American Colege of Rheumatology Management

Old age is a phase in life that is quite sensitive; elderly people require comfort and care to enable them lead healthy lives without the unnecessary anxiety and worries. (AgeUK, 2015). Old age, adulthood, adolescence, childhood, and birth are the critical stages in every person's life. Each stage is characterized by its own challenges and issues. As one proceeds from one stage to another, it reaches a point when physical strength deteriorates and so too the mental stability (Bragen, 2013). As age progresses, several medical issues occur the most common being osteoarthritis, dementia, diabetes, cardiovascular diseases, visual impairment, kidney infections, and other geriatric medical conditions. Besides disease, other issues are interlinked with old age. A major concern among the elderly is loneliness and depression. As one ages, the relationships that one had begin to sever; children grow up and move out, souses die, friends and family move away and soon an elderly person finds that they are all alone. Depression begins to manifest even as the elderly person starts to visualize a different life from what they have been accustomed too (Mental Health America, 2017). In this paper, the patient, Barbara Green is an 89 year old widow who has reported at the health center with multiple complaints.   The patient complains of swollen feet and enlarged joints; painful joint pains in the knees, fingers, hip, and back; joint stiffness, minimal joint movement; visual impairment; constipation; weight loss; and dizziness that occur on and off (Levett-Jones, 2013). The decrease in physical functionality has caused her to cut off socializing with her friends at the German Association, her eating habits have deteriorated; and her house keeping has reduced causing her to live in poor condition. The physical conditions that the patient in this case has complained about and which are geriatric in nature include constipation, the visual impairment, and stiff painful joint   (Siamak, 2016, Levett-Jones, 2013). The risk factors associated with constipation include use of multiple pharmacological drugs, poor diet that is deficient in roughage and fluids; and reduced amount of physical activity (Hunter, 2016). In addition, the fact that Barbara has a visual impairment renders her at risk of physical injury. The visual impairment is most likely caused by macular degeneration (WebMd, 2016) a condition that is common among the elderly and also among the Caucasian community (Haddrill, 2016). In addition, reduced amount of activity as well as poor eating habits have been known to exacerbate the condition among the elderly (WebMd, 2016). In this scenario, the three major illnesses that will be addressed are Osteoarthritis/Rheumatoid arthritis, Constipation, and Macular degeneration. Although Barbara is currently living a solitude life, the underlying reason behind it is not depression, rather it is as a result of reduced activity resulting from joint pain (Hunter, 2016). The inactivity has resulted in the patient developing constipation (also caused by her prescribed medication) and exacerbated macular degeneration (also caused by age) (Hunter , 2016). Based on the presentation of facts and by utilizing clinical reasoning, the optimal patient outcomes will be achieved when Barbara is able to manage her pain   (Bullock, & Hales 2013) which will in turn help her achieve her ADLs, eat healthier, become more active, and resume her normal life and restore severed relations with her German Association friends as well as her family. Eating healthier will reduce incidences of constipation and   will slow down macular deg eneration. To manage her pain, Barbara will need to adhere to her medication regimen. Barbara reported that she lives alone in a one-storey building. She said that she experiences joint pain especially on the hip and knees which could result in limited movement. Although she did not mention it, it is probable that her housekeeping as well as other ADLs is below par because of the physical pain in her joints. It is also possible that she has resulted in eating poorly because of her inability to make healthier food purchases at the grocery due to her reduced mobility caused by her painful joints. Other than not being able to go to the grocery, her weight loss could be attributed to depression as she reported that she no longer visits with her friends at the German Association and that she is widowed. Visual impairment is caused by macular degeneration in older patients. Macular degeneration occurs when the retinal macular wears out from ageing which causes one to lose central vision (WebMd, 2016). However, a patient is able to see using the peripheral vision. Macular degeneration can either be dry or wet with the most common being the dry macular degeneration among the elderly. (WebMd, 2016) Constipation is a common occurrence among the elderly. There is a distinction between hospital environment constipation and that which is influenced by other external environments. The occurrence of constipation among the elderly increases with age, the older one gets the more incidences one experiences (Gandell, Straus, & Bundookwala et al., 2013). In addition, constipation can be as a result of drug interactions in the body (Hunter, 2016). Barbra is currently prescribed on slow release Paracetamol which causes slow bowel movement. Another common medical condition among the elderly is Rheumatoid arthritis and/or osteoarthritis (Hunter, 2016). The medical condition is as a result of bone cartilage wearing out with age which causes joints to rub off against each other. The friction between the joints causes stiffness, mild to acute pain, as well as development of swollen nodes (Udell, 2017). Assessment of the patient showed blurred vision and a centralized blind spot in the visual filed. In addition, Hydroxychloroquine can also cause impaired vision ((Tiziani, 2014). The patient has visual impairment and is at risk of injury from poor vision. The patient may also experience challenges in her ADLs because of minimal vision. To manage the condition, the patient will be advised to wear sunglasses and avoid direct light or sunlight once she has undergone photodynamic therapy (Arnold J, Heriot W , 2007; WebMd, 2016). The patient will be required to give details on the time of day and frequency of constipation. Symptoms to look out for include confusion, diarrhea, nausea, urinary retention, loss of appetite, and abdominal pain (Mandal, 2016). The patient is already on multiple drugs which predisposes her to constipation.(Hunter, 2016). The limited physical activity that is caused by her painful joints is another risk factor that contributes to the patient's constipated condition. The patient will be advised on increasing her fluid and roughage intake (Orenstein, 2016). In addition, she will be advised to adhere to her pain management medication for her joint aches. Once she is able to manage her joint pain, the patient will be able to increase her physical activity which will help ease the constipation that she is experiencing. Assessment of the patient shows joint swelling and deformity with Heberden and Bouchad nodes in the distal and proximal joints respectively. The pain in the joints intensifies with physical activity such as walking, exercising or basic ADLs. Patient also indicated that the pain intensifies during the night when the room temperatures are low, and upon getting up after sitting or lying down. The diagnosis is chronic pain that results from joint deterioration. Evaluation using x-rays shows joint narrowing and sclerosis in the knee, hip, and finger joints. The synovial fluid analysis showed the occurrence of both rheumatoid arthritis and osteoarthritis in the affected joints. The patient will be advised to manage the pain through strict adherence to medication. She will also be advised to avoid strenuous activities that can trigger painful joint episodes. Heat application will be done on the affected joints. A terry clothe will be placed under the patient's neck to relieve any pain on the cervical area as she sleeps. Simple exercises will be taught to the patient that will help reduce joint stiffness. The patient will also be advised to wear foot pain relieving shoes and support. In addition, calcium supplements will be included in her medication. The four main goals that need to be met with regard to taking care of Barbara include: The first issue that needs to be resolved is medication non-adherence. The first step is o have a conversation with the patient and educate her on the need to stick to her medication regimen, the health benefits she stands to gain from her medications, any side effects she should be on the look-out for, and how to use a medicine chart (Jimy, & Jose, 2011). Barbara's medication will be packaged in different colored bottles and placed in easy to reach areas. This will allow Barbra to be engaged in her own therapy. As she is suffering from visual impairment, placing the medications in places she uses often will help her in adherence. For the drugs that are to be taken before she sleeps, the bottles will be placed on her nightstand. Those that need to be taken in the morning will be placed in the toothbrush stand and those that need to be taken during or after meals will be placed on top of her refrigerator. A medication chart will also be created to enable the patient take her medicines at the right time (Jimmy et al., 2011) Tracy will be informed on the action plan so that she is able to discuss with Barbara about her daily goals when she calls her. Barbara will be required to purchase a water bottle and advised to fill it with water which she will be expected to drink during the course of the day. A meal plan will be drafted by the healthcare nutritionist to help Barbra make healthier meal choices and also enable her regain her weight. After three weeks: Barbara has gained weight of 1-2kgs The patient has rejoined her friends in the regular meetings at the German association As people become older, I not excluded, the things that we value become lesser and we are left with that which is most precious. The key is to expand our horizons, value more relationships, and more variety in what makes our lives rosier. When a person spends his early years establishing and strengthening many good relationships, it pays off in the sunset years as such a person will always have people around them to laugh, share, and confide in. In addition to people investment, health investment is critical. I have resolved to live healthier now so that I do not have to struggle with some of the geriatric conditions n the future. For the overall wellness and enhanced productivity, Barbra's care will include taking care of her physical needs through pain management and medication adherence; healthier eating and consumption of daily fluids; and regular mild exercises. For her socio-psychological health, Barbra will be able to socialize with her friends and family and get out more as she makes visits to the grocery store. Health eating and exercising will improve her mental health and decrease chances of depression occurring AgeUK. (2015). Protecting yourself and others from abuse. Retrieved 03 09, 2017, from https://www.ageuk.org.uk/health-wellbeing/relationships-and-family/protecting-yourself/what-is-elder-abuse/ Bragen, J. (2013). The Berkley Daily Planet. Retrieved 03 09, 2017, from https://www.berkeleydailyplanet.com/issue/2013-01-03/article/40630 Bullock, S & Hales, M. (2013). Principles of Pathophysiology. NSW: Pearson Australia. Gandell, D; Straus, S; & Bundookwala et al., (2013). Treatment of constipation in older people. CMAJ , 663-670. Haddrill, M. (2016). What Is Age-Related Macular Degeneration? Retrieved 04 09, 2017, from All About Vision: https://www.allaboutvision.com/conditions/amd.htm Hunter, S. (2016). Miller's Nursing for wellness in older adults. North Ryde: Lippincott, Williams and Wilkins. Jimmy, B & Jose, J. (2011). Patient Medication Adherance: Measures in Daily Practice. Oman Medical Journal , 155-159. Levett-Jones. (2013). Clinical reasoning: Learning to think like a nurse. NSW: Pearson. Mandal, A. (2016). Constipation in the Elderly. Retrieved 04 09, 2017, from News Medical : https://www.news-medical.net/health/Constipation-in-the-Elderly.aspx Mental Health America (2017). Depression In Older Adults: More Facts. Retrieved 04 09, 2017, from Mental Health America: https://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts Orenstein, B. (2016). How Fiber Helps Ease Constipation. Retrieved 04 09, 2017, from Everyday heakth.com: https://www.everydayhealth.com/digestive-health/fiber-and-constipation.aspx Siamak, N. (2016). Senior Health. Retrieved 04 09, 2017, from eMedicine: https://www.emedicinehealth.com/senior_health/article_em.htm Tiziani, A. (2014). Havard Nursing Guide to Drugs. (9th ed.). Chatswood.NSW; Mosby Elsevier. Udell, J. (2017). Osteoarthritis. Retrieved 04 09, 2017, from American Colege of Rheumatology: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis WebMd. (2016). Age-Related Macular Degeneration Overview. Retrieved 04 09, 2017, from WebMd: https://www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-overview#1

Exampaper Essay Example | Topics and Well Written Essays - 1500 words

Exampaper - Essay Example Irigaray, Nozick and Delaney have attempted to articulate this idea in more modern terms. However, William Shakespeare’s Sonnet 116 presents this concept quite eloquently. The idea that love can have a somewhat illusory nature was put forward by Rorty when she used Spinoza’s to help illustrate her concept. She argued that indulging in fantasy and unrealistic expectations of love are potentially dangerous because they distort our perception of love. Instead of an authentic experience, idolatrous love offers an illusion. Over the centuries humanity has developed certain romanticized ideas of idealized male and female roles in relation to romantic love. Simone de Beauvoir and Marilyn Friedman, in particular, discuss the dangers of such romantic ideology and their relation to male chauvinism. We live in an increasingly â€Å"cyberized† world. The Internet and social media have allowed â€Å"cyber-relationships† to become increasingly more frequent. However, Zygmunt Bauman and Hubert Dreyfus underscore the need for traditional, face-to-face interactions in building more lasting and exclusive relationships. They warn that online relationships run a very high risk of more ephemeral and promiscuous interactions, precluding lasting and substantial relationships from developing. Montaigne presents the idea that a perfect friendship emphasizes as an essential aspect of the friendship. He goes further to describe such a friendship as one characterized by such unconditional openness and trust that each individual’s need is met by the other. However, Montaigne is careful to distinguish such an ideal from homosexual love. Possible modern interpretations of this â€Å"perfect friendship† could be the ideas of â€Å"bromance† and â€Å"womance† that have become more prevalent nowadays. Touch is one of the most concrete ways in which we express love and affection for one another. Although sexual intimacy is

Diet Essay Example | Topics and Well Written Essays - 2000 words

Diet - Essay Example Humans are omnivorous in nature, but both psychological and social factors have a significant influence on the dietary habits of individuals or a community, some of which may be useful and others harmful. For the purpose of this paper, ethnic/cultural and educational factors will be examined under the social angle, while memory and attitude factors will be discussed under the psychological aspect. Such factors strongly influence the deliberate choice of food intake. Indeed, diet has its detrimental effects on health when not undertaken properly and as per guidance from professionals. Individuals wishing to undergo a diet will be restricting themselves in what they drink and eat aiming at losing weight or becoming healthier (Conner & Norman 2005). Although healthy dieting averts complications like diabetes, the partakers may also fall victim to various negative outcomes like the weakening of the immune system. Such negative results deter the body’s ability to manage the changes dieting causes and how well it adapts to new behaviors. The understanding of the variables encountered in the body enables dieting people to decide their failure or success. For example, calories are essential in providing energy and supporting bodily functions. However, if consumed excessively during a diet, they not only increase the body’s fat content, but body weight as well. A deficit leads to lack of energy and constant fatigue. Carbohydrates are also a source of energy, but failure to distinguish between healthy sources is detrimental. Rather than getting the supply from sugary foods like sweets and soft drinks, they should be obtained in a more readily available form like corn, rice and cereals. Over indulging and under indulging in certain nutrients leads to either dangerous and unhealthy weight gain or loss. Life threatening conditions then set in, such as binge eating, bulimia and anorexia. In anorexia, a dieter is tormented by the fear of getting overweight, and in bulimia, a dieter usually ends up in recurring cycles of purging and binge eating. The dieter abuses diuretics and laxatives in a bid to acquire desired looks. Below is an examination of social and psychological factors and their influence on health. Cultural/ethnic Factors Growing up in distinctive traditions, cultural values and beliefs determines diet choices and how food is prepared among diverse communities in diverse sections of the world, with each ethnic group having their own culturally based food habits (Shepherd 1999). Therefore, different cultures, which are further embedded in ethnicity and religion, produce varied health risks in different people. As an example, African Americans are prone to diabetes and heart diseases mainly due to their cuisine. On the other hand, although they cannot be completely written off, such diseases are less prevalent among the East Asian cultures as their cuisine is mainly composed of vegetables, seafood and low-fat foods (Rubin 2004). This is because some diets are already a part of some nations’ culture. Migrating populations may, however, be an exception, as seen among South Asian women who moved to Scotland and recorded an increased intake of fats that was associated with a higher body mass index and more incidences of heart disease. In the same fashion, food is a key aspect of the Mexican