Enhancing Interdisciplinary Care for Sarcopenia in Elderly Patients

Case Study 1

The interdisciplinary care is the context of care that integrates and develop collaboration between different members in the healthcare team to deliver quality care support to the patient for enhancing their health and well-being (Tapsell et al., 2017). In case of Mrs Morris, she is currently been admitted to the hospital on emergency basis as a result of fall at home. She is found to show clear signs of sarcopenia which is loss of muscle atrophy with age and already suffers from osteoporosis for which medication Fosamax is already administered to control the condition. However, no intervention is seen to be provided separately to Morris in controlling sarcopenia that has the potential to make elderly vulnerable to fall apart from osteoarthritis. This is because loss of muscle atrophy leads the elderly unable to maintain straight and balanced posture, in turn, making them vulnerable to fall and face mortality in extreme conditions (Pal et al., 2020). In this context, the initial inter-disciplinary care management required by Mrs Morris is support from physiotherapist. This is because physical therapy is found to be most effective in managing sarcopenia instead of pharmaceutical intervention (Reijnierse et al., 2017).

During the hospital stay of Morris, as a nurse, I need to arrange resistance exercise training for her to help her manage sarcopenia by collaborating with the physiotherapist. This is because the physiotherapist are physical therapy experts in informing benefits of exercise and training patients the way they are to perform the exercises to improve muscle strength and power along with reform muscle composition to reach enhanced mobility in sarcopenic condition (Moore et al., 2020). It would also help to minimise the risk of fall in her due to sarcopenia. The other interdisciplinary management required for Morris is arrangement of fall-free care environment to ensure her avoid facing additional fall which she is prone face as she shows hindered mobility. For this purpose, rails along her bed in the hospital is to be installed under my supervision as a nurse and ensure her bed remain lower to the ground to avoid making her face further fall or injury from fall (Tsuda, 2017). According to Wu and Chen (2019), alarm is to be installed near the bed of elderly patients and their belongings are to be present within the easy reach of them to limit movement. This is because such safety environment would avoid hindered movement and getting out of bed by elderly patient like Morris who have reduced muscle and skeletal system functioning and would make them avoid further fall that may worsen her condition.

The case study mentions that Morris is suffering from confusion that may have been raised due to the long-term health condition and current vulnerable health perception created due to fall. This is because elderly develop confusion when they are unable to manage their own care and face adversities (Reilly and Houghton, 2019). In order to resolve confusion raised in Morris regard her health and care support, I as a nurse would try to know and address her needs directly by develop empathetic communication with her. This is because direct empathetic communication with the patients by the nurses makes the individual understand the need and nature of their care, way it is delivered which makes them resolve confusion and aware of the way her health is being managed (Jo et al., 2020). Moreover, to avoid confusion regarding health in case of Morris, I as a nurse would provide her evidence regarding nature of care been provided and reassure them by creating familiar surroundings of care (Jo et al., 2020). This is because familiar and well-directed care with assurance of health improvement helps patient like Morris to be avoid getting confused that they are deprived of effective care support. The confusion and limited mobility are also seen to have affected Morris is to be unable to maintain proper hygiene as seen from her untidy clothes. Thus, the other care to be provided to Morris is management of her effective hygiene during her stay in the hospital. For this purpose, she would be assisted and helped by me with her permission in bathing, washing her clothes and cleaning. Mrs Morris also expresses signs of weight loss for which she is to be referred to the dietician. This is because dieticians have effective expertise in analysing patient health to determine the specific nutrient required by the body and they accordingly develop diet chart for the people to enhance their health (Ryan et al., 2019). As a nurse caring for Mrs. Morris, I would access diet chart provided by the dietician based on Morris’s health to arrange the nature of food and ensure mentioned amount of nutrients are taken by her and for this purpose, I would monitor her eating habits during stay in the hospital.

The health vitals of Mrs Morris mention that she has normal heart rate, breathing rate and blood composition but her blood pressure is identified to be extremely high. This is evident as normal blood pressure of individuals remain at 120/90 mm Hg whereas in case of Morris it is seen to raise to 178/87mmHg (Atkins and Perkovic, 2019). The impact of high blood pressure is that it damages the arteries and cause blockage that prevents the flow of blood to the heart leading to cause stroke (Akinyede et al., 2020). In the hospital, Morris is already seen to be provided Lisinopril and Frusemide in managing hypertension, but they have found not been effective in lowering her blood pressure. Thus, immediate application of validators like nitro-glycerine and nitroprusside is to be made to avoid lower the blood pressure with emergency actions. This is because vasodilators like nitroprusside and others acts immediately and lower the mean blood pressure by 25% within minutes to 1 hour in stabilising the condition of the patient (Barić et al., 2019). Thus, Morris is to be provided the medication as emergency action to lower her raised blood pressure to normal. During Morris's stay in the hospital, I as a nurse would also involve a physiotherapist for her to educate her about the exercises she can perform and way to execute them to control her blood pressure and hypertension along with remain clam while coping with the raised health difficulties. This is to improve both her emotional and physical health during her stay in the hospital (Barić et al., 2019).

Case Study 2

The case study analysis of Mrs Norman mentions she is admitted to the hospital in a confused and agitated state with her chronic obstructive pulmonary disorder (COPD) currently exacerbated as evident from her increased respiratory problem where her oxygen saturation in room in 82%. The confusion and agitation in people with mild cognitive decline often occur in stressed situation such as exacerbation of their health. This is because they are unable to understand and control their health which makes them develop hindered mood (Iodice et al., 2021). Thus, the initial priority for Mrs. Normal would be to reduce her increased breathlessness to make her develop ease with her health which may act to lower her agitation. The normal oxygen level in adults is 95-100% whereas saturation below 90% is considered risky and below 80% may even lead to organ damage (Radhakrishnan et al., 2019). The oxygen saturation level of Mrs. Norman indicates that her blood contains 82% of oxygen. This is a vulnerable condition and the immediate action to be taken by me as a nurse is to provide her oxygen therapy. The oxygen therapy is to be provided to Mrs. Norman by using an oxygen mask or small tube that has been clipped to the nose to allow supplement delivery of oxygen (Branson, 2018). The advantage of oxygen therapy is that it immediately helps to deliver oxygen to the blood through the lungs to raise the oxygen saturation and resolve hypoxia (Pavlov et al., 2018). During the oxygen therapy, pulse oximeter is to be used for Mrs. Norman by me as a nurse to monitor her oxygen saturation in the body in response to the thearchy so as to determine if additional health support is required. In case of Norman, during her stay in the hospital, she is to be trained with the help of respiratory nursing specialist regarding the way to perform pursed-lip breathing. This is because pursed-lip breathing helps the patients with COPD to take emergency action in reducing shortness of breath that leads them to develop fatigue (Yang et al., 2020). Thus, Mrs. Norman is to be educated pursed-lip breathing so that after release from the hospital she is able to personally take emergency self-step in controlling shortness of breath which if raised due to exacerbation of COPD at any time. The amount of sputum produced by Mrs. Norman during hospital stay is to be monitored so that physiotherapy can be referred to her to make her learn about the way active breathing cycle is to be managed through exercise so that the sputum amount can be reduced (Kolsum et al., 2017). This is because increased sputum production in COPD is seen to worsen the health condition of the patient by making them develop breathlessness (Kolsum et al., 2017). On the basis of the chest X-ray and the sputum microbiology report, the dose of bronchodilator is to be determined. This is because the test and the X-ray would inform to the extent lungs of Mrs. Norman is affected and extent of level of medication is required by her to resolve the situation. The bronchodilators are provided to COPD patient as it acts to help in immediate dilation of bronchioles and airway passage to allow entry of increased oxygen in the body to avoid breathlessness (Anzueto and Miravitlles, 2018). Thus, Mrs Norman is to be suggested effective dose of bronchodilator based on her condition so that while in the hospital as well as after release from the hospital she can take the medication to avoid feeling extreme breathlessness while suffering from COPD.

In the case study, Mr. Norman mention that he is facing difficulty in managing care of Mrs. Norman due to currently been suffering from vascular dementia. In this condition, Mrs. Norman who has mild cognitive decline is to be educated regarding self-management of COPD. The NICE mentions that self-management of COPD includes educating patient about the exacerbation action plan to be followed during worsening of the disease. In this process, the patient is to be educated regarding the way to use short course of oral corticosteroids and antibiotics and in which condition to avail it benefit and avoid risk towards health (Labaki and Han, 2017). A clinical assessment of Mrs. Norman is to be executed during her stay in the hospital to determine if she is involved in smoking or vulnerable to second-hand smoking. This is because smoking is mentioned to be key risk factor in the exacerbation of COPD (Koblizek et al., 2017). Therefore, if such condition is present while are not yet revealed is to be identified and according actions are to be taken. Moreover, she is to be communicated to understand the environmental reason behind her to develop agitation in the evening. This to inform her about the ways and exercise to be performed to remain calm.

During stay in the hospital, the ability of Mrs. Norman in performing everyday activities based on Ropery-Logan-Tierney model is to be evaluated. On the basis of the evaluation, the social care service workers are to be referred to her who would assist her in performing the activities, in turn, making her avoid being burden of care on Mr. Norman. The social care workers are also to be made responsible in arranging health examination of Mrs. Norman for her COPD and cognitive decline to keep check on their health performance. Moreover, social support is also to be arranged for Mr Norman in helping him to cope with vascular dementia so that he avoids being been of care on his wife who is already sick. During stay in the hospital, Mrs. Norman is to be referred to a dietician who would develop a diet for her health management. This is because effective intake of nutrient in adequate amount help people to overcome and manage steady health condition with COPD (Holst et al., 2019). Moreover, Mr. and Mrs. Norman is to be educated by the social care workers about the different organisational help they can access to have additional assistance in managing their health and copping the health condition.

Case Study 3

The Parkinson’s disease experienced by Mr Connolly is a progressive disorder of the nervous system that mainly affects movement. The symptoms of exacerbation of Parkinson’s disease includes increased trembling of hands and legs, stiffness of muscles, reduced movement and impaired coordination and balance leading people to fall (Riboldazzi et al., 2020). The NICE guidelines mention that before initiation of treatment of Parkinson’s disease, thee individual clinical circumstances like co-morbidities and symptoms of the disease along with risk from polypharmacy is to be identified (NICE, 2017). Therefore, thorough clinical diagnosis and assessment of Connolly is to be performed to determine his symptoms resulting from the exacerbation of the disease. The pathophysiology of Parkinson’s disease indicates that it occurs due to the loss of range of neurotransmitters that is mainly dopamine in the body which worsen the disease with time. This is dopamine is the key neurotransmitter in the body that acts to transmit chemical signals from one cell to other through the synapse (Burbulla et al., 2017). Thus, the key to treatment of Parkinson’s disease is enhancing the release and amount of dopamine in the brain as it supports enhanced transmission of signals in the body for effective nervous system functioning. The NICE mentions that levodopa is to be used as first-line of treatment for Parkinson’s disease (NICE, 2017). They cross the blood-brain barrier and get converted to dopamine resulting to increase dopamine concentration in the brain which assist in improving their movement disorder and nerve conduction in the disease (Haddad et al., 2018). The case study mentions that Parkinson’s disease is already known for the person and therefore, it can be determined that he is provided levodopa as first-line of treatment for the disease since it is already detected. However, it is not sure whether Mr Connolly effective followed the dose of medicine or even if the medicine is provided. Thus, health history of Mr Connolly is to be developed by communicating with him to determine if he is under any medication. The NICE guidelines inform that people with exacerbated Parkinson’s disease showing development of motor fluctuations and dyskinesis are to be provide medication treatment that includes administration of Monoamine oxidase-B (MAO-B) inhibitor along with levodopa to relive them from the health complications (NICE, 2017). The MAO-B inhibitor is to be provided instead of Dopamine agonists and catechol-O-methyl transferase (COMT) inhibitors to Mr Connolly as the other medication shows risk of increased adverse events, hallucinations and off-time reduction compared to the MAO-B inhibitor that express fewer of such adverse events (Szökő et al., 2018). The MAO-B inhibitor acts in the synaptic space of the nerve to interrupt the breakdown of dopamine by the action of MAO enzyme. It leads to create increased dopamine to be present in the synaptic cleft and allows increased binding of them to postsynaptic membrane in enhanced transmission of nerve signal from one nerve to another (Szökő et al., 2018). According to NICE guidelines, before the initiation of dopamine agonists therapy, the nurses are to educate the family members as well as the patient through oral and written information about the increased risk of impulse control disorder to be faced by the patient due to the therapy (NICE, 2017). The patient and their family members are also to be informed about the way impulse control disorder are to be managed in the affected person, nature of impulse control disorder to be faced and whom to contact for its control (Martini et al., 2018). Since Mr Connolly is already suffering from exacerbated condition of Parkinson’s disease, therefore use of dopamine agonists therapy may be essential. Thus, as a nurse it is my responsibility to alert him as well as his immediate family members about the impulse control disorder to be faced by him due to the therapy and way to control it so that quality health condition can be established. In case Mr Connolly shows continued development of dyskinesia or fluctuations in motor functioning even after providing levodopa therapy, the ergot-derived dopamine agonist is to be used (Voon et al., 2017).

In Parkinson’s disease, one of the common non-motor symptoms is excessive daytime sleepiness that affect nearly 55% of the people suffering from the disease and it is caused by impact of the medication (Xiang et al., 2019). The daytime sleepiness may also be associated with restless leg, rapid eye movement and periodic limb movement in people who have developed severity of the disease (Xiang et al., 2019). In case of Mr Connolly, it is seen that he had develop severity of the disease and may experience the addition non-motor symptoms. In order to manage daytime sleepiness in Mr Connolly, he is initially to be involved any occupation and the dose of medication is to be alerted to consider of it helps in anyway. However, modafinil is to be used in managing excessive daytime sleepiness in Mr Connolly (NICE, 2017). This is because modafinil acts to enhance the synaptic ability of the neurotransmitter like serotonin, dopamine, catecholamines, adenosine and other creating a wakefulness-promoting agent within the body to ensure the person avoid sleepiness (Ando et al., 2018). In case Mr Connolly develops rapid eye movement as a result of Parkinson’s disease severity, he is to be administered melatonin or clonazepam for treatment (NICE, 2017). This is because the medications are group of benzodiazepines that acts to increase the release of clamming agent, gamma-amino- butyric -acid (GABA) in the brain that reacts to support relaxation of tense muscles and stop seizures (Gilat et al., 2020). During care at the hospital for Mr Connolly, the nursing specialist are to be involved in monitoring his health. This is to accordingly adjust the medicine dose and allow change of medication or stopping them from being used to ensure better quality health condition of the patient with reduced additional side-effect of medicine (NICE, 2017). Mr Connolly is to be referred to a dietician for developing his diet chart required according his health condition. This is because in Parkinson’s disease increased need of protein is required and the dietician has the expertise to inform and set the diet chart accordingly to meet the specific amount of protein to be required by the patient so that they develop enhanced health condition (NICE, 2017).

Case Study 5

Sepsis is usually life-threatening condition caused due to any infection within the body that worsen the blood flow to vital organ and makes them impaired (Levy et al., 2018). Thus, immediate action is to be taken in controlling sepsis condition as seen in case of Mrs Grainger. In the first hour, the Sepsis Six bundle mentioned by UK Sepsis Trust is to be followed to allow Mrs Grainger overcome sepsis. The Sepsis Six bundle mentions that at the initial stage within 1 hour the oxygen titrated in the body is to be reach saturation level of 94 % (Anthwal et al., 2018). This is because oxygen acts as key energy in supporting effective chemical reaction for enhanced functioning of the body organs (Wang et al., 2019). In case of Mrs Grainger, it is seen that her oxygen saturation is 88% and needed to be provided oxygen therapy. This is because oxygen therapy allows direct transmission of oxygen through tube or mask clipped to nose in the lungs from where the oxygen is more easily and efficiently absorbed in the blood to increase the level of saturation of oxygen in the blood (NHS, 2019). In order to monitor the oxygen saturation increased during oxygen therapy, pulse oximeter is to be attached to the finger of Mrs Grainger. This is because pulse oximeter is the non-invasive tool that allows measuring the saturation level of oxygen in the blood in effective manner (NHS, 2019). The next action to be taken is performing blood culture of Mrs Grainger which is to be done as early as possible to develop idea regarding source control. The blood culture is to be made in two phase that is one to be performed before the administration of intravenous antibiotics to determine source and nature of infection and another to be performed after administration of antibiotic to determine level of infection control after the antibiotic administration within 1-3 hour (Anthwal et al., 2018). The source and nature of infection is required to be identified in sepsis so that the doe and type of antibiotic to be provided can be determine for thee patient (Anthwal et al., 2018). Thus, based on initial blood culture, the antibiotic nature and dose for Mrs Grainger is to be determined and the antibiotic is to be administered intravenously. The advantage of intravenous administration of antibiotic is that the medication is directly administered into the oxygen-rich blood to be immediately used by the body and resolves the additional time taken for absorption when taken orally (Anthwal et al., 2018).

The lactate test in people with sepsis is to be performed within the first hour in serial manner to determine the level of lactic acid present in the blood. This is because the higher the amount of lactate in the blood, it indicates greater presence and less control of infection (NHS, 2019). The lactate level in blood during sepsis increases because the endogenous epinephrine stimulates the beta-2 receptors. This increases glycolysis and makes the body generate increased pyruvate that results to cause tissue hypoxia and acidosis leads to damage the internal organs (NHS, 2019). Thus, serial measurement of lactate level in Mrs Grainger is required as it would help the nurses to determine the performance of the antibiotic and fluid intervention made for her in controlling sepsis. In case of Mrs Grainger, if the lactate level is below 4 mmol/L, then as a nurse I require to administer minimum 30 mL/kg of crystalloid solution to the patient in intravenous manner within 1-3 hours to prevent the individual from going into septic shock. The fluid resuscitation is to be done rapidly and no intravenous pump is to be included in the process (NHS, 2019).

The study by Milano et al. (2018) mentions that human body normally requires increased fluid to manage the blood pressure from getting reduced to dangerous level which may result in making the patient develop septic shock. Thus, fluid resuscitation is required in sepsis because it help the nurses to control the level of body fluid and avoid hypotension which in turn help them to ensure enhanced functioning of the body organs and reduced damage of them due to sepsis (Anthwal et al., 2018). The normal lactate level in blood in case of unstressed individual is 0.5-1 mmol/L (NHS, 2019). The level is to be reached through the fluid resuscitation in case of Mrs Grainger to ensure she is safe from developing sepsis. The sepsis bundle within 1-3 hour mentions to execute urine output measurement of the patient. This is because lesser urine output indicates increased presence of infection in the body that is causing it to go into a shock and produce less urine (Leisman et al., 2017). However, increased urine output would indicate there is effective flow of blood to the kidney which is leading them to function properly and generate adequate amount of urine to throw away the infectious elements and harmful chemical released by the bacterial infection in the body (Anthwal et al., 2018). Thus, the urine output of Mrs Grainger is to be measured continuously to monitor her sepsis condition.

In case the hypotension in the body of Mrs Grainger is not reduced after following the fluid resuscitation in the Sepsis Six Bundle for 1-3 hours, then in the next 3 hours she is to be administered vasopressin. This because vasopressin in septic shock lead the patients like Mrs Grainger develop increased vascular tone, enhanced blood pressure and it spares using conventional catecholamine in the body to reach improved arterial pressure for supporting enhanced blood flow to the organs for their effective functioning (Anthwal et al., 2018, NHS, 2017). The urine output, lactate level and oxygen saturation level in Mrs Grainger’s blood is to be continuously monitored till 6 hours. In the end of six hours, the urine output of Mrs Grainger is required to be more than 0.5 mL/kg/hr, oxygen saturation needs to be above 94% (must to be achieved within 1 hour), breathing rate is to be normal and body temperature is required to be within 35-37℃ (Anthwal et al., 2018, NHS, 2017).

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