Care Plan for Mobility Impaired Older Person

Mrs. Blackwell represents many aged individuals in Australia and around the world who need comprehensive and to cope with their situation as a result of advanced age (Borowski, Encel and Ozanne, 2007, p.20). Developing a comprehensive and long-term care strategy for aged individuals like Mrs. Blackwell requires an adequate nursing diagnosis of the conditions and situation of the individual. Conducting a nursing diagnosis of Mrs. Blackwell, three conditions are identified that subsequently require interventional strategies. Mrs. Blackwell exhibits impaired mobility and increased bowel irregularities, which can be linked to total hip arthroplasty, leading to an experience of difficulty in using a walking frame. Secondly, Mrs. Blackwell exhibits increased potential risk of falls that are related to previous falls, difficulty using a walking frame, and an overall expressed fear of falling. Lastly, diagnosis reveals that Mrs. Blackwell exhibits potential for adverse drug reactions and this is related to polypharmacy and infrequent visits to GP.

Objectives for long-term care strategy for aged people in society emanate from two frameworks developed earlier; ADLs (assistance with basic activities of daily living) and IADLs (instrumental activities of daily living) that when implemented, is likely to see an improved situation for aged people (Balducci, Ershler and Gaetano 2008, p.26). ADLs goals involve among other aspects, bathing, dressing, eating, and other basic chores, while IADLs goals revolve around providing assistance with household chores, money management, shopping, medication management, and other activities (Balducci, Ershler, and Gaetano, 2008). Therefore, the subsequent sections will largely look at the nursing interventions originating from the identified nursing diagnosis and rationale behind each of the adopted or suggested interventions. Lastly, there will be a short discussion on how nurses attitudes to older people affect the quality of care they receive.

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Intervention Strategy
Diagnosis One
The overall goal is to achieve relatively reduced instances of impaired mobility, injuries, and increase the functionality of the bowel system. To achieve this goal, three interventional strategies are proposed. The majority of elderly people experience impaired physical mobility that leads to increased falls, and this aspect increases as older people continue to advance in age (Brunner et al. 2009). Among elderly people aged above 85 years like Mrs. Blackwell, falling incidences are higher and the outcomes of falls become even worse.

Intervention one
Bowel irregularities that Mrs. Blackwell exhibits have contributed to her frequent mobility problems. However, falls can be managed through the administration of the right dietary intervention (Hindle and Coates, 2011). Majority of elderly people who exhibit higher chances of experiencing mobility problems lack the right diet. Chances are that her problem has been largely motivated by a lack of vitamin B1 and B12. Lack of vitamins B1 and B12 in the diet is associated with the development of bowel problems, light-headedness, and sometimes confusion (Hindle and Coates, 2011). The rationale for this intervention lies in the role diet plays in contributing to the strengthening of fragile bones and joints, which vitamins B1 and 12 are known to provide. Further, a good diet will lead to improvement of vision, mental, and overall steadiness which is vital for Mrs. Blackwell (Hindle and Coates 2011).

Intervention two
Light exercise intervention constitutes the second set of prevention and management strategies. Mrs. Blackwell requires light exercises. Many elderly people abandon exercise as their health deteriorates, and this leads to clogging of blood veins, making it difficult for blood supply to take place (Hindle and Coates 2011). When this happens, an individuals physical joints become weak and fragile, constantly leading to impaired mobility. Introduction of simple feet exercises that include raising the heels, stretching, ankle rotating, moving, squeezing, and also opening and curling toes should be largely encouraged and elderly people helped to perform them (Hindle and Coates, 2011). The exercises should take place at least every day and in undertaking the exercises, the elderly should be encouraged not to have shoes on or to wear socks to enable greater flexibility (Hindle and Coates, 2011). Moreover, these exercises can be done while the elderly patient is sitting down; hence, standing is not necessary. The rationale for this intervention is premised on the fact that exercises have been found to be ideal prevention strategies for mobility problems among elderly people and people with medical conditions that limit their movement (Hindle and Coates, 2011).

Intervention three
The third intervention strategy involves foot care management. Older individuals who complain of mobility problems and increased fall instances lack effective foot care management (Hindle and Coates, 2011). Mrs. Blackwell should be encouraged to take great care of her feet, and this will involve washing regularly and drying them thoroughly. After they have been cleaned, the feet should be applied with moisturizing cream to keep the skin supple. In most cases, unsafe footwear causes falls and therefore, elderly people are encouraged to wear supportive, low-heeled, and (Hindle and Coates, 2011). The shoes should enable an elderly person to wriggle her toes while snugly fitting around the heel. The rationale for this interventional strategy is informed by the fact that increased falls among elderly people are associated with poor foot care, which subsequently limits elderly movement (Hindle and Coates, 2011).

Diagnosis Two
The overall goal is to achieve a considerable reduction of fall risks and increase patient confidence with regard to mobility. To achieve the objective, three interventional strategies are proposed. Mrs. Blackwell exhibits increased potentials for risk of falls that are related to previous falls, difficulty in using a walking frame, and an overall expressed fear of falling.

Interventional one
Environmental modification constitutes the first interventional strategy for this condition. Elderly individuals tend to exhibit reduced confidence about their ability to move without falling. This fear emanates from the presence of the poor home environment in which the elderly person lives. Interventional measures to be undertaken here include increasing the surrounding illumination of steps and stairs to ensure proper and safe foot support and balance, as well as increasing bathroom grab bars to help reduce the fear associated with toileting and bathing activities (Tideiksaar, 1997). Other measures include eliminating mobility obstacle elements such as trailing flexes, loose rugs, loose carpets, slippery flooring, and many more, which may cause fall; thoroughly wiping spillages; furniture equipment to be easy to reach especially those involving bending; sockets to be located at an appropriate height level; and generally, increasing heating and warmth in the house (Hindle and Coates, 2011).

The rationale for this intervention strategy is premised on the role inappropriate home and institutional environments have played in accelerating the level of fear among elderly people. Improving the home environment has been found to result in decreased falling phobia, with a level of confidence in mobility activities among the elderly increasing (Hindle and Coates 2011).

Intervention two
The second proposed strategy to deal with increased fear of falling includes development, introduction, and promotion of habituation therapy activities (Tideiksaar, 1997). In most cases, older people express great fear with regard to activities such as bathing, toileting, climbing stairs, walking outdoors and even walking in the streets. Habituation therapy can be developed based on two prominent scales; Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC) that have been found to be effective (Tideiksaar, 1997). Habits to develop among fearful elderly patients include guided walks up and down the stairs inside the house, bending over, and picking few items on the floor, and slight and guided walks outside the house to a car parked in the driveway (Tideiksaar 1997). Other habits to encourage include getting in and out of the chair, standing on a chair and picking objects slightly above, light housekeeping, simple shopping, and taking showers (Tideiksaar 1997). Rationale for this intervention can be exhibited in the fact that confidence among elderly people having mobility problems has been found to increase when habitual activities that result into fear are encouraged and practiced continuously (Tideiksaar, 1997).

Intervention three
The third intervention strategy involves promotion of balance and muscle-strengthening exercises. People with increased fear of falling need to participate in some coordinated and guided balance and muscle-strengthening exercises, which have potential to increase and improve their mobility (Tideiksaar, 1997). In developing exercise plan, the focus should be put on enhancing muscular strength, joint flexibility, and sensory interaction. These kinds of exercises have been found to improve the gait and balance of older people (Tideiksaar, 1997). Further, weight-bearing exercises should be encouraged, since they have proved to reduce the rate of bone loss and reduce chances of fractures.

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