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Well Elder Project: Annemarie RosinskiJill GarrettCollege Of Dupage: NursingIntroductionIn the class of 2015’s Introduction to Core Concepts class, we are doing a project called “The Well Elder Project.” This consists of each student picking an elderly person above the age of 70 to interview for our class purposes. We interviewed them, did specific assessments, and got to know each and every one of them in our own personal ways. Throughout this assignment, our clinical instructors have been reinforcing what it is that we need to be doing, and constantly checking our work for validity. This was a fun project, and in this paper, I will go detail by detail, my journey with my well elder, Annemarie Rosinski. Mrs. Rosinski is a 73-year-old female who loves life and everyone in it. She is very alert and oriented, so she does live on her own. Her husband has been deceased for a little over two years. Getting to know Mrs. Rosinski was a great experience, and I will now begin to tell all about her.Overall Health StatusBesides Mrs. Rosinski’s high blood pressure and high cholesterol, she seems to be a pretty healthy woman. She is alert and oriented times 3, and even owns her own business at 73! Since Mrs. Rosinski has high cholesterol and high blood pressure, I know it is very important that she has a healthy diet and a diminished amount of stress. In the teaching plan, I taught her the importance of a healthy diet and reduced amount of stressed, to which she responded positively, and now she is even going to start keeping track of what she eats in a notebook.Psychosocial NeedsMy client described ‘health’ and ‘aging’ as getting older and becoming aware of your body. “There are changes happening to your body that you need to look out for, an example being getting a breast exam” (Rosinski, 2015). My conception is that Mrs. Rosinski does know it is important to attend to her body more frequently and paying more attention to her health as she ages. The stage of development my client is in according to Erickson’s Stages of Psychosocial Development is Ego Integrity versus Despair. As we grow older (65+ yrs.) and become senior citizens, we tend to slow down our productivity, and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life (McLeod, 2011). Erickson believed that if we view our lives as unproductive and feel guilty about the past, we become dissatisfied with life. This often leads to developing despair, often leading to depression and hopelessness (McLeod, 2011). Being successful in the Ego Integrity vs. Despair stage means that this leads you to the virtue of wisdom. Wisdom enables a person to be able to look back on there life with a sense of completeness and closure. It will also lead them to accept death without fear. Mrs. Rosinski is in this stage because when she reminisces on her life, she looks at the good things that have happened. She does not look back with remorse or regret, but happiness and satisfaction. My client has definitely been successful throughout this stage. She shows no signs of depression and she seems to be very happy with her life. She also verbally acknowledges she would not change a thing, and she is happy. Moving onto Maslow’s identification of hieratical needs, I need to identify which stage my elder uses to cope with change. I believe that my elder uses a lot of love and belongingness to justify or use for a lot of her changes. ?(McLeod, 2007).She already has the other parts of the pyramid satisfied, and she really loves her family. She thinks her family is everything, and that is awesome. She often turns to her daughter to support, and now since her husband is gone, only really has her daughter around here. She has her mother as well, which is good, but she is getting extremely old and may not be with us soon. While looking at my client’s formal and informal network of social support (this also ties in with Maslow), she mostly turns to her family. Her informal network is her family; she is always able to confide in them when she needs to. Her formal network of social support would be her doctor, or other healthcare provider. Since Mrs. Rosinski owns her own business as a dog kennel owner, she has many different types of responsibilities. She has her mother work at the kennel just to give her something to do. She also takes care of her daughter, whom she lives very close to, and sees her brother and sister often. She has the ability to participate in other’s lives, but she is such a busy woman with her business alone, that her life mostly consists of working with that. I think this may be leading up to her feeling extremely stressed out. Her coping mechanisms were not very good previously, but now I have taught her some things to do such as breathing exercises or taking a little “me” time. She said she will cope with these and she thanked me. Some nursing interventions I can give to my client to cope with are: avoiding unplanned or abrupt events, encouraging expression of feelings, and arranging situations to encourage the patient’s autonomy. (Gulanick & Myers, n.d., p. 168). These will develop both self-esteem and self-actualization in my client. Overall, I believe my client has aged very well and she seems to be doing well for herself.Physiological NeedsThere are many concepts that go along with physiological needs. In this paragraph and at this time, I will list these concepts along with nursing interventions and rationales to prove my points. The first concept is functional ability. My client, Mrs. Rosinski, demonstrated phenomenal functional ability because she is alert and oriented x3. She is safe, and I do not feel the need to give her any less thought than that. The second concept is mobility. Mobility is the ability to move around. Mrs. Rosinski is perfectly capable of walking on her own and is not at any risk for immobility. The only thing I would do for mobility for Mrs. Rosinski is monitor nutritional status. I would do this because proper nutrition provides needed energy for ambulation and transfer techniques, and participating in exercise. Moreover, pressure ulcers develop more quickly in patients that have a nutritional deficit. (Gulanick & Myers, n.d., p. 134). I am not very worried about Mrs. Rosinski with mobility, but she definitely could have a healthier diet. The third concept is tissue integrity. Tissue integrity is the ability of body?tissues?to regenerate and/or repair to maintain normal physiological processes. Mrs. Rosinski, like I said before, is pretty mobile, so I do not think she is at risk for impaired tissue integrity. For an assessment, I assessed the condition of her tissue. I did this because redness, swelling, pain, burning, and itching are signs of the body’s immune response to localized tissue trauma. (Gulanick & Myers, n.d., p. 198). I did not see any redness, etc. and she did not complain of any pain or discomfort, leading me to take the assessment no further. Nutrition is the forth concept, and it is very important for somebody to have a balanced diet. Previously, Mrs. Rosinski’s diet had been more than body requirements. She would not eat fruits or vegetables. I advised her to start an intake log, and now she keeps track of what she eats, letting her know if she is eating too excessively or unhealthy food. (Gulanick & Myers, n.d., p. 144). I think her daughter also needs to take part in this to make sure Mrs. Rosinski is doing what she is supposed to be doing, as it is important for her high cholesterol and high blood pressure. The final concept is fluid and electrolyte imbalance. This means when your body doesn’t have the correct amount of electrolytes or fluids, and symptoms/side effects happen. Mrs. Rosinski seemed to be healthy in this area, she gets enough fluids, and electrolytes do not seem to be a problem. If I did assess for electrolyte imbalance, I would have to do a blood test and look at all of the different serums (Gulanick & Myers, n.d., p. 618). Mrs. Rosinski overall seems like a pretty healthy individual due to all of the assessments and reflections I have done of her. As I have stated before in the teaching plan, I taught her about a healthier diet and understanding what she can do to reduce stress to help her blood pressure and cholesterol.NursingPatient EducationMrs. Rosinski was a very quick learner with my teaching plan. I put it in a table with labels and each one separate so she would know how to read it. She expressed that it is a good idea. I let her keep a copy of it so she can be reminded of what to do and what our goals were. I was able to address all the needs I felt were important and needed addressing. She took well to all of my suggestions, and I felt satisfied that she understood what I was teaching. I taught Mrs. Rosinski about three things: Having a healthier diet for her high cholesterol, reducing the stress in her life to help with her hypertension, and to replace the throw rug with a non-slip rug in her bathroom. For her diet, we decided that writing down her intake would make her more self-aware of what she is eating, and let her see what she still needs to eat to make some healthier choices. For her stress and hypertension, I taught her how her hypertensive medication works. I also taught her some different coping mechanisms used to deal with stress, as listed before. For the throw rug in her bathroom, her daughter helped her replace it with a non-slip rug instead. I think my teaching went very well, and it turned out to be very effective. I am happy with the way she took to me teaching and I definitely look forward to seeing Mrs. Rosinski in the future. To me, helping people feels great, and this just reinforces why I would love to be a nurse.Clinical JudgmentClinical judgment is a crucial puzzle piece that you need to have to be a nurse. Without it, how would we make decisions? I can remember two times specifically I used clinical judgment while talking to my client. The first time, I was teaching Mrs. Rosinski about her hypertensive medication. I could not use all of that medical jargon that we as nurses use, so I put it into terms she would understand, and she did! It felt great to know that I could get my point across without using a lot of confusing words that would not help her in any way shape or form. The second time I used clinical judgment was not talking about me a lot, and just letting her talk. Even though she would ask me questions, I would answer quickly but carefully (not rushed) and let the conversation flow back to her. It is important to let your patient talk and to not have them feel overpowered. Mrs. Rosinski was a pleasure to have in this project and all the interviews, and I know she would say the same.ConclusionI have learned more from this project than I could ever put into words. An older adult can be completely alert and oriented so on the surface it may look like nothing is wrong, but they may be struggling somewhere else. I am glad Mrs. Rosinski allowed me to interview her because not only did I learn a lot about her, I learned a lot about the way I will be talking to and interacting with patients. At first I was pretty nervous to interview an adult and teach them something, because usually I am the one learning from adults! After I did it, I feel confident enough to even do another one! If you know the knowledge you’re supposed to know, the possibilities are endless. I love the elderly (geriatric) population, and I would love to work with them when I do finally become a nurse. This project helped better me as a nurse because now I know that I do not have to be nervous while talking to someone, I should be able to trust myself and my knowledge.ReferencesGulanick, M., & Myers, J. L. (n.d.). Nursing Care Plans (7th ed.). Elsevier, Mosby. book gives diagnoses, interventions, and outcomes, along with rationales. It is very convenient and I used it for my patient teaching plan.McLeod, S. (2007). Maslow's Hierarchy of Needs. Retrieved from Simply Psychology website: website helped me pinpoint which needs my Well Elder seemed to fall into.McLeod, S. (2011). Erik Erickson:Psychological States. Retrieved from Simply Psychology website: website specifically deals with the different stages of Erik Erickson's Psychological States. It goes into each one according to age and gives you stage-specific information. I used this website to determine which stage my 'well-elder' was in and researched just that. ................
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