Geriatric Care Plan
Geriatric Teaching Plan Bryant and Stratton College Nursing 222 Geriatrics Geriatric Teaching Plan Mr. R. D.
is an eighty-year-old male. He currently resides at the Manor Care Rehabilitation/Nursing Center. Mr. D was admitted on January 5, 2010 for pneumonia. Mr. D has other medical history problems, which include leukocytosis, headache, hypertension, depressions, postural insufficiencies, arteriosclerotic heart disease and dementia Parkinson’s.
Mr. D does not currently have any food or drug allergies. Mr.
D has a wife, three children, two girls and one boy. Mr. D has four grandchildren.
He has at least one person visiting him every day, and you can tell by his expression he is very happy when they are visiting. Mr. D is a very pleasant quiet patient that is very helpful at answering questions to nursing students and the center staff. Mr. D is on a mechanical soft diet but uses honey-thickening liquids to ease his swallowing of fluids and has no added salt.
Mr. D does not have a history of drinking or smoking. Mr. D’s current medications
OAcidophilus Capsule- two capsules twice a day to regulate good bacteria in intestine OCarbidopa-Levo 25-100mg 1 tablet every six hours for the treatment of parkinsons disease OComtan 200mg 1 tablet every six hours for the treatment of Parkinson’s disease OFlomax 0. 4 mg cap 1daily for the treatment of urinary urgency and nocturia OFludrocortisone 0.
1 mg tab 1 twice a day a synthetic adrenocortical steroid possessing very potent mineralocorticoid properties and high glucocorticoid activity; it is used only for its mineralocorticoid effects.
OGuaifenesin 200 mg tab 1 tab four times a day- an expectorant OLovastatin 20mg 1 daily- a statin for cholesterol control OMidodrine HCL 2. 5mg three times a day with meals used as a vasoconstrictor used to treat dizziness from orthostatic hypotension ONamenda 10 mg tablet 1 twice a day for moderate to severe Alzheimer’s dementia OSenna 10mg laxative tab OAcetaminophen pain medication used as needed for pain Potential Learning Needs: 1. Diet 2. Fall precautions 3.
Occupational and physical therapy 4. Safety concerning medication administration and side effects
Nursing Diagnosis: At risk for aspiration related to difficulty swallowing Goal: Client will maintain patent airway and clear lung sounds during the stay at Manor Rehab/Nursing Center (Ackley, 2006, pg 151) ???? Nursing Diagnosis: At risk for falls related to impaired physical mobility Goal: Client will remain free from falls while at Manor Rehab/Nursing Center ???? Nursing Diagnosis: Impaired verbal communication related to Parkinson’s dementia Goal: Demonstrate congruency of verbal and non-verbal behaviors ???? Nursing Diagnosis One: At risk for aspiration related to swallowing difficulty Mr.
D is at risk for aspiration related to swallowing difficulty because of his Parkinson’s dementia. SHORT TERM GOAL: Mr. D will remain free of aspiration while at Manor Rehab/Nursing during my shift.
Nursing Interventions: OMonitor respiratory rate, depth and effort ONote any signs of aspiration such as dyspnea, cyanosis, wheezing or fever OTake vital signs frequently noting onset of temperature LONG TERM GOAL: Client will remain free of aspiration using the following precautions during his duration at Manor Rehab/Nursing Center Nursing Interventions:
OClient needs to be fed slowly and allow adequate time for chewing and swallowing OKeep head above bed elevated when feeding and at least one hour afterwards ONote any are onset abdominal distention or increased rigidity of the abdomen OIf client shows side symptoms of nausea and vomiting position on side OWhen feeding client watch for signs of impaired swallowing or aspiration, including coughing choking or spitting food. EVALUATION: Mr. D has not had any episodes of aspiration during my shift or his stay at Manor. The client verbally states an understanding of the precautions to prevent future aspiration.
Nursing Diagnosis Two: At risk for falls due to impaired physical mobility Mr.
D is at risk for falls because of his impaired physical mobility related to his Parkinson’s dementia. SHORT TERM GOAL: Client will remain free from falls during my shift using the proper precautions for falls. Nursing Interventions: OUse adequate lighting OUse non-skid socks or soles OPlace mats on floor OHave call light within reach LONG TERM GOAL: The client will remain free from falls during his stay at Manor Nursing Interventions: OKeep mats on floor OKeep call light within reach OAssist for transportation as needed
OFrequent room checks on the patient OMonitor for cognitive changes OKeep bed on lowest position and locked OAssist during position changes as needed OAdminister medications as directed EVALUATION: Client will remain free from falls during his stay at Manor Rehab/Nursing Center. Nursing Diagnosis Three: Impaired Verbal Communication related to Parkinson’s Dementia Mr. D has impaired verbal communication that is related to his Parkinson’s Dementia.
SHORT TERM GOAL: Mr. will be able to successfully communicate with staff and myself during my shift at Manor Rehab/Nursing Center.
Nursing Interventions: OCarefully assess all clients for hearing difficulty using an audiometer OAvoid using elder speak OInitiate communications with the client with dementia OUse presence, spend time with the client allow time for responses and make the call light readily available. LONG TERM GOALS: Mr. D will be able to communicate with staff and myself during his stay at Manor Rehab/Nursing Center.
Nursing Interventions: OInvolve familiar person when attempting to communicate with a client who has difficulty with communication OAvoid making assumptions about communication choice
OListen carefully, validate verbal and nonverbal expressions particularly dealing with pain OMaintain eye contact and at clients level OBe persistent in deciphering what the client is saying and do not pretend when a message is not clear. OEvaluation: Client will successfully be able to communicate with staff and myself during his stay at Manor Rehab/Nursing Center. Objective Content Method Time Evaluation Client and family will be able to explain the signs of aspiration Be able to explain what is aspiration and what causes it Discussion Brochure 10 min
Client and family are able to successfully verbalize the signs and symptoms of aspiration Client and family will be able to verbally explain precautions for aspiration Be able to verbally explain what precautions can be done to prevent aspiration: proper food, honey thickening liquids, sitting up during feedings Discussion Brochure 10 min Client and family are able to successfully verbalize the precautions of aspiration Client and family will be able to demonstrate how to safely help the client if he aspirates Be able to demonstrate what can be done for a patient who has aspirated
CPR, suctioniong Video Demonstration 15-20 min Client and family are successfully be able to demonstrate proper methods of how to safely help the client if he aspirates Objective Content Method Time Evaluation The client will be able to verbalize that he recognizes safety measure Call for assistance Discussion 10min Client successfully verbalizes what are safety precautions and why they are needed The client will be able to verbalize the precautions that are needed to prevent falls Adequate lighting, bed in low position, skid socks, mats on floor Discussion 0min Client successfully verbalizes what precautions are used to avoid falls The client will demonstrate safety precautions that prevent falls Ask for assistance when transporting, adequate lighting, call light near client, skid socks, mats on floor, bed low to ground and locked Demonstration 10-15min Client successfully demonstrates safety precautions Objective Content Method Time Evaluation Client will be able to use effective communication techniques Be able to use effective communication techniques to get message across Verbal 10 min
Successfully be able to use effective communication techniques Use alternative methods of communication effectively Be able to use the proper methods of communication to make it easier on the patient to get the message across Verbal 10 min Successfully be able to use proper alternatives to communicate effectively Demonstrate understanding even if not able to speak Be able to use sign language, pen and paper to get a message across Verbal Hands on Demonstration 15-20 min Successfully be able to demonstrate an understanding and use alternative methods to get their message across
