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The effect of Co-morbidities on autonomy 

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The effect of Co-morbidities on autonomy 

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-Symptoms of CHF can be weight loss, refractory volume overload, hypertension and happen because of fluid accumulation

-symptoms; acute compensated heart failure (shortness of breath), chronic (fatigue, anorexia, peripheral edema), reduction of cardiac output (fatigue, weakness)

-Main cause is ischemic heart disease

-Age also impacts CHF

-Two medications that help with CHF are Lasix and Enalapril (ace inhibitors and diuretics)

-CHF makes patient loose autonomy, harder to exercice, mobility issues, self-care difficulties, affects social life

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Emilie

chronic bone disease that has no common symptoms until first fracture

Low bone mass and disrupted architecture of bones

Compromises bone strength

Risk increases with age because of the progressive loss of bone mass that was builded

Increases risk of fall and fracture because bones are weaker

Women are more at risk than men due to decline of level of oestrogen which is an hormone slow the natural breakdown of bones

People may lose mobility as the result of weaker bones

Loos of ability to perform ADLs (dress, cook, bath)

Fractures as results of osteoporosis can lead to pain, fear and restrain to activities that they might have enjoyed in the past

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Emilie

is an exaggeration of the spine’s curvature

Can occur after a trauma, tumor, or chronic diseases as tuberculosis

Linked to apex pain

Can moderately or chronically impact mobility depending on the type and stage of the disease

Type 1 the deformity is more diffused whereas at stage 2 there is one column impairment and stage 3 both columns are lost

Can lead to decrease in function such as reduced walking speed, impaired balance

Can also increase the risk of injury and fall because vision field is reduced

As the condition worsens, it can lead to graded increase in difficulty in physical function

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Processing speech may decline after 3rd decade of their life is expected.

There is very little decline expected in attention.

Polypharmacy plays a role in neurocognitive decline.

Difficulty performing everyday tasks is abnormal.

Depressive symptoms such as mood swings or feelings of loneliness is an abnormal neurocognitive change.

Grief can lead to greater neurocognitive decline

A decrease in social activity is linked to a decline in cognitive function later on. It also increases the risk of dementia.

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Mrs. Ryan is taking Lasix, the side effects include

Kidney injury

Fluid & electrolyte loss —> cardiac arrhythmias

Allergic reactions

Hearing loss

Potassium loss

With zoledronic acid, depletes calcium

It results in high urine output which can result in incontinence or falls as she hurries to the bathroom. If she takes them too late in the day it can result in her needing to pee at night putting her at risk for falls as well as sleep disturbances.

She is taking Enalapril which include side effects such as

dizziness

Fatigue

Headache

These side effects also put her at risk for falls especially considering her alcohol consumption.

She is taking calcium & vitamin D

it is important that they be taken together as vitamin D promotes calcium absorption

They should also be taken in the morning as vitamin D is synthesized in the skin by exposure to sunlight

She is taking zoledronic acid, the side effects include:

hypotension

Constipation, diarrhea, nausea, abdominal pain

Dizziness, drowsiness, anxiety, confusion, insomnia

Muscle pain

Skin lesions

It is stated that it’s important that she drinks lots of water before her dose but she is on fluid restriction.

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Patricia

Uniqueness of the person

Person & Environment are integral

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alcohol consumption increases the risk of hypertension & stroke

Contributes to development of dementia and cognitive impairment

Long term consumption results in an increased risk of dementia & Alzheimer’s disease

Alcohol impacts balance, gait and can exacerbate osteoporosis leading to an increased fall risk

Alcohol can disturb the sleep

Alcohol- drug interactions can lead to hypotension (dizziness), drowsiness, liver damage & more

Alcohol is often used to self medicate to deal with depression, grief, anxiety, isolation & boredom

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-Drugs can affect falls such as drugs for CNS (neuroleptics, benzodiazepine, antidepressant) and drugs for antihypertensives and cardiovascular medications

-exercices can be done to prevent falls: gait and balance, strength exercices, aerobic, flexibility

-assistive devices: canes, higher toilet seats, bars

-risk factors: old age, alcohol use, cognitive impairment, vision

-complications of falls: bruises, hip and femur fractures

-alcohol use can affect gait, balance and cognition

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CHF:

People with CHF are unable to function independently.

Fatigue and shortness of breath is seen in those patients.

They also have difficulty with self-care and have reduced ability in participating in social events.

This can decrease their self-confidence and plays a role in the decline of their mental health.

Comorbidities:

Lead to isolation --> negatively impacts mental health

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Patricia

For individuals with

chronic illnesses

disabilities

functional limitations

Types

Nursing Homes:

Offer 24/7 nursing care

Support for activities of ADLs

Medical supervision

Assisted Living Facilities:

Personal care

Support with ADLs

Residential environment (less medical care than nursing homes)

Continuing Care Retirement Communities (CCRCs):

Continuum of care levels (independent living, assisted living, and skilled nursing).

Activities

Social, recreational, and therapeutic activities to promote residents’ mental and emotional well-being.

Exercise classes, arts and crafts, games, and social events to encourage engagement and community.

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Emilie

Put mount grab bars near toilets, near the front door, and on both the inside and outside of tub shower to provide balance

Carpet on on all surfaces that may get wet

Use of non-slip mats and rugs

Use of light night that turns on automatically in the dark

Keep walkways and corridors clear and well lit

Wear sensible shoes ( properly fitting, sturdy, flat shoes with nonskid soles) and avoid floppy slippers

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Taking into account the patient's environment and the value it holds is very important.

It can impact their risk for injuries but also explains why their wants and opinions

Patient education is important.

In our case, Miss Ryan was not aware that there are residences where pets are allowed.

Taking into account how grief can affect a patient

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Attachment and connection to the home (Kaira)

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Attachment and connection to the home (Kaira)

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Miss Ryans wants to die in her home.

Her house is a familiar setting that offers comfort and reduces anxiety

It also reduces the risk of depression

It reminders her of memories that she cherishes, which makes her feel more emotionally stable

Staying in her home can also

Allow her to maintain her independence and make choices

Preserves her established routines

Both of which will help boost her self-esteem and give her a sense of control

Keep her close to friends, neighbors and family which can reduce her feeling of loneliness

Moving to a senior residence can cause stress and anxiety