Running head: ANALYSIS OF GERIATRIC CARE NEEDS

Analysis of Geriatric Care Needs

Amanda Hubbard
Ferris State University

ANALYSIS OF GERIATRIC CARE NEEDS

Abstract
Nursing diagnoses and plans of care are explored for a patient that has cancer and does not want
friends and family to know. Outcomes and interventions with rational are discussed as the plan of
care develops. Public policy is also discussed in regards to options for the patient.
Keywords: nursing diagnoses, plan of care, interventions, outcomes

ANALYSIS OF GERIATRIC CARE NEEDS

Case Study
Jesse and Jeanette were told that Jeanette has the early stages of multiple myeloma. They
were told that she may die in a year or she might have remissions and live longer than that. Jesse
and Jeanette had raised two sons, were financially stable and looking forward to living out their
retirement. Both researched the disease and decided to hit this head on. However, Jeanette did
not want anyone to know about her disease because of the way she thought others would look at
her. She also believed that she was going to live to be 75 years old and be in remission. Because
of that belief Jesse respected Jeanettes wishes and kept quiet about her disease. She decided to
take several rounds of chemotherapy which had severe side effects. When friends asked what
was wrong she said she was fine. When her son asked out right if she was hiding something
serious she denied it. Rob her son knew something was wrong. His dad was withdrawing and
drinking more than normal which left Rob at a loss.
Analysis of Assessment Findings
In this case study there are multiple patients. You have Jeanette who is dying from her
cancer and does not want to burden anyone with it. Jesse is grieving for his wife and not coping
well with it. Then there is Rob who knows something is not right but cannot find out what is
going on. And last but not least you have the family as a whole that is compromised due to denial
of the patients part.

ANALYSIS OF GERIATRIC CARE NEEDS

Biological Theories
There are many things that cause aging throughout the body. Some believe that aging is
programmed at conception. Touhy and Jett (2012) state that, Cells become increasingly
complex. The cells also accumulate damage resulting in errors seen in replication, (pg. 34). This
is defined as the biological theory of cellular functioning. In Jeanettes case, the damage to the
cells could have been what caused her cancer.
Another biological theory that may be the cause of Jeanettes cancer and aging is the
Immunity theory. According to K. Jin (2010), The immune system is programmed to decline
over time, which leads to an increased vulnerability to infectious disease and thus aging and
death (pg. 72). Cellular stress and death is caused by antibodies that are no longer effective and
unable to fight new diseases. Dysregulated immune response has been linked to cardiovascular
disease, inflammation, Alzheimers disease (AD), and cancer (Jin, K. 2010, pg. 72).
The free radicals theory also shows that damage to the cells of the body are caused by
free radicals. These free radicals cause damage to the structure of the cell membrane resulting in
accumulation of damage leading to cell and then eventually organ damage and death .Free
radicals are found naturally in the body due to the way cells metabolize oxygen. Free radical
formation has been known to cause cancer.
NANDA Diagnoses
Ineffective Coping
According to the Nursing Diagnosis Handbook (2006), Ineffective coping is the
inability to form a valid appraisal of internal or external stressors, inadequate choices of

ANALYSIS OF GERIATRIC CARE NEEDS

practiced responses, and/or inability to access or use available resources (pg. 367). Jeannette
proves this in the evidence of some of her comments. Jeannette stated that she did not want
anyone to know about her disease because she did not want them to pity her and that she was
going to live to be 75 years old. She also lied to her son when he asked her directly is she was
hiding a serious illness. All of these were probably done out of fear. Unfortunately her denial
caused social isolation for both her and her husband, which led Jesse to drink more than normal.
Client Outcomes
In the next two weeks, Jeanette will be able to verbalize the ability to cope and ask for
help when needed, communicate needs and negotiate with others to meet needs, and demonstrate
new effective coping strategies (Nursing Diagnosis Handbook 2006, pg. 368).
Nursing Interventions and Rationales
1.) Help the client set realistic goals and identify personal skills and knowledge.
Adaption of the client to the diagnosis is through education of the disease and resources available
to help (Nursing Handbook 2006, pg 369).
2.) Use empathetic communication and encourage the client and family to verbalize fears,
express emotions, and set goals. By allowing the patient and family to express their emotions and
effectively listening to them allows all parties to start coping help (Nursing Handbook 2006, pg
369).
3.) Discuss the clients and familys power to change a situation or the need to accept a
situation. The nurses assessment of the situation allows the patient and family to learn what is
expected from them help (Nursing Handbook 2006, pg 369).

ANALYSIS OF GERIATRIC CARE NEEDS

Social Isolation
Social isolation is aloneness experienced by the individual and perceived as imposed by
others and as a negative or threatening state (Nursing Diagnosis Handbook 2006, pg. 1125).
Jeannette had imposed the social isolation on herself and without realizing it, on her husband as
well. She did not want her friends to know because she did not want them to pity her. Jesse, by
following his wifes wishes had no support. Friends and family could not help him with his grief
because they did not know about it. Friends and family noticed the isolation and Jesses
increased drinking.
Client Outcomes
In the next 2 weeks, Jeannette and Jesse will identify feelings of isolation, practice social
and communication skills needed to interact with others, and initiate interactions with others: set
and meet goals (Nursing Diagnosis Handbook 2006, pg. 1126).
Nursing Interventions and Rationales
1.) Discuss causes of perceived or actual isolation. A patients and families way of
dealing with the disease, fears and grief play a part in the way the illness is handled (Nursing
Diagnosis Handbook 2006, pg. 1127).
2.) Establish trust one on one and then gradually introduce the client to others.
Individualized care means allowing the patient to approach their care the way they see fit
(Nursing Diagnosis Handbook 2006, pg. 1127).
3.) Provide positive reinforcement when the patient seeks out others. By doing so it
increases the patient well-being (Nursing Diagnosis Handbook 2006, pg. 1127).

ANALYSIS OF GERIATRIC CARE NEEDS

Compromised Family Coping

Compromised family coping is defined as, Situation in which usually supportive
primary person (family member or close friend) provides insufficient, ineffective, or
compromised support, comfort, assistance, or encouragement that may be needed by the client to
manage or master adaptive tasks related to health challenge (Nursing Diagnosis Handbook
2006, pg. 396). Jesse is unable to fill the primary caregiver role because of the feelings he is
unable to share. Rob the son does not know how to cope because he knows something is wrong
but Jeannette and Jesse will not tell him.
Client Outcomes
In the next 2 weeks, Jeannette and her family will verbalize internal resources to help
deal with the situation, verbalize knowledge and understanding of illness, provide support and
assistance as needed and identify need for and seek outside support (Nursing Diagnosis
Handbook 2006, pg. 397).
Nursing Interventions and Rationales
1.) Assess the strengths and deficiencies of the family system. By assessing the family the
nurse is able to guide the family to maintain support and coping mechanisms (Nursing Diagnosis
Handbook 2006, pg. 397).
2.) Help the family members recognize the need for help and teach them how to ask for
it. By doing this the nurse is helping the family members to maintain control (Nursing Diagnosis
Handbook 2006, pg. 397).

ANALYSIS OF GERIATRIC CARE NEEDS

3.) Encourage expression of positive thoughts and emotions. Coping helps the family
continue to strive for their own well-being (Nursing Diagnosis Handbook 2006, pg. 397).
Policy
They public policy of physician assisted suicide, needs to be changed. If Jeannette had
the opportunity to not put herself, family and friends through her disease her mental state to not
have to hide it from everyone may not have existed. Anyone with a life threatening disease
should have the right to end their own life. According to Procon.org, There are three states that
have legalized physician assisted suicide by legislation and one state that has legal physician
assisted suicide by court ruling (2014). At the very least if the patient is not allowed to make the
decision to take their life in a legal and dignified manner, than the legislative and judicial
systems should step in on a case by case basis and make a determination. Allow people the right
to end their life in a comfortable, personal way that works for them and their families instead of
letting them suffer through horrible side effects from their disease.

ANALYSIS OF GERIATRIC CARE NEEDS

References
Ackley, B. & Ladwig, G. (2006). Nursing Diagnosi Handbook:A Guide to Planning Care.Mosby
Elsevier, St Louis Missouri.
Ebersol & Hess (2012). Toward Health Aging: Human Needs and Nursing Response. Mosby, St.
Louis Missouri.
Jin, K. (2010). Modern Biological Theories of Aging. Aging and Disease, 1(2), 7274.
Procon.org. (2014). Euthansia Pros and Cons, State by State Guide to Physicain Assisted
Suicide.