Clinical Reflection Paper on Nursing

Introduction

Generalized weakness or fall describes a situation when a person rests on the lower level such as the ground inadvertently. In this case, this form may be as a result of something else other than loss of consciousness, violent blow sustenance, epileptic seizure or even paralysis sudden onset. Among older people, injuries related to falls/Generalized weakness have become the major issues affecting social care and healthcare provision across the world. Older people experience 'falls' incidents while in their homes and has been resulting in large numbers of admission to hospitals or other care settings (Rubenstein, 2006). As a person gets old, he/she experiences physical weaknesses owing to multiple pertinent disease processes that tend to interact with each other resulting in generalized weaknesses. Physical assessment of the patients and diagnostic testing may reveal the causes of falls especially among older people and appropriate treatment take the course to all the restoration of their strength. This paper examines a client complained of fall/generalized weakness whose diagnostic testing focuses on Diabetes Mellitus, Chronic Kidney, hypothyroidism, and cardiac issues to define the right treatment of her condition.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Pertinent Disease Processes

In this case is a female client at the age of 67 years which is considered to belong to the old age based on the life expectancy in the country. The client has a pacemaker with NSTEMI history, complete heart block, and heart failure. It is relatively common for patients with acute ST-elevation myocardial infarction (STEM) to have abnormalities with cardiac conduction and may exhibit complete heart block (Schmidt, Schmitt, Hochadel, Giannitsis, Darius, Maier, & Senges, 2018). NSTEMI history entails having some sharp chest pain and the breathlessness increases following the heart failure and the complete heart block. The history depicts NSTEMI, physical examination of the client's Poorly-controlled Diabetes Mellitus, Chronic Kidney Disease in stage 3, hypothyroidism, and her cardiac issues. Micro vascular and macro vascular complications are majorly associated with the Diabetes Mellitus. Some of the complications associated with Macro vascular include heart diseases and complications such as heart failure and the blockage of the heart (Rubenstein, 2006). Other macro vascular complications are the stroke that is as a result of the heart blockage when blood is unable to flow through blood vessels and peripheral vascular disease. Micro vascular complications resulting out of Diabetes Mellitus including diabetic retinopathy are related to the poor control of the disease. Hence, it is essential that diagnosis involves the physical examination of the poorly controlled Diabetes Mellitus using various diagnoses.

As a result, consistent Diabetes Mellitus that cannot be efficiently controlled develops diabetic nephropathy as the major complication associated with the disease. People who have these complications have more chances of having chronic kidney disease as well as end-stage renal disease. For the chronic kidney disease to occur, there should be a condition which ends up impairing the function of the kidney. Diabetes Mellitus has been identified as one of the leading causes of Kidney disease, heart complications including the heart block and failure as well as high blood pressure. The heart diseases will dysfunction the heart towards pumping blood in and out of the kidney for purification. Hence, the need to make the diagnosis of the kidney disease to establish whether macrovascular complications including heart blockage has affected the way blood flows in and out of the kidney. At stage 3, chronic kidney disease does not show symptoms yet, but the person tends to develop many health complications as the waste build up in the body. The waste accumulates and causes heart blockage that likely to lead to heart failure hence the client is at the risk of experiencing falls.

Hypothyroidism mainly affects the heart and the circulatory system in general in the sense that if thyroid hormone is not sufficient, the heart rate also slows down. The arteries become less elastic and likely to lead to blood pressure so that blood can be supplied around the body. The same condition is seen with Diabetes Mellitus and the kidney failures where there is heart blockage, and the heart has to work under a lot of pressure to ensure blood circulates the body. Hypothyroidism causes cardiac issues since mild hypertension with pulse pressure that is narrow are some of the findings (Jaeggi, Fouron, Silverman, Ryan, Smallhorn, & Hornberger, 2004). Even though hypothyroidism itself may not lead to the heart failure directly, it does lead to cardiac issues such as cardiac unloading which are the surrounding complications to the inability of the heart to pump blood around the body. Sometimes, if a person has Subclinical hypothyroidism, it is likely to have increased cardiac systolic time intervals at the same time the pre-ejection period prolongs. Hence most of the hypothyroidism effects are associated with the failure of the heart due to some blockage.

The fact that the client exhibit the history of heart failure and complete heart block means many cardiac issues need to examined to determine the exact problems. The complete heart block indicates that the blood vessels that are involved in the passage of the blood to the body parts including kidney have narrowed down. The results can be a heart attack, chest pain, and stroke, some of the main effects that poorly-controlled Diabetes Mellitus and kidney failure causes. It is coincident that the client in question has exhibited having heart failure over quite some time (Higgins, Hummel, Niazi, Giudici, Worley, Saxon, & Yong, 2003). All the four diseases that need to be diagnosed, Poorly-controlled Diabetes Mellitus, Chronic Kidney Disease in stage 3, hypothyroidism, and her cardiac issues are interrelated. In a way, the four try to explain the historical suffering of the client in the case who associates his falling woes with the heart-related troubles including heart failure and complete heart blockage.

Diagnosis

The diagnosis process entails understanding the patient well. Falls has many risks to the client and understanding some of these risks is essential. For a client within the bracket of only age, falls result in fractures with some falls causing severe injuries. The fractures occur in the hip, pelvis, humerus, spine, and wrist. The hip fractures are the commonest for falls in residential homes. Sometimes the falls may be non-injurious but sometimes end up being unreported for medical attention. However, if the fall is non-injurious but the faller is unable to get up from the floor, it is still fatal. Lying on the floor for long is the risk in the sense that it results in hypothermia, dehydration, and pressure sores.

Cross-Examination of the patient indicated that the client's legs show some instability that causes her to fall. Even with a walker, she demonstrates unsteady gait and requires assistance. Often, she feels irritated and is restless and has poor diet control hence obesity. The diabetic cardiac diet that is consistent in carbs and controlled cholesterol would assist the patient control the diet. The level of blood glucose increases just before the patient falls and goes even beyond 500.

Physical examination of the general appearance, HEENT, neck, cardiac, pulmonary, abdomen, extremities, and skin did not disclose in many abnormalities. The client appears well nourished and well developed with no evidence of respiratory distress apart from the left knee which appeared bruised with some mild pain when palpated. The bruises and the mild pain reported in left knee is because of the fall that the client experiences. Knee bruises are some of the risks that occur when a person falls. The results of the diagnosis were as follows; that no acute fractures were noted in both the lower extremities after the X-Rays were carried out. Fractures are the commonest risk outcomes of falls which occur in the hip, knee, ankle joints, and all bones in the parts of the body below the waist. Carrying out X-Rays for these parts is essential. Further CT testing was done on the head, thoracic, and lumbar spine is revealing no fractures. The performance of electrocardiogram (EKG) indicated that the client had a normal EKG with the heart beating in a regular rhythm with about 60 to 100 beats in a minute. The essential intervals of the EKG performance recording indicated that they were within the normal ranges. Other signs included from the client showed that temperature was 98.1, the pulse was 68, blood pressure 134/68. Others included respiration that was at 16 which was 98% on room air and the BG 214 mild pain reported as 3/7.

Medications

Over the stay in the hospital, the client exposed to multiple medications based on the outcome of the diagnosis. The client was first ordered to take Tylenol 650 mg PRN Q at the interval of 6 hours and any exceed on the doses should be under the supervision of the healthcare supervision. Tylenol 650 mg PRN Q was used to reduce the pain since the client had verbalized of having some mild pain that has been caused by the bruised left knee due to the falls at home. Some of the side effects include dizziness, disorientation, angioedema, hyperammonemia, and rash among others (Machado, Tynan, Curry, & Allan, 1988). The client was put on Acetylsalicylic acid (ASA EC 81mg QD) that is used in patients with acute myocardial infarction-like the case of the client. Its purpose involves relieving pain, inflation, and fever in the neck pain, nerve pain, muscle pain, and lower back. It has been found to preventing heart attack for those who are the risk of having a heart attack. It is best suited for the client to help relieve the pain and prevent or reduce the risk of heart attack. The side effects of administering ASA EC 81mg QD are dose-related which include gastrointestinal, bleeding, Dizziness and tinnitus, Hematologic, and Dermatologic and hypersensitivity. Lipitor 40mg QD is best when given to the client because she has the problem with heart disease to help reduce risk myocardial infarction as well as stroke. The fact that the client does not indicate steadiness when walking even with a walk and needs assistance to ambulate means Vitamin D3 was not sufficient and need some Vit D3 2000 units to boost the level of calcium and phosphorus to increase steadiness. The client is having the symptoms of diabetes, the Dextrose 50% injection PRN hypoglycemia, Lasix 20mg BID, and Gabapentin 600mg BID were needed to reduce the level of glucose in the body.

Description of Treatment

For the client, the chief complainant was falling with the pacemaker history NSTEMI, heart failure, and complete heart block. Hence most of the problems of falls experienced by the client emanate from the heart dysfunctioning. Therefore, the treatment for the client entails medical attention meant to address the complications of the heart as well as any pain that the client might experience due to the fractures resulting from falls. The treatment involved oral and injection of doses that could help address the high level of glucose in the body that put the body at the risk of experiencing diabetes mellitus. For instance, Dextrose 50% injection PRN hypoglycemia, Lasix 20mg BID, and Gabapentin 600mg BID increase the level of insulin in the body.

The high level of insulin aids in body attraction of the glucose to reduce its much concentration within the body. Majority of the medicines prescribed to the client were meant to help reduce pain and prevent treat heart diseases. Heart disease in the client was the leading factor to the kidney and cardiac issues experienced by t...