Case Analysis Of How Individuals Respond To Illness
Using the most relevant and recent literature, this research project aims to compare and contrast evidence based practice in relation to how individuals respond to illness. Age, life experiences, gender, health status and support are some factors that can influence this. The two case studies of four year old Anna Hayes and 85 year old George McAdams, will be used to illustrate how caring for individuals can vary, using the priority health problem of impaired fluid and electrolyte balance.
From observing George and Anna’s cases they both have similar assessment results, with only slight variances. In both cases their lips are pale, tongue is dry, capillary refill is over 2 seconds and there has been no urine output for 8 hours. George feels like headed when he stands up and Anna has no tears when she cries. The results from the assessments as well as the background information of vomiting and diarrhea for the past two days with little fluids consumed, have led to impaired fluid and electrolyte balance for both Anna and George. This impairment can be fatal unless otherwise corrected. At the moment Anna and George’s body fluids are too concentrated and the volume of fluid in the extracellular compartments is too little. Due to the diarrhea and vomiting with no replacement of water or electrolytes, their bodies are excreting large quantities of sodium which causing this imbalance.
Assessing patients hydration status is a crucial component to a nurses job. The way in which the assessments are conducted varies between age groups as each patient is at different developmental stages meaning the technique and communication will vary. For George he is at time in his life where he is no longer thinking about how his health is affecting him, but rather his wife and/ or family. He is likely to be thinking of ways to better himself to ease the worry, which is why the communication method that should be used is to discuss the benefits and educate him on how the assessments and implementations will increase his current state. At George’s age of 85, it is uncommon for him to refuse or be uncooperative when assessing his hydration and electrolyte balance. This is very different for Anna, as she is at a developmental stage where trust is a crucial component to cooperation. Having Anna’s mum present and actively contributing to the conversation enhances this. With Anna’s age of four, she is at the opposite spectrum to George in the aspect of her cognitive level is focused on herself and how things affect her. Additionally, communicating to Anna in a way that she understands and implementing a reward system or praise can contribute to the trust and ease of the assessments.
In addition to the modifications of techniques between patients, the interpretations of the assessment data as well as the signs and symptoms will also vary. For Anna she complains of thirst where as George doesn’t. This is due to the decrease in the thirst sensation as we age and the feeling of satisfaction after small amounts are consumed, making the older population more susceptible to dehydration. Therefore in the case of George identifying that he feels light headed when he stands is crucial in detecting that there is a fluid and electrolyte imbalance. Indicators other than thirst for Anna, is the absence of tears when cries. This signifies that Anna is severely dehydrated as her body is retaining water rather than using it to keep her eyes moist.
The SMART goal framework, standing for Specific, Measurable, Achievable, Realistic and Timely, will be implemented to structure the care goal for the patient. For the cases of Anna and George the goal for treating the priority area is to improve their electrolyte and fluid balance to normal age appropriate levels as measured by the hydration health assessments. Due to the acute cause of the impairment, vomiting and diarrhea this goal is achievable within a short time frame. To address the SMART goal for George and Anna, would be to place them both on oral rehydration therapy (ORT). ORT is a critical intervention for all age groups experiencing fluid and electrolyte imbalance associated with vomiting and diarrhea. This method is inexpensive and can also continue to be administered at home once adequate education has been given to care givers of the patients. ORT works by ingesting a solution of water and electrolytes which allows for sufficient restoration of the fluid that was lost, even when normal adaptive mechanisms are impaired from diarrhea and vomiting.
Getto, Zeserson & Bryer (2011) enhances this intervention through analyzing a study that compares intravenous fluids and ORT in pediatric patients. It discovered that both methods were successful in rehydrating the patients, however, the patients that had ORT had a shorter stay in the emergency departments and had fewer hospitalizations later in life. While both Anna and George should be placed on this method, the way in which it is implemented will differ due to developmental differences. In Anna’s case, as she is a four year old she most likely will resist the electrolyte solution due to its salty taste. However, to overcome this barrier giving her a oral rehydration solution that has added flavor or even in an Icey-pole form will encourage the consumption as it is more appetizing. Additionally when she has consumed the solution a reward system can be in place which will further encourage the consumption. For George, educating him on the benefits of ORT and the risk factors for being dehydrated at his age, will encourage the consumption of the solution. Likewise, to Anna giving George the option of a flavored solution will additionally help with the consumption.
The second nursing intervention to address the goal of care is education. Education is an important aspect of a nurses job in all nursing situations. In the case for Anna, educating Anna’s mum on how to continue the ORT at home is a crucial component to managing her imbalance. Also providing education on how to manage the vomiting and diarrhea if it was to occur again to limit hospitalization in the future. Informing Anna’s mum on the correct preparation for the rehydration solution is a crucial aspect as if the ratio is inadequate, rehydration will not occur. Vomiting can pose a barrier for ORT so small amounts need to be given frequently and will need to continue once the vomiting has subsided.
Additionally, educating Anna’s mum on the use of sports drinks for treating vomiting and diarrhea is not sufficient as the ratio of electrolytes is inappropriate and the best oral rehydration solution other than home-made is those available to the public. For George, education has played a sizable role in his care, due to the developmental stage that he is at. Likewise to Anna encouraging small amounts frequently is most suggested to minimize the reoccurrence of the vomiting. In George’s case the education needs to be directed to himself as well as his wife on how to manage the oral rehydration therapy at home.
This time can also be used to inform them of the importance of hydration at their age and the recommended intake that should be drunk daily. This can be enhanced by the use of urine color charts and encouraging them to drink small amounts throughout the day. To indicate whether the assessment data has been effective for Anna and George, a hydration assessment will need to be conducted again. In relation to the physical results of the assessment, both Anna and George will have a moist tongue, lips pinkened, capillary refill under 2 seconds, temperature will have decreased and urine output increased. For Anna her eyes will be clear and George will no longer feel light headed when he stands up.
When conducting the hydration assessment for Anna, ensuring that there is trust is very crucial for the cooperating as well as explaining to her each component of the assessment before it happens in a way she understands. Having Anna’s mum present and demonstrating a caring attitude to both of them will influence the cooperation and trust. For George simply explaining what is being assessed directly to him rather than his wife will encourage his cooperation. The room needs to be warm and comfortable and likewise to Anna having a caring attitude and allowing as much time for the assessment will ensure the assessment is done accurately.
