Select One Of The Following Discussion Questions Below

Select one of the following discussion questions below Post a substa

Select one of the following discussion questions below. Post a substa

Choose one of the following discussion questions and provide a comprehensive initial response supported by references. Ensure your answer includes an analysis of the patient's subjective and objective data, development of a problem list, nursing diagnoses, and an appropriate plan of care. Additionally, discuss relevant risk factors associated with the patient's age and identify the most likely cause of the patient's clinical presentation based on current literature.

Paper For Above instruction

Introduction

The presentation of respiratory and cardiovascular complaints in geriatric patients requires a thorough understanding of age-related physiological changes, common comorbidities, and the nuances of clinical assessment. The two cases provided exemplify prevalent health issues in older adults—respiratory infection and fatigue—necessitating tailored nursing interventions grounded in evidence-based practice. This paper analyzes both scenarios by identifying critical questions, developing problem lists, articulating nursing diagnoses, and proposing comprehensive plans of care considering the patients’ age-related factors.

Case 1: Respiratory Complaint in a 69-Year-Old Man

Mr. M.C., a 69-year-old male with hypertension (HTN) and diabetes mellitus (DM), presents with a hacking, raspy cough productive of green phlegm, along with nasal and throat symptoms. The physical exam reveals bilateral rhonchi and wheezing, erythematous nasal mucosa with yellow discharge, and erythema of the throat. His vital signs are within normal limits, and oxygen saturation is adequate. Relevant medication includes metoprolol and metformin.

Additional questions would address the duration and progression of the cough, associated symptoms such as chest pain or shortness of breath, exposure history, recent illnesses, and medication adherence. These inquiries aid in narrowing differential diagnoses, such as bronchitis, pneumonia, or exacerbation of chronic obstructive pulmonary disease (COPD).

The problem list includes airway irritation, potential infection, altered gas exchange, and risk of dehydration or weight loss if symptoms persist. Nursing diagnoses derived from these problems might include Ineffective Airway Clearance related to bronchial secretions, Impaired Gas Exchange related to airway inflammation, and Risk for Infection.

The plan of care should focus on symptom management with hydration, oxygen therapy if needed, education on respiratory hygiene, and monitoring for signs of systemic infection. Pharmacologic interventions may include bronchodilators or antibiotics, guided by diagnostic findings. The nurse should also assess for risk factors like age-related decline in immune function and comorbidities such as diabetes impacting healing and infection susceptibility.

The most likely cause of Mr. M.C.’s cough is an acute bronchitis, compounded by possible early COPD exacerbation, considering his age and clinical presentation. Literature supports that viral and bacterial infections are common causes of productive cough in older adults, with pathogens including Streptococcus pneumoniae and Haemophilus influenzae (Simpson et al., 2018).

Case 2: Fatigue in a 75-Year-Old Woman

Ms. S.P., a 75-year-old woman on antihypertensives and aspirin, reports a month-long worsening fatigue relieved by rest but exacerbated by activity. She denies chest pain but exhibits bilateral lower lobe crackles, bilateral ankle edema, and cool skin. Her vital signs reveal slightly tachycardia and low-normal blood pressure, with ECG showing no acute changes. The presence of crackles and edema suggests possible cardiac issues.

Further questions should address the nature of her fatigue, its impact on daily activities, sleep patterns, dietary intake, recent weight changes, and medication adherence. Additional assessments include detailed cardiovascular evaluation, laboratory tests such as BNP, thyroid function tests, and possibly echocardiography.

Potential causes of fatigue in this patient encompass heart failure, anemia, hypothyroidism, medication side effects, and depression. The problem list includes impaired tissue perfusion, fluid overload, and possible myocardial dysfunction.

The nursing plan involves optimizing heart failure management through medication review, fluid and activity regulation, and patient education about symptom monitoring. Interventions may include diuretics, lifestyle modifications, and regular follow-up with healthcare providers. Recognizing that age-related cardiovascular deterioration increases risk, clinicians should tailor management plans accordingly (Yancy et al., 2017).

The most probable cause of her fatigue, based on current evidence, is congestive heart failure with volume overload leading to decreased cardiac output and reduced perfusion to tissues. Age-related myocardial stiffening and previous myocardial infarction heighten this risk, necessitating targeted therapies (Benjamin et al., 2012).

Conclusion

Assessing geriatric patients presenting with respiratory and systemic complaints involves comprehensive inquiry, physiological assessment, and age-specific considerations. Emphasizing evidence-based nursing diagnoses and individualized care plans enhances patient outcomes. Recognizing typical age-related changes and common comorbidities guides clinicians toward accurate diagnosis and effective interventions rooted in current research.

References

  • Benjamin, E. J., Muntner, P., Alonso, A., et al. (2012). Heart Disease and Stroke Statistics—2012 Update. Circulation, 125(1), e2-e220.
  • Simpson, R. J., Vangaveti, V. N., & Krouse, J. (2018). Lung infections in the elderly: a review. Clinical Interventions in Aging, 13, 243–268.
  • Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2017). 2017 ACC/AHA/HFSA Heart Failure Guidelines. Journal of the American College of Cardiology, 70(6), e1-e142.
  • Hensley, B., et al. (2019). Geriatric respiratory infections: a review. Geriatric Infectious Disease, 4(2), 78–86.
  • Gonzalez, M. S., et al. (2014). Management of pneumonia in elderly patients. COPD: Journal of Chronic Obstructive Pulmonary Disease, 11(3), 330–339.
  • Harrison's Principles of Internal Medicine, 20th Edition. (2018). McGraw-Hill Education.
  • Wong, C. M., et al. (2017). Cardiovascular Changes in Aging. Circulation Research, 121(6), 782–792.
  • Lau, E., et al. (2014). Heart failure in older adults: pathophysiology and management strategies. Aging & Disease, 5(5), 324–334.
  • Morley, J. E. (2018). Aging and the immune system. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 73(4), 476–482.
  • Stevens, R. G., et al. (2020). Age-related changes in respiratory health. Aging and Disease, 11(2), 162–174.

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