The The Complex Concept Of Aging Assignment Paper

The The Complex Concept Of Aging Assignment Paper

The purpose of the assignment is to integrate and synthesize concepts learned throughout the modules. Please use your textbook, reliable online resources, and peer-review articles to support your arguments. Also, please follow the submission parameters and rubric.

Submission Parameters:

For this plan of care/case study, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 6-7 pages, which does not include the cover page and reference page(s)The The Complex Concept Of Aging Assignment Paper.

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Introduction (including purpose statement)
Case Summary or Synopsis
Include a short (75-100 word) description of the patient in terms of age, sex, race, height, weight, marital status, occupation, social/cultural history, previous hospital admissions, and chief complaint on current visit. This serves to orient the reader to the case study patient and provides an overview of clinical issues of the patient.
Discussion Questions and Answers
Conclusion
In regards to APA format, please use the following as a guide:

Include a cover page (this is not part of the 6-7 page limit)
Include transitions in your paper (i.e., headings or subheadings)The The Complex Concept Of Aging Assignment Paper
Use in-text references throughout the paper
Use double-spaced 12-point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 6-7 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e., NCSBN, AANP)
Case Study #1:

Mr. Hendrickson is a 77-year-old man who is known to your practice. He is brought in today by his daughter, who reports a new onset of confusion accompanied by urinary incontinence. When you see the patient today, he is oriented to place and person but not time and does not recall much about events of the past few days. He says that he is eating and drinking as usual (but the daughter is shaking her head to the contrary). He denies any change in bowel function but is fearful of sleeping because he might “wet the bed.” The daughter states that he has been drinking a lot more water than usual and urinating more frequently. He denies any acute pain other than chronic arthritis. He was a regular attendee at the local senior center but has not been there for a week and seems to have forgotten about it.

Past medical history: coronary artery disease, hypertension, hyperlipidemia, elevated fasting glucose, osteoarthritis of knees. The The Complex Concept Of Aging Assignment Paper

Medications: Lisinopril 20 mg PO daily, hydrochlorothiazide 12.5 mg PO daily, metoprolol 50 mg PO daily, simvastatin 20 mg PO daily. OTC medications include Aleve, 2 tablets every 12 hours as needed for severe knee pain; topical “Icy Hot” for knee pain daily; glucosamine-chondroitin tablet daily; multivitamin “male over 50 years” daily.

Vital signs: BP 130/84; HR 60, RR 16; Temperature 99.2°F; BMI 38.

Case Study Questions (BELOW IS RUBRIC TO USE AS A GUIDE FOR THIS ASSIGNMENT):

What additional subjective and objective data would you gather?
What is the list of differential diagnoses? What additional diagnostic tests would you include to confirm or rule out each condition?
What national guidelines are appropriate to consider?
Treatment plan: Based on your assessment and current research, what treatment would you recommend?
What else should you teach your patient? Are there any Healthy People 2030 objectives that you should consider?
What is your evaluation/follow-up plan?
Are there any legal/ethical considerations?
Using the circle of caring, what or who else should be involved to hear the patient’s voice, getting him/her and family involved in the care to reach optimal health?
What billing codes would you recommend?
Conclusion

Introduction

In this assignment, strong emphasis is placed on integrating and synthesizing relevant concepts learned throughout the modules. The discussion focuses on critically examining the assigned case study through a comprehensive analysis of the Subjective, Objective, Assessment and Plan (SOAP) note (methods of documentation) to assist in the clinical reasoning process. The paper is divided into a number of sections and sub-sections namely: case summary, discussion questions and answers, differential diagnoses, additional differential tests, national guidelines, treatment plan, and the concluding remarks. The The Complex Concept Of Aging Assignment Paper

Case Summary or Synopsis

The identified patient (Mr. Hendrickson) is a 77-year old man brought in to the clinic by his daughter. The chief compliant reported by the patient include: confusion and urinary incontinence. In terms of medical history, past medical conditions experienced by the patient include: hypertension, coronary artery disease, elevated fasting glucose, hyperlipidemia and osteoarthritis of knees.  The patient appears to be a single parent, and without any occupation. Other key information regarding the patient’s vital signs include: BP 130/84; HR 60, RR 16; Temperature 99.2°F; BMI 38. Conducting a detailed SOAP note analysis is a key step toward ensuring proper clinical documentation of the health-related issues and concerns raised by the patient and his daughter.

Discussion Questions and Answers

Subjective Data

The subjective section is considered an integral component of the SOAP note. In the assigned case study, the subjective data encompasses the personal views, experiences and/or feelings experienced by the patient (Mr. Hendrickson) and someone close to them (the daughter). The subjective data provided in this scenario covered the chief complaint (e.g. confusion, altered thought process, delirium and urinary incontinence), history of present illness, past medical history (past medical conditions such as hypertension, osteoarthritis of knees, coronary artery disease, hyperlipidemia, elevated fasting glucose) and current medications (e.g. metoprolol, Lisinopril, Aleve, glucosamine-chondroitin tablet). As noted in the provided subjective data, the patient complained of experiencing episodes of urinary incontinence, strong and sudden urge to urinate, confusion and bladder control problems (e.g. frequent urination, bedwetting)The The Complex Concept Of Aging Assignment Paper. Equally, relevant information on the social history is provided in relation to the eating habits and sleeping patterns of the elderly patient. Other additional data and information for inclusion in the subjective section of the clinical documentation may revolve around the activity level, employment status, medical trials, family history, surgical history, allergies, functioning, education level and environmental history (Podder, Lew & Ghassemzadeh, 2022).

Objective Data

The objective section of the SOAP note covered key data and information as observed and measured by the healthcare practitioner based on the current presentations of the identified patient. Some of the main elements included in the objective section are physical examination findings (e.g. behavioral and psychomotor activity, attitude toward examiner, appearance), vital signs (e.g. temperature, weight, height, respiratory rate, body mass index, and blood pressure). Some of the additional data and information for inclusion in the objective section of the SOAP note include: laboratory data and other diagnostic data, imaging results, data on the psychological state of the patient, characterization of urinary incontinence, thought process and content, insight and judgment, fund of knowledge, attention and concentration (Podder, Lew & Ghassemzadeh, 2022).

Figure 1: a diagnostic work-up of urinary incontinence in men (Mangir & Chappel, 2020)The The Complex Concept Of Aging Assignment Paper

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Differential Diagnoses

Conducting a comprehensive differential diagnosis by a competent specialist (urologist, family physicians or other qualified medical practitioner) can help to attain an accurate diagnosis and confirm or rule out each condition. Below are some of the potential differential diagnoses of further consideration in the current case:

1. Overactive Bladder Syndrome

Urinary incontinence is associated with the involuntary loss of urine, and remains one of the major public health issues for the elderly, those aged over 65 years. Some of the notable symptoms associated with overactive bladder include immediate urinary urgency, frequent nighttime urination, and pollakisuria, persistent urge to urinate, and urge incontinence (Theisler, 2022). In this case, conducting a set of differential tests including urinalysis may help to in the screening for the existence of microscopic hematuria, glycosuria or other infection (Lozo & Sand, 2018). In the event the patient indicates a positive urinalysis, conducting a urine culture may assist to confirm the presence of a urinary tract infection. Other optional tests that may be performed included the use of the volume-frequency chart or bladder diary to evaluate whether the identified patient is experiencing voiding dysfunction (Narasara et al., 2017)The The Complex Concept Of Aging Assignment Paper.   This is the most likely diagnosis since the patient presents many of the signs and symptoms (e.g. urge urinary incontinence, frequent urination) associated with overactive bladder syndrome.

2. Detrusor Hyperactivity With Impaired Contractility (DHIC)

Another key diagnosis is detrusor hyperactivity with impaired contractive function. Theisler (2022) indicated that this condition is mainly reported in debilitated older patients, and may be characterized by overflow incontinence, bladder distention, limited detrusor reserve power, a slow velocity of bladder contraction, inefficient bladder emptying, and bladder trabeculation. Similarly, Tran and Puckett (2022) indicated that patients with this particular condition may also experience deterioration of detrusor contractile efficiency, triggering the geriatric urge incontinence in elderly patients. Kowalik and MacLachlan (2022) insisted that accurate diagnosis can be achieved by conducting a number of diagnostic tests including the Schafer pressure/flow nomogram, UDS testing, linear passive urethral resistance relation, video-urodynamic evaluation, among others. Primarily, these diagnostic tests may help to assess the specific clinical presentations and complications faced by patient and to confirm or rule out the presence of DHIC (Gilling, 2017)The The Complex Concept Of Aging Assignment Paper. Whilst this likelihood of this diagnosis is enhanced by the cognitive impairment experienced by the assigned patient, further diagnostic tests and patient assessment may help to inform an accurate diagnosis.

3. Diabetes

Research has shown that diabetes may heighten the risk of an individual suffering from urinary incontinence. Among elderly patients, the growing prevalence of diabetes has been associated with the increased risk of severe incontinence symptoms due to the occurrence of diabetes-related functional impairments and the changes in the peripheral and central polyneuropathy (Wein, 2018). Other factors that might contribute to the risk of urinary incontinence in diabetic patients included reduced mobility owing to diabetic foot, changed sensory reflect due to polyneuropathy, impaired vision due to diabetic retinopathy and changes in the intake of fluid as a result of diabetogenic nephropathy (Mangir & Chappel, 2020). As such, more extensive diagnostic tests and clinical examination should be conducted in order to assess impaired bladder function, measure residual urine after deliberate micturition, and to determine the underlying malfunction (Lozo & Sand, 2018)The The Complex Concept Of Aging Assignment Paper.

Additional Diagnostic tests

A range of additional diagnostic tests, maneuvers and examinations may also be conducted to enhance the accuracy of diagnosis. Wein (2018) commented that performing cytoscopic examination of the bladder and urethra may be instrumental to rule out other pathologies including bladder neck strictures while undertaking an urethrogram can assist in the imaging of a urethral stricture. Other additional tests include laboratory and imaging investigations (urine culture, blood test, urine analysis, and ultrasonography) to determine the presence of urinary tract infection. Performing renal ultrasound may also assist in the assessment for hydronephroris in the event there is suspicion for obstruction (Tran & Puckett, 2022)The The Complex Concept Of Aging Assignment Paper.

National Guidelines

Numerous guidelines have so far been recommended on the management and treatment of urinary incontinence in both men and women. Theisler (2022) explained that conducting initial evaluation of urinary incontinence in many can take place in general practice. Effective management of men with UI demands a good deal of careful evaluation that is focused on physical examination and extensive history-taking in order to identify the underling pathology, and to streamline the diagnosis and treatment plan in line with the distinct needs and conditions of the individual patient (Urology Care Foundation, 2022)The The Complex Concept Of Aging Assignment Paper. Equally, conservative management (e.g. bladder training, pelvic floor muscle training, lifestyle interventions) are considered to be the first-line treatment for urinary incontinence (Narasara et al., 2017). Similarly, Kowalik and MacLachlan (2022) pointed out that the use of invasive procedures should be strictly limited when dealing with uncomplicated patient, and other treatments (e.g. the mid-urethral sling and the autologous facial sling) may be assessed to determine their suitability and efficacy in the management of urinary incontinence.

Treatment Plan

The most likely diagnosis for this particular patient is overactive bladder syndrome. The treatment plan combined both pharmacologic and non-pharmacological interventions. In terms of the pharmacologic approaches, a number of medications (e.g. tolterodine, fesoterodine, solifenacin, trospium and oxybutynin) may be used in the treatment of urinary incontinence. In terms of invasive or surgical treatment interventions, numerous measures (including the use of indwelling catheters, onabutulinumtoxinA injection and neuromodulation, peri-urethral bulking agents, artificial urinary sphincters) may also assist in managing some of the symptoms and complications associated with geriatric urge incontinence (Theisler, 2022; Tran & Puckett, 2022). Similarly, Tran and Puckett (2022) explained that non-pharmacological interventions should also be considered in the management and treatment of urinary incontinence. Some of the physical measures and behavioral interventions that can be useful in elderly patients include: bladder management, pelvic floor exercises, individualized physical therapy. Other treatment options that may be considered to treat the condition experienced by the identified patient include the use of external collecting systems, urine drainage bags, absorbent products, skin care products and toilet substitutes (Urology Care Foundation, 2022)The The Complex Concept Of Aging Assignment Paper.

Complications

The patient must be informed about the side effects and adverse events associated with some of the medications used in the treatment of urinary incontinence. Moreover, providing clear referral guidelines may also become a viable means through which the healthcare providers can refer the elderly patient to specialists with relevant expertise in treating men with urinary incontinence (Rolston & Özel, 2017). Referral guidelines are highly helpful in the event of uncertain diagnosis, suspected diagnosis of bladder carcinoma, or gross hematuria and complicating factors. Moreover, a number of Healthy People 2030 goals and objectives should be considered and they include behavioral and lifestyle changes (e.g. weight management to avoid the problem of obesity, engagement in physical exercise) (Kowalik & MacLachlan, 2022)The The Complex Concept Of Aging Assignment Paper.

Evaluation/Follow-up Plan

Regular evaluations must be conducted to identify and respond to some of the complications experienced by elderly patients with urinary incontinence. Strong emphasis needs to be placed on determining the therapeutic response and patient outcomes following implementation of the comprehensive treatment plan (Lim, 2017). In terms of follow-up, more attention should be placed on educating the patient on bladder training, supplements, medications, pelvic floor exercises, and proper hygiene (Narasara et al., 2017)The The Complex Concept Of Aging Assignment Paper. Tran and Puckett (2022) mentioned that the provision of patient education may assist the patient to understand the importance of medication adherence, and to determine whether the management and treatment of the health concerns experienced by the patient can be attained by the involvement of an inter-professional health care team.

Legal/Ethical Considerations

Upholding the ethical principles of informed consent, beneficence, non-maleficence, integrity, due process, integrity, responsibility, professionalism and accountability may alleviate the legal and ethical concerns associated with the treatment of elderly patients with urinary incontinence (Lim, 2017). Strong emphasis in the treatment plan should be placed on ensuring improvements in therapeutic response, and provision of evidence-based, patient-centered, top-quality and holistic care and support to this particular patient and his family (Rolston & Özel, 2017).

 

Circle of Caring

In view of this holistic model, consultation with the elderly patient may involve the involvement of his family (daughter), and relevant healthcare practitioners (primary physicians, family nurses, community nurses, urologists). Enhanced collaboration and functioning of all healthcare team members as a unit is vital in ensuring successful diagnosis, management and treatment of the healthcare condition(s) experienced by the elderly patient (Kowalik & MacLachlan, 2022).

Billing Codes

The recommended billing codes include 1090F (bladder control assessment) and 0509F (bladder control plan of care). Whilst core 1090F shows that the bladder control assessment was performed and billing should only made for management and evaluation services, code 0509F is only billed upon the detection of a bladder control issue (Highmark, 2021).

Conclusion

The findings presented in this assignment provide meaningful insights into the clinical documentation of an elderly patient with urge urinary incontinence, and a diagnosis of overactive bladder syndrome. Conducting a comprehensive SOAP note analysis may assist the involved healthcare practitioner to collect and analyze a wide pool of objective and subjective data that may be used to inform a detailed patient assessment, and ultimately ensure an accurate diagnosis and treatment plan. Considering that the most likely diagnosis for this particular patient is overactive bladder syndrome, applying proper diagnostic tests and examinations may prove instrumental in the development and implementation of an individualized treatment plan to help in the treatment and management of the identified health condition The The Complex Concept Of Aging Assignment Paper.

References

Dray, E., & Pavuluri, H. (2022). Diagnosis of urinary incontinence in women. Female Urinary Incontinence, 51-60. https://doi.org/10.1007/978-3-030-84352-6_3

Gilling, P. (2017). Faculty opinions recommendation of impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. https://doi.org/10.3410/f.726277115.793516675

Highmark, (2021).How to Code for Bladder Control Measure. https://www.bcbswny.com/content/wny/provider/news/blue-bulletin/how-to-code-for-bladder-control-measure.html#:~:text=Conducting%20a%20bladder%20control%20assessment,65%2Dand%2Dolder%20patients.&text=CPT%20II%20code%201090F%20indicates,for%20evaluation%20and%20management%20services.

Kowalik, C. G., & MacLachlan, L. S. (2022). Urinary incontinence in the elderly. Female Urinary Incontinence, 465-476. https://doi.org/10.1007/978-3-030-84352-6_25

LIM, S. C. (2017). Managing the elderly with urinary incontinence and dementia. International Archives of Urology and Complications, 3(2). https://doi.org/10.23937/2469-5742/1510027

Lozo, S., & Sand, P. K. (2018). The placebo effect in overactive bladder syndrome. Contemporary Pharmacotherapy of Overactive Bladder, 27-45. https://doi.org/10.1007/978-3-319-97265-7_3

Mangir, N., & Chappel, C. (2020).Management of urinary incontinence in men. Trends in Urology & Men’s Health, 11(2), 18-22. https://doi.org/10.1002/tre.740  The The Complex Concept Of Aging Assignment Paper

Narasara, G. G., Satyawati, R., & Nugraheni, N. (2017). Urinary incontinence prevalence and its relation between pelvic floor muscle strength and type of incontinence urine based on incontinence questions (3IQ) among elderly men. Proceedings of the International Meeting on Regenerative Medicine. https://doi.org/10.5220/0007318001630166

Podder, V., Lew, V., & Ghassemzadeh, S.(2022). SOAP Notes. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482263/

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Rolston, R., & Özel, B. (2017). Urinary incontinence: Diagnosis, treatment, and avoiding complications. Handbook of Gynecology, 743-754. https://doi.org/10.1007/978-3-319-17798-4_71

Theisler, C. (2022). Urinary tract infection (UTI). Adjuvant Medical Care, 350-351. https://doi.org/10.1201/b22898-342

Tran, L.N., & Puckett, Y. (2022). Urinary Incontinence. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559095/

Urology Care Foundation, (2022). What is urinary incontinence? https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence

Wein, A. J. (2018). Re: Male incontinence: The etiology or basis of treatment. Journal of Urology, 200(4), 703-704. https://doi.org/10.1016/j.juro.2018.07.032 The The Complex Concept Of Aging Assignment Paper