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Unit 5 Discussion-Age-Related Functional Changes in Geriatric Client

Unit 5 Discussion-Age-Related Functional Changes in Geriatric Client

Sample Answer 

Unit 5 Discussion-Age-Related Functional Changes in Geriatric Client

Age-Related Functional Changes in Geriatric Clients

Pertinent positives

The patient is old since she is 97 years old female. She also wakes up frequently at night, feels stressed from lack of sleep, is unable to walk daily as she used to, and sleeps more during the day. In addition, she suffers from heart failure and is thus on metoprolol. Heart failure and beta-blockers such as metoprolol have been found to lead to a lack of sleep (Schwartz et al., 1999). Lack of sleep causes a lack of energy that could have made the patient not walk normally as she used to.

Pertinent negatives

There is the absence of anxiety, depression, shortness of breath, headache, gastrointestinal problems, and the use of alcohol. Moreover, the patient has a regular sleep schedule and behaves normally for her age. She also has a normal thyroid gland and respiratory rate.

Missing information

There is no information on the behaviors and movements of the patient during sleep. For instance, it has not been mentioned whether the patient periodically moves her limbs during sleep. It has also not been mentioned if the patient coughs as a result of angiotensin-converting enzyme inhibitors such as lisinopril. Coughs caused by angiotensin-converting enzyme inhibitors can make a patient unable to sleep (Jessica et al., 2008).

List of differential diagnosis and actual diagnosis

The differential diagnosis includes insomnia, parasomnias, sleep apnea, restless leg syndrome, and circadian rhythm sleep-wake disorder. Based on the findings, the actual diagnosis is insomnia, sleep apnea, and parasomnias.

Plan for the Priority Diagnosis

  • Substitute the metoprolol with a non-adrenergic agent that is effective.
  • The patient should continue sticking to a regular sleep schedule.
  • The patient should start a relaxing bedtime routine such as meditating before bed.
  • The patient should keep avoiding alcohol.
  • The patient should do regular exercise.

References

Jessica A. Jiménez, Barry H. Greenberg,  and P. J. M. (2008). Effects of Heart Failure and its Pharmacological Management on Sleep. Bone, 23(1), 1–7. https://doi.org/10.1038/jid.2014.371

Schwartz, S., Anderson, W. M. D., Cole, S. R., Cornoni-Huntley, J., Hays, J. C., & Blazer, D. (1999). Insomnia and heart disease: A review of epidemiologic studies. Journal of Psychosomatic Research, 47(4), 313–333. https://doi.org/10.1016/S0022-3999(99)00029-X

Unit 5 Discussion-Age-Related Functional Changes in Geriatric Client

Instructions

It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Unit 5 Discussion-Age-Related Functional Changes in Geriatric Client

Unit 5 Discussion-Age-Related Functional Changes in Geriatric Client

Discussion Prompt 

Unit 5 is about age related changes in the older adult which includes sensory and sleep changes.  One type of sleep disorder that affects 50% of the elderly population is insomnia.  It is also the third most common complaint in the United States (Xiong, 2019).  As Nurse Practitioners, we must address these age-related and sleep changes to ensure our clients are achieving optimal quality of life.

Xiong, G.L. (2019).  Geriatric sleep disorders.  Medscape.  Retrieved from               https://emedicine.medscape.com/article/292498-overview#a5

Initial Post Instructions: 

  • Please critically evaluate the subjective and objective information provided to you in the attached file below.
    The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
  • Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
    Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
  • Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.

 

Nu 627 Week 5 Case Study C.C. “I can’t sleep.” HPI: 97 y.o. F presented to HU Clinic for follow up trouble sleeping. First noticed the sleep dysfunction when she was hospitalized three months ago with acute exacerbation of heart failure. Since then she has been waking up frequently at night. She denies trouble lying flat, weight has been stable, and no swelling. She denies CP or SOB. She reports not having issues with initiating sleep, but it is maintaining sleep. She wakes up and lays in bed for hours until she falls back to sleep. She has noticed this causes her to have increase daytime sleepiness. She is wanting to try something to help her sleep since she is frustrated at this point and it has never been an issue. Past medical history: HFpEF, HTN, HLD, CAD Allergies: Cephalosporin, PCN, Carbapenems. Medications: Metoprolol Succ 50 mg PO daily. Lasix 40 mg PO daily. Atorvastatin 40 mg PO daily. ASA 81 mg PO daily. Amlodipine 10 mg PO daily. Lisinopril 10 mg PO daily. Tylenol 500 mg PO Q6H as needed for generalized pain. Social history: Lives in assisted living. Usually active walking laps around apartment complex with rolling walker. Has four adult children who live close by and visit her weekly. She denies tobacco, alcohol, and illicit drug use. Family history: Was adopted does not know biological family. Health Promotion: UTD on routine screening, prevention and vaccinations. Last PCP appt 1 month ago for follow up after hospitalization: CBC, BMP, TSH, BNP, Lipid panel, EKG check and in normal limits. Review of system General – Denies fever, chills or dizziness. She has been sleeping more during the day. Goes to bed around 8PM without issues, then wakes around 12AM. She lays in bed until around 4AM and usually falls back to sleep. Skin – denies rash and skin ulcer HEENT -denies hearing and vision loss, headache Neck – denies swelling and stiffness Cardiovascular – denies chest pain/tightness palpitations, heart racing Pulmonary – denies shortness of breath, cough Gastrointestinal – denies abdominal pain, nausea, vomiting, and diarrhea. No change in appetite, weight gain or loss. Genitourinary – Reports increase urination in the morning with Lasix but denies burning or blood. Peripheral vascular – denies discoloration and edema Musculoskeletal – denies muscle and joint ache Neurological – denies confusion, memory loss, numbness or tingling. Denies lightheadedness or feeling of faintness. Psychological – denies anxiety, depression and confusion. Feels stressed from not sleep because it is affecting her during the day and not walking daily like she typically does. Endocrine: Denies weight loss or weight gain. Hematologic: Denies bruising or bleeding easily. Objective Data Vital signs:. T- 98.6 F, HR- 59 RR- 19, BP – 132/76 mmHg Pulse ox – 96%, Wt.: 165 lbs. Ht 62 in General appearance: No acute distress, well-nourished and cleanly kept. HEENT: Normocephalic, face symmetrical. PERRLA. Auditory canal intact and clear. Hearing intact. Oral mucosa moist without ulcerations or lesions. Uvula midline. Dentures. Neck: Non-palpable, non-tender lymph nodes. Thyroid gland without enlargement or nodules. CV: Regular rate, rhythm, S1/S2. Lungs: Bilaterally clear to auscultation, no adventitious sounds. No clubbing noted. Abdomen: Bowel sounds present in all four quadrants, abdomen is soft and non-tender, no guarding, no rebound, no enlargement, or organomegaly noted. Genitourinary: No suprapubic or CVA tenderness. PV: B/L, equal +2 distal pulses. Capillary refill less than 3 seconds. No swelling, erythema or ulcerations on exam. No edema. MSK: Active and passive ROM within normal ranges. Uses rolling walker without issues. Neuro: Alert and oriented to person, place, date and situation. Appropriate conversation. Strength 5/5 throughout. Cerebellar Rapid alternating movements intact. Psychiatric: Behavior appropriate for the age. Thoughts are coherent Neurological: Alert, oriented, cooperative. Speech is clear. Oriented to person, place, and time.

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