Running head: SENIOR HEALTH PROMOTION

PROJECT 1

Senior Health Promotion Project

NUR4113
Fall 2016
Jennifer Crumb

I pledge, I have neither given nor received aid, other than acknowledged, on this
assignment or Test, nor have I seen anyone else do so.
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Introduction and Background

I chose to perform my assessment on a 78 year old Caucasian female, originally

from the United States, who was retired yet currently works as a transport driver. She

could read, write, understand, and speak English. There were no speech or hearing

impairments, however she did need reading glasses. The interviews and assessments

occurred in her home on the dates of September 10 th, October 1st, and October 22nd.

She did not have any transportation issues and was comfortable with personal space as

assessment took place.

Interview and Assessment

My client (I will refer to her as L.B.) stated that her current health was fair, as

shed been dealing with a recent bout of bronchitis and had back pain from a recent fall,

both of which were making it hard for her to sleep at night. She defined good health as

the ability to do things in life easily, to not be confined to her house. Bad health,

according to her, meant to be unable to live a good quality of life. To keep herself

healthy, she aims to stay engaged in learning opportunities and social opportunities.

She admitted exercise was not a part of her daily routine.

Shes been widowed for 6 years, and is currently seriously dating a gentleman.

She has 3 children, all of which are involved in her care, and her parents are deceased-

mother from spinal cancer, father from stroke. She is of sound mind, and makes her

own healthcare decisions. Client suffers from the chronic illnesses of hypertension,

obesity, stage III kidney failure, and type II diabetes. She recognizes the importance of

keeping these illnesses under control. Client appeared regimented to her medication
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schedules, and checks her blood glucose levels at the same time each morning,

recording them in a diary. Her recent onset of bronchitis and back pain has affected her

sleep patterns and her daily activities. She has not been able to work due to the pain

and general malaise from not sleeping and chronic cough.

It appears that this client has her chronic illnesses somewhat under control.

Healthy People 2020 has aimed for more type II diabetics to check their blood glucose

level daily, which she does faithfully (Healthy People 2020, 2016). Through using my

assessment tools, it seems that she is at moderate risk for falls (she scored a 4 on The

Hendrick II Fall Risk Model). More alarming, however, is her poor sleep quality. On the

Pittsburgh Sleep Quality Index (PSQI), she scored 17. Her latest fall, along with lack of

energy to perform activities of daily living is most likely due to her poor sleep health.

Healthy People 2020 has aimed for 70.8 percent of adults to get sufficient sleep

(Healthy People 2020, 2016). This project aims to help my client with this widespread

problem.

Nursing Diagnosis

L.B. suffers from fatigue related to sleep deprivation as evidenced by lack of

energy for activities of daily living (ADLs), increased physical complaints, and history of

recent falls. L.B. self-reports that she does not get enough rest, and that she is tired

throughout the day. She admits she self-medicates with 2 Benadryl (diphenhydramine)

nightly, in efforts to help her sleep better. Due to diphenhydramine being listed on the

BEERS criteria list, I have strongly advised L.B. to discontinue this practice, particularly

due to her recent falls. I also advised her that this type of drug (anti-cholinergic) should

not be taken due to her stage III kidney disease. She was surprised to find out that
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Benadryl is not a safe medication for her, and that it could lead to more grogginess and

possibility of falls. Due to so many of L.B.s comorbidities being linked to her lack of

sleep, I decided that the above diagnosis would be the most appropriate for her.

L.B.s short term outcome will be for her to sleep for 7 uninterrupted hours at

least 5 nights per week, within one week of interventions. I learned how regimented

L.B. was in my initial interview (i.e., recording daily blood glucose levels in a diary).

Therefore, I asked her to keep a sleep diary for two weeks, which we could then review

to evaluate outcomes. According to Jett and Touhy, a sleep diary should be kept to

track when the patient goes to bed, when she goes to sleep, when she wakes up, when

she gets out of bed, when she takes naps, when she exercises, when she consumes

alcohol, and when she consumes caffeinated beverages to determine the best

interventions for care (2016). I developed a chart for L.B. to record in, dividing it

appropriately for each category stated above. Based on short-term outcomes, L.B.s

long term outcome would be that she could develop an appropriate ADL routine,

including low impact physical exercise without exhaustion, within 6 months. Outcomes,

including clients self-reported fatigue, fall history, and sleep logs, will be evaluated by

her and myself at the end of the time period. We will review which exercises are

working for her for these 6 months, and adjust as necessary.

Teaching Plan (Interventions)

L.B. was very regimented and honest with her healthcare. Her daily sleep diary

would allow for linkage between relationships, or when her highest levels of energy are

throughout the day (Gulanick & Myers, 2014). This would allow her to take advantage

of those peaks of energy to get important tasks accomplished. To help her get a better
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quality sleep, I suggested that she begin a daily exercise routine. Low impact exercise,

including stretching and yoga has been proven to improve sleep quality in the geriatric

population (Pa, et al., 2014). She stated that most people her age liked to walk, but that

wasnt the case for her. She stated that swimming was her favorite form of exercise

when she was younger. I suggested that she look into her closest YMCAs senior

memberships, so that she could try water exercises. She stated that this may be a

good idea, and she had a little extra money per month so that she could maybe take

classes with other seniors (she really enjoyed the social aspect that this idea could

provide).

Along with a YMCA membership, I also suggested chair yoga. I provided her

with a teaching sheet from Live Yoga Life (Bryan, 2009). L.B. was intrigued as I

demonstrated these simple chair-yoga techniques that she could use after breakfast

every morning. Using aerobic and muscle-strengthening exercises would help her

reduce general fatigue, and improve her functional capacity for ADLs (Gulanick &

Myers, 2014). Within 6 months, L.B. should develop a personal routine that allows for

adequate physical exercise, accomplishment of ADLs without exhaustion, and adequate

sleep. Her sleep diary will serve as an evaluation method for both her and myself to

determine if she is now on the right track for good sleep quality and lower risk for falls.

Due to L.B. being both a visual and kinesthetic learner, I felt that these teaching

methods were appropriate for her.

Evaluation

Nursing outcomes were related to both primary and tertiary preventions. A

primary prevention strategy for getting more sleep is adding low-impact exercise to
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L.B.s daily routine. Exercise can also be considered a tertiary prevention strategy

when applied to her need for weight loss for increased diabetic control. The withdrawal

of dyphenylhydramine in her nightly routine can be applied as both a primary and

tertiary prevention as well. Primarily, the discontinuation of the medication will help

decrease the risk of falls. Regarding L.B.s kidney disease, the discontinuation of this

medication will be a tertiary prevention strategy.

Overall, L.B. responded well to the teaching plan that I provided. She stated, I

am so happy you let me know that Benadryl was no good for me. I asked my Dr. about

it and he said you were absolutely right! Due to the fact that the physician reiterated

what I had told her about the medication, her trust in me grew and allowed me to

continue suggestions to better her quality of life. She purchased a YMCA trial

membership for a month and realized she really loved it. She stated, Ive made so

many new friends that share my same interests, this was a great idea. L.B. discussed

her lack of enjoyment for all of the chair yoga techniques, though she said she kept a

few moves in her back pocket for when she was watching television at night.

Due to the addition of exercise, L.B. scored a 10 on the PSQI scale when re-

evaluated. Though there is room for improvement (she only slept for an average of 6

hours per night), it seems that this single intervention helped with her sleepless nights.

She stated that she has more energy for her daily activities, and swimming is helping

her muscles get stronger. Judging by these desired outcomes, it appears that the

simple addition of exercise was a great suggestion for L.B. After assessing my teaching

plan, I may have added a few more interventions to increase her sleep quality. These
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could have included: reduction of caffeine, reduction of stimuli close to bedtime, and

maybe a guided imagery compact-disc she could play at bedtime.

Discussion

When I began my initial interview, I felt slightly nervous due to the fact that I was

just a student. L.B. quickly put me at ease, stating this was a learning process for the

both of us. By the end of this project a trusting rapport was built between us, and I was

much more comfortable. Overall, this teaching experience was very valuable to me as

a nursing student. This patient was very responsive to my suggestions, and I realize

that this may not always be the case. However, she was a great way to begin my

teaching/nursing career. By helping this geriatric patient have a better quality of life,

confidence in myself as a future nurse grew.

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References

Bryan, J. (2009). Live Yoga Life. Live Yoga Life Pty Ltd.
Gulanick, M., & Myers, J. (2014). Nursing Care Plans: Diagnoses, Interventions, and

Outcomes. Philadelphia, PA: Elsevier, Inc.

Healthy People 2020. (2016, March 24). Retrieved from www.healthypeople.gov:

https://www.healthypeople.gov/2020/topics-objectives/topic/geriatric

Jett, K., & Touhy, T. (2012). Ebersole & Hess Toward Healthy Aging: Human needs. St.

Louis: Elsevier.

Pa, J., Goodson, W., Block, A., King, A., Yaffe, K., & Barnes, D. (2014). Effect of

Exercise and Cognitive Activity on Self-Reported Sleep Quality in Community-

Dwelling Older Adults with Cognitive Complaints: A Randomized Controlled Trial.

The American Geriatric Society, 2319-2326.