soon.
PART 2
Care Plan Template
In your plan you must:
1. Select and justify the top three (3) care priorities/objectives for nursing care;
2. Discuss evidenced-based nursing interventions to achieve each objective; and
3. Describe the evaluation criteria that you will use to judge whether the plan addressed the
identified objectives.
Select and justify the top three care priorities/objectives for nursing care. In priority order,
what is care priority 1? what is care priority 2? and what is care priority 3? What
recommended text/primary research references support my choice of each care priority and
why are they important?
The top three priorities related to health condition of Jack consist his health issues that are
required to be focussed by care practitioners in order to make correct decisions of treatment.
It includes to establish more effective as well as efficient care plan based on these care
objectives which are explained here.
1. Initially, the main care priority is to focus on chronic obstructive pulmonary disease
(COPD) and maintain ineffective breathing pattern.
2. However, the secondary care objective is to maintain sugar levels to solve problem
of diabetes type 2 of patient (Roth and Reichert, 2019).
3. Moreover, the third care priority consist to focus on balanced nutrition of the patient
in order to maintain appropriate body weight that helps to improve high blood pressure
condition.

Discuss evidenced-based nursing interventions to achieve each objective. Ask yourself: What
are the significant health care needs for my older patient related to each identified care
priority? What nursing interventions will address the nursing care priorities I have identified?
How can I support my selection of care priorities using text and primary research sources?
1. Care priority 1: Chronic obstructive pulmonary disease (COPD)
Nursing Interventions consist to place patient in semi-fowlers position that will promote
maximum expansion of lungs. Firstly, it is necessary to increase intake of fluid as suitable
which will facilitate to liquefy secretions. Secondly, keep back of patient dry that is supportive
to ignore stasis of secretion and prevent further complexities (Stephens, 2017). Thirdly,
Position of patient should be change in every 2 hours that promote drainage and secretion
movement. However, apply chest physiotherapy and place pillow while patient is sleeping as
Physiotherapy helps in loosing secretions and placing pillow that facilitate adequate lung
expansion while sleeping. In addition to this, it is essential to balance patent airway and
suctioning of secretions may be complete as ordered which facilitate to remove secretions
which obstructs an airway. Basically, it consist to render respiratory support including oxygen
inhalation per given order which aid in relieving the patient from dyspnoea. Meanwhile,
administer prescribed cough suppressants and analgesics and be cautious because opioids may
depress respiration more than desired which will increase deeper respirations and cough.
2. Care priority 2: Diabetes Type 2
Nursing interventions of diabetes type 2 includes to inject Lantus (long acting insulin) for a
once or twice on daily basis because long acting insulin does not have a peak of action. Insulin
glargine is effective over duration of 24 hours. Initially, it is required to inject humulin
(prandial insulins) before 30 minutes of meals on regular basis. Secondly, rapid acting insulins
(Novolog, Humalog) can be inject before and after eating as dosage of insulin can be managed
as per intake amount of food because rapid insulin is injected after meal (Swall and et. al.,
2016). Thirdly, it is necessary to guide patient to rotate insulin injection sites because injecting
insulin on same sites for multiple times can cause deposition of fat. Meanwhile, provide
information about significance of inserting the needle perpendicular to the skin that will make

sure regarding deep subcutaneous administration of insulin. However, Make patient understand
and demonstrate regarding method & timing of monitoring glucose on regular basis which is
helpful to gain information about degree of glucose control and determines requirement for
changes in insulin dosage. Moreover, teach client to obey proper diet which is low in sugars &
fats and high in fibre as well as whole grains that consist that refined and simple sugars should
be decreased and complex carbohydrates like rice, cereals should be improved. Additionally,
make patient aware about signs of hypoglycaemia like tremors, slurred speech and anxiety
which indicates about hypoglycaemia that cause coma, seizure or even death (McCance and
McCormack, 2016). Furthermore, it is necessary for guiding patient the condition of
hypoglycaemia with the help of crackers, a snack or glucagon injection that the problem of
hypoglycaemia can be treated through carbohydrate snack and glucagon an be provide when a
person is not in a conscious state.
3. Care priority 3: Maintain overweight condition
Nursing Interventions consist evaluating cause of overweight and review daily food intake
(calories) of patient as it is favourable to reduce calories intake by removing high caloric food
items. Firstly, it includes to remain alert to binge eating and develop strategies for dealing with
these episodes (substituting anther steps to eat) that reduce negative feelings of patient about
weight loss efforts and facilitate further cooperation. Secondly, it is mandatory to weigh
periodically and obtain body measurements that provides information about outcomes of
maintaining diet efforts of patient. Thirdly, create plan of appetite re-education for the client
which helps to person to avoid signals of hunger and not recognising fullness. However,
reassess the calorie needs in ever 2 to 4 weeks and render extra support when plateaus occur
that changes in weight helps to reduce high blood pressure to maintain stable condition of Jack
and helps to indicate need of extra support. In addition to this, provide required medications
such as appetite suppressant drugs like diethylpropion (Tenuate), hormonal therapy, Orlistat
(Xenical), vitamin and mineral supplements that are helpful to improve metabolic activity in
body. These medications helps to maintain metabolism in body which facilitate to balance fat
that provide support in maintaining the problem of high blood pressure (Virgincar, Doherty and
Siriwardhana, 2016). Moreover, it consist hospitalise for fasting regimen and stabilisation for
medical problems which helps to monitor Jack on regular basis or determining his other health

problems like chronic obstructive pulmonary disease (COPD), high blood pressure and
diabetes type 2. Furthermore, evaluate the patient outcomes by monitoring their weight and
high blood pressure that will determine need of implementing additional efforts to improve
condition of given patient.
Describe the evaluation criteria that you will use to judge whether your care plan has
addressed the identified care priorities. Ask yourself: How did I evaluate each nursing
intervention? What measures did I use? What time line was chosen and why? Was the plan of
care successful?
1. Care priority 1: The evaluation of nursing care plan established for chronic
obstructive pulmonary disease by monitoring symptoms of COPD. It can be evaluated
by determining that Jack feel relieved from symptoms of this problem and
communicating with patient regarding their breathing pattern. However, it consist to
identify actual condition by conducting certain pathological activities such as lung
function tests, chest X-ray, CT Scan, arterial blood gas analysis and laboratory test to
evaluate effectiveness of care plan of COPD (Jowsey, 2016). Moreover, these clinical
procedures facilitate to determine condition of given patient and indicate success of
nursing plan.
2. Care priority 2: In context of Diabetes type 2, it has been analysed that monitoring
blood sugar level is required to be conduct on daily basis through blood test to maintain
appropriate glucose amount on body of patient (Buetow, 2016). It is necessary to
analyse relevant symptoms including delayed healing of wounds, yeast infections,
peeing a lot, blurry vision, being very thirsty, tingling or numbness in hand or feet,
feeling worn out etc. Meanwhile, the effective communication should be used to
maintain relation with patient and gain actual information about condition of Jack by
ensuring that he will not hide any kind of aspect. It is helpful to evaluate the
effectiveness of nursing care plan for diabetes type 2 and it respective success.
3. Care priority 3: The care plan to overcome with overweight condition and high blood
pressure can be evaluated by looking at physique of Jack. It is essential to monitor

blood pressure through respective machines and determine effectiveness of providing
balanced diet and low calorie food items. Moreover, it is efficient to weigh body
weight and blood pressure on daily basis to identify requirements of adopting another
technique to solve the care priority 3 in context Jack.
CONCLUSION
From the above report, it has been concluded that health problems are required to be
diagnosed and make an effective care plan by focussing on respective priorities for making
patient healthy. It consist three care priorities including chronic obstructive pulmonary disease
(COPD), Diabetes type 2 and overweight condition of given patient to make nursing care plan
for improving their health condition properly. Moreover, effective medications & clinical
practices should be considered and evaluate their effectiveness accordingly.

REFERENCES
Books and journals
Buetow, S. (2016). Person-centred health care: balancing the welfare of clinicians and patients.
Routledge.
Hastings, A. C. (Ed.). (2019). Health for the whole person: The complete guide to holistic
medicine. Routledge.
Marengoni, A. & et. al., (2016). Coexisting chronic conditions in the older population: Variation
by health indicators. European journal of internal medicine. 31. 29-34.
McCance, T., & McCormack, B. (2016). The person-centred practice framework. Person-
centred practice in nursing and health care: theory and practice. 36.
Pedersen, M. K., Meyer, G., & Uhrenfeldt, L. (2017). Risk factors for acute care hospital
readmission in older persons in Western countries: a systematic review. JBI database of
systematic reviews and implementation reports. 15(2). 454-485.
Roth, G., & Reichert, M. (2019). Providing integrated health and social care for older persons in
Germany. Providing Integrated Health and Social Care for Older Persons: A European
Overview of Issues at Stake.
Stephens, C. (2017). From success to capability for healthy ageing: Shifting the lens to include
all older people. Critical Public Health. 27(4). 490-498.
Swall, A. & et. al., (2016). ‘Bringing respite in the burden of illness’–dog handlers’ experience
of visiting older persons with dementia together with a therapy dog. Journal of clinical
nursing. 25(15-16). 2223-2231.
Virgincar, A., Doherty, S., & Siriwardhana, C. (2016). The impact of forced migration on the
mental health of the elderly: a scoping review. International psychogeriatrics. 28(6).
889-896.
Jowsey, T. (2016). Time and chronic illness: a narrative review. Quality of life research. 25(5).
1093-1102.