Adam Kowal, aged 88, has been feeling weak for several days. He is at home, lying in bed. This is the second visit of the health nurse. During the first visit, the nurse assessed the patient’s family status. The patient lives with his wife (84 years old), next door at home lives his daughter with his son-in-law and two grandchildren. He lives in a small village. He has always kept chickens for eggs and meat and planted own vegetables.
Contact with patient – maintained, patient is logical, answers questions briefly, needs time to respond, speaks with difficulty, patient’s mood – lowered.
Starting with the leader, the participants describe in detail what happened one by one. Each student should say what they were responsible for and what they did.
This is an exploration of the reasons for the actions taken and their evaluation. In this phase the participants analyse the feelings they have experienced; this is the emotional and empathic content of the discussion. Each student chooses one or two things they did well. We do not comment on students’ opinions. The analysis phase allows to discover the reasons for successes or failures in the scenario, to understand the reasons for action.
- What was most challenging for you when you made the measurements?
- For what purpose did you make the vital signs measurements
- How did you feel when you made contact with the patient?
- What actions did you take towards the patient and why?
- Which decisions were good and why?
- What did you do first and what did you do next?
- What was your biggest success while doing the task?
- What did you find most challenging during the task?
- What actions did the leader take and why?
In the analysis phase it is also good to ask the following questions:
- How well did you as a team perform the task?
- What was the result of your action?
- What caused your frustration?
- What would you have done differently?
- How would you have done it?
It allows the students to try to compare with real events, to assess the needs, possibilities and how to use the experience gained in everyday practice.
- Please tell us what you would use from the experience gained today in a real-life situation with such a patient?
- What did you learn from the simulation?
- What do you think is important in caring for a dehydrated patient?
- What do we need to pay attention to when performing these actions?
- What is the most important thing you learned during the simulation?
- Please have everyone say what they learned during the scenario. Where can we apply the skills learned?
- What do you think should be done if the patient has culture related requarements or limitations (religious, regional, etc)?
- What do you think should be done if the patient has culture related requirements or limitations (religious, regional, etc)?
I know what the patient’s medical history should contain in order to diagnose malnutrition and its causes.
I know how to measure basic vital functions according to the procedure (blood pressure, pulse, oxygen saturation) using medical equipment and breathing, and how to interpret the results.
I know knows how to assess the degree of malnutrition, e.g. calculate the BMI, measure the arm circumference.
I am aware of the types of malnutrition and what the symptoms of malnutrition may be.
I know what the risk factors for malnutrition can be in an older person.
I know what the consequences of malnutrition can be.
I can conduct a medical history in order to identify malnutrition and its causes.
I can carry out measurements of basic vital functions according to the procedure in force (blood pressure, pulse, oxygen saturation) using medical equipment and breathing, and to interpret the results.
I can assess the degree of malnutrition.
I can calculate BMI.
I am prepared to act in the best interest of the patient, to respect the dignity and autonomy of persons entrusted with care, to show understanding for the world-view and cultural differences and to show empathy in relation to the patient and his/her family.
I am ready to respect patients’ rights.
I am ready to independently and diligently perform the profession in accordance with ethical principles, including respecting values and moral obligations in patient care.
I am ready to take responsibility for the professional actions performed.
I am ready to foresee and take into account factors influencing his/her own and the patient’s reactions.
Assessing the level of nutrition of a patient in home care
In today’s class we will learn how to manage a patient with malnutrition.
We are aware that the consequences of malnutrition are a serious threat to health and life. Knowledge of its causes and consequences can contribute to improving health. The nurse has the opportunity to directly influence patient management. To be effective, it is essential to acquire knowledge, skills and social competences. In this scenario you will consolidate your knowledge and acquire the skills needed to care for a malnourished patient. In today’s medical simulation class you will learn how to recognise symptoms and carry out appropriate tests and measurements on a malnourished patient. Skills required:
- conduct an interview for the diagnosis of malnutrition,
- take vital function measurements according to the procedure (blood pressure, pulse, body temperature) using medical equipment and breathing, and interpret the results,
- calculation of BMI,
- interpret and document the results of measurements and communicate the patient’s condition to the therapeutic team.
Do you remember the importance of food in the human body? What do you think is the daily need for nutrients? Do you recall what types of malnutrition we have? Do you remember what the risk factors for malnutrition are?
Do you know what the symptoms of malnutrition can be? How do you think we can assess malnutrition in an older person? Answer: We can ask how much the patient eats, we can measure basic vital signs (RR), we can assess arm circumference and calf circumference, and we can evaluate the test results. Is it important to do these tests?
Do you have any ideas about what else you could ask the patient? Check: https://www.mna-elderly.com/sites/default/files/2021-10/mna-mini-english.pdf.
How do you calculate BMI? Check: https://www.calculator.net/bmi-calculator.html.
Imagine that you are working as a family health nurse and there is a malnourished patient at home.
Two people will take part in the scenario. One person will act as the first nurse, who will be the team leader and will be responsible for collecting the interview. The other will be the nurse responsible for taking measurements of basic vital signs. Do you understand all the information and know what you are responsible for?
REFERENCES, MATERIALS FOR CLASSES
- Tanvir Ahmed and Nadim Haboubi. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010; 5: 207–216.
The student has knowledge of:
- Risk factors and health threats in patients of different ages
- Etiopathogenesis, clinical symptoms, course, treatment, prognosis and principles of care
nursing care for patients in selected diseases
- Principles of diagnosing and planning patient care in nursing
- Nursing standards and procedures used in the care of patients of different age and health condition
The student has the skills:
- Gather information, formulate a nursing diagnosis, and set goals and care plans
- Implement nursing interventions and evaluate nursing care
- Provide counseling in the field of self-care of patients of different age and health status regarding malformations, diseases and addictions
- Prevent complications occurring in the course of diseases
Adam Kowal, aged 88, has been feeling weak for several days. He is at home, lying in bed. This is the second visit of the health nurse. On the first visit, the nurse assessed the patient’s family status.
CURRENT CLINICAL CONDITION
Patient lying in bed, weakened. Skin dry. He reports drowsiness and headache and lowered mood. He has suffered from hypertension for 20 years – treated for this and takes medication in pills.
Time of onset of first symptoms – a few days before
- Patient passes hard stools every other day with difficulty.
- Patient has incomplete teeth, has dentures but got them done at age 65.
- The patient’s daughter noticed that she had to take the patient’s pyjama trousers in. She also noticed that the shirt was too wide.
- In the interview, the patient states that he is not hungry, his wife does not cook anymore and his daughter does not do it very well. This is too salty, that is too hard. He does not like modern food.
- He does not like yoghurt or other processed food.
- Treatment – Hydrochlorothiazide 1 x 1 tab, Indapamide 1 x 1 tab, Perazine p. o. 25 mg 2 x day, Spironolactone 1 x 1 tab, Hydroxyzine 10 mg at night.
- Allergies – none.