Part 1: Case Assessment
Alcohol Withdrawal Risk Assessment
Understanding alcohol withdrawal risk is a comprehensive process that uses drug history, which can take some time to obtain. In the assessment, a full history of problems and reasons for seeking treatment, goals, and motivation for seeking treatment and drinking history timelines should be covered (Zhang et al., 2018). Furthermore, in the assessment, the withdraw risk will be determined by the alcohol dependence rate measured through different parameters. For instance, a psychiatrist will seek to understand the recurrence of alcohol use, the strong desire for help, and unsuccessful efforts to control.
The purpose and the goal of this assessment are to understand the effective strategies to apply for the patient to have risk-free alcohol withdrawal. According to the paragraph, withdrawal from alcohol without understanding the dependence ratio or the risk after withdrawal can be dangerous for a patient. In that regard, understanding all the challenges and life dimensions they are through will help recommend a better withdrawal plan. Some of the features of alcohol withdrawal include anxiety and agitation, sweating, seizures, insomnia, and hypertension. Mr. Jungala is suffering from Type 2 diabetes, which means that his immune system to repair the damaged cells may take more time for many results. From clinical guidance, alcohol may damage the immune system further, which means it may weaken the body (Zhang et al., 2018). In that regard, alcohol cessation would be beneficial for Mr. Jungala. Therefore, an assessment of the withdrawal risk is essential to determine their fitness to the process of cessation.
Cognitive assessments measure and quantify different aspects of the brain functions, including the level of concentration, speed of processing information, language, reasoning capabilities, and engagement. A neuropsychologist conducts the testing and gives recommendations on optimizing brain health. One of the purposes of cognitive assessment is to understand mental health in a patient and track their brain functioning (Hodges, 2017). Understanding these aspects of their brain will allow the health professional to recommend personalized measures to optimize their cognitive functioning.
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In Mr. Jungala’s case, it is understood that his pre-existing complications such as diabetes and his 71 years of age are valid reasons to want to conduct a cognitive assessment on the patient. For instance, for fast healing, some of the life stressors must be eliminated, especially at this age, to ensure good mental health. In that regard, understanding their family relations, wellbeing, and overall cognitive functioning is essential to recommend treatment measures and stress removers. Also, on Mr. Jungala, it is crucial to understand whether there are people that can help him out, especially at this time that he needed support and care. This would ensure that he heals properly.
In understanding risk assessment for falls, the physician would want to understand the patient’s fall history, environmental assessment, and physical examination. A fall history will determine the number of falls in the past year and the circumstances that followed, such as assistive devices, use of glasses, or footwear. According to Phelan et al. (2016), medications in previous treatment engagements may also contribute to falls. The medicines tend to impair body balance and alter the sensorium. Such medications include nonsteroidal anti-inflammatory drugs, diuretics, and antihypertensives).
Considering that Mr. Jungala uses plenty of these medications due to diabetes and other illnesses that he has, there is a possibility that he might have fallen again. Despite that not all of them are severe, the man might have experienced other falls in the previous years. Some of these sessions can be answered by the family members considering that he might not remember most of these instances. In the process, the severity of the consequences of the fall will be determined, which may also have contributed to the recent fall experience. Therefore, with this information, the hospital can recommend effective support methods for the man to reduce the probability of another fall in the future.
In a functional assessment, the psychologist wants to understand the functioning of the patient over the years or before their health condition. In that regard, the health professional will engage the patient’s families and engage with them. The aim is to observe, listen, analyze, and create collaborative rapport building for effective relationships with them. In a functional assessment, the history of a patient’s thinking, communication, behavior, and activities are revealed.
A functional assessment is needed for Mr. Jungala to establish his behavior, body functioning, communication, and relationship with others. The evaluation will help the psychologist understand the challenges that he might be having in their everyday life. In the case of memory loss and impaired vision, early intervention will be undertaken to alleviate severe impacts.
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A nutritional assessment involves the interpretation of anthropometric, clinical, and dietary data to determine whether a person is malnourished or well-nourished. These assessments happen through different methods, including anthropometry, biochemical processes, clinical and nutritional methods. The purpose of these methods is to assess growth, body composition, and nutritional status (Tsai, Chang & Wu, 2018). Understanding these three dietary aspects of a person allows on to understand what a patient lack in their body. During this assessment, the nutritionist will understand what type of food the patient often feed on. In the process, the family can participate in answering some of these questions.
In Mr. Jungala’s case, his age and diabetic condition require a more nutritious diet to strengthen his body. A healthy diet is balanced, consisting of enough vitamins, carbohydrates, proteins, and fats. Recommended, it would be better when Mr. Jungala could have adopted a more balanced diet and eliminated sugar content in his body. Sugar content in his body may have been contributed by the beers he takes once in a while to remove stressful conditions. Therefore, assessing their nutritional status will allow the nutritionist to develop different mechanisms for the patient to avoid future falls and incapacities in the body.
Part 2: Plan and Implementation
Regular aging changes in the body usually contribute to physical, cognitive, and affective changes that may lead to risks of falls. Usually, women may fall more often than men. However, they have more tolerance for injuries than men. Due to aging, a person records the following changes in their body;
- Loss of motor neurons and decrease of anabolic hormones
- There is reduced locomotor power and inability to perform work
- There is a reduction in size and number of myocytes
- Muscle mass also reduces (dos Santos & Baixinho, 2020).
From the above factors, the elderly can develop weak muscles and may fall often. In Mr. Jungala’s case, he was disrupted by the kid’s toys and eventually fell on the floor. In that regard, his muscles that would have protected the inner muscles from damage may have already reduced significantly.
As a nurse, handling this condition would be challenging, mainly because the patient is going through numerous challenges. It includes family challenges, aging problems, diabetes, and an ailing daughter at home. However, several prescriptions and advice on nutrition are adequate to ensure that the patient recovers well.
As a nurse, in this case, I would recommend different practices and interventions to ensure that the patient adopts a healing process and avoids such occurrences in the future.
Tai chi: This is a form of exercise to reduce the tensions in the body, usually recommended to the elderly. Tai Chi has a high prevention capacity for falls, especially for those patients that have no previous fracture, such as Mr. Jungala. In this case, this form of exercise will ensure that their muscles are relaxed and flexible. It also adds strength to the muscles around the joints and boosts motor cells in the body, especially around the joints.
Medication: In consultation with healthcare teams, periodic medicines would be beneficial for the patient. Some of the patients that have developed challenges may have used drugs that the elderly frequently use. For instance, trazodone, serotonin-reuptake, and tricyclic antidepressants (Zhang et al., 2018). Excess intake of these medications can contribute to loss of muscle size and strength.
Hip protector: In the future, the right hip of Mr. Jungala is hurt, and the challenges they experience with the pain may affect normal movement or perhaps contribute to fear of falling. Furthermore, this fear may develop into anxiety or depression, which may cause other falls. In that regard, a hip protector would be useful for the elderly to prevent fractures in their hips whenever they fall.
Exercise: Multi-factorial teams in the healthcare sector can recommend different intervention mechanisms for this condition. One of the overall recommended intervention measures is exercise. In exercising, the patient will try to move their body often and ensure that the paining muscle is put into practice. However, a routine should be followed, whereby the patient will exercise for a particular period and a specific time. Therefore, they can be assured of muscle healing and added strength in the future.
Part 3: A Biopsychosocial Approach
Psychosocial adversity may contribute to particular actions that further damage the healing process of the patient. In Mr. Jungala’s case, currently, he is experiencing stress due to her daughter’s diagnosis with cancer. In that regard, he enjoys indulging in alcohol to ease the stress and to engage with a few people in the joints. Before he retired, he was a station hand, and during his life, he has managed to put up a family and get grandchildren also. Although he is a non-smoker, he enjoys exposure to campfire smoke while listening to music, which he often does. Although he does not use other drugs, the alcohol he takes 2-3 times a week may contribute to their condition, especially knowing that he is diabetic and hypertensive.
Due to the alcohol indulgence and stress levels, he experiences hypertension. Hypertension and other health effects that emanate from alcohol leads to more stress, and the cycle continues. Another negative impact is the patient’s experiences of anxiety from time to time. Although he considers it bad luck for tripping the toy truck and hurt his hip, he is aware that his conditions of renal failure and diabetes cannot bear something positive, which is a negative thought process.
However, on the positive side, his family is supportive, and it is the source of his strength. For instance, the wife and the girls at home contribute to a full community of friends and families that become the support system for the entire family. These people help him in shopping, banking, accessing hospitals, and performing different chores at home. He also practices walks in the bush, which helps him unwind.
One of the coping mechanisms that the patient has used is strolling in the bush for some time and sitting and relaxing for a while without stressing. Due to the fall, the patient will be given regular massages by his wife to help him reduce the tension of the muscles around the area. Also, he should practice Tai Chi and use the family members for support and guidance when conducting these exercises. This will benefit him in becoming more flexible and tolerant to pain.
Similarly, the patient will replace their medicines with healthier eating habits. For instance, the family will prepare healthy food full of vitamins for him most of the times. Having enough vitamins in the body will strengthen his body cells, thus ensuring he is able to fight other infections that may emanate from the underlying health challenges (Tsai, Chang & Wu, 2018). Therefore, the patient will develop a high tolerance for diabetic conditions and hypertension due to the strength of their body. In the process, blurred vision caused by low eye-lid power in his eyes will be restored, and the he can start taking control of their sight. Therefore, these coping mechanisms will improve his health within a short time.
Furthermore, the patient will go for regular checkups to keep track of his performance. This will guarantee that he understands the challenges and solutions to implement for betterment. Therefore, with the coordination of the nurses and other disciplinary teams, they can organize educational sessions for self-awareness of the patient. The sessions will help him understand different facets of his health and instill him with the desire to change some of this behaviors, routines, and other practices. These behaviors such as taking alcohol or inhaling the smoke in the campfire may be affecting him indirectly. Therefore, the sessions will help him change some of his behaviors.
dos Santos, B. W., & Baixinho, C. L. (2020). Possibilities for nursing interventions in the prevention of falls in the elderly: a review. Cogitare enferm, 25, e71326.
Hodges, J. R. (2017). Cognitive assessment for clinicians. Oxford University Press.
Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. Medical Clinics, 99(2), 281-293.
Tsai, M. T., Chang, T. H., & Wu, B. J. (2018). Prognostic impact of nutritional risk assessment in patients with chronic schizophrenia. Schizophrenia research, 192, 137-141.
Zhang, X., Sun, M., Liu, S., Leung, C. H., Pang, L., Popat, U. R., … & Tripathy, D. (2018). Risk factors for falls in older patients with cancer. BMJ supportive & palliative care, 8(1), 34-37.