Running head: Senior Health Promotion 1

Senior Health Promotion Project

Chelsea Woodmore

Bon Secours Memorial College of Nursing

NUR4113 Gerontological Concepts & Issues

April 17, 2017

I pledge.
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Assessment

The client I chose to do my health assessment on is my uncle Daryl

Woodmore. He is a 66-year-old African-American male who is currently married

with one daughter and one son, both adults who do not live in the home. He is

retired from the United State Navy and lives with his wife in Virginia Beach. My

client appears well nourished and states that he considers his overall health is good.

He occasionally uses a cane when he is required to walk long distances, however, he

did pass his Get Up and Go test, and does not appear to be a fall risk. My client does

wear glasses for reading, but no other sensory deficits were apparent. His current

medical history revealed that he has hypertension and glaucoma, and has a family

history hypertension. He is a former smoker who quit in 2003. He also had a

previous history of back surgery and a hip replacement. After completing his

assessment utilizing the different assessment tools, it revealed that my client has a

potential problem with chronic pain and alcohol. Both these assumptions were

based off the scores of the clients Short Michigan Alcoholism Screening Test and the

Numeric Pain Rating Scale. The overall goal of Healthy People 2020 as it relates to

older adults is to improve the health, function, and quality of life in older adults

(Healthy People, 2017). In 2012, 60% of older adults suffered from at least two

chronic diseases (Healthy People, 2017). From looking at the overall goal of Healthy

People 2020, I conclude me that it was important to teach my client how to manage

one of his chronic conditions, which was pain.

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Nursing Diagnosis

I chose the chronic pain diagnosis for my client because it is something that

he has been battling for quite some time. He was involved in a job related accident in

2003, and suffered from extensive nerve damage. As a result of his accident, he had

to have multiple surgeries, including a hip replacement and major back surgery. The

accident and subsequent surgeries left my client with persistent lower back pain

and a permanent limp. Chronic pain is defined as pain that last longer than the

expected healing time or longer than 3 months (Takai, Yamamoto-Mitani, Yoshiki, &

Suzukie, 2015). One pain hits the chronic stage; it can become a disease within itself,

causing a psychological, social, and economic impact on the individual (Takai,

Yamamoto-Mitani, Yoshiki, & Suzukie 2015). With a diagnosis of pain, the obvious

goal is pain relief. However, with an individual suffering from chronic pain,

permanent pain relief might not ever happen, so it is important that my client finds

a way to at least manage his pain so he can continue to function in his daily life. The

short-term goal for my client was for him to be able to engage in desired activities

without having an increased level in pain. My client was given to the end of the week

to achieve this goal. The long-term goal for my client is to establish non-

pharmacological treatment to decrease his pain or use it as a supplement it with his

pharmacologic treatment.

Interventions/Teaching

In teaching my client how to achieve some of his goals, I decided to offer

some nonpharmacologic options to manage his pain. Makris, Abrams, & Gurland

(2014) concluded that a combination of pharmacologic and nonpharmacologic

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approaches help achieve realistic therapy goals. Some of the strategies I introduced

to my client included applying cold applications, heat applications, massage, and

relaxation techniques. Cold reduces pain, inflammation, and muscle spasticity by

decreasing the release of pain-inducing chemicals (Gulinack & Myers, 2014). Heat

reduces pain by improving the blood flow to the area causing pain thereby reducing

pain reflexes (Gulinack & Myers, 2014). I suggested my client utilize heating pads

and ice packs to the affected area to help with pain relief. Another method of pain

relief I taught the client was the use of relaxation techniques and the use of

distraction. Relaxation techniques such as guided imagery and music therapy can

help reduce muscle tension and stress, which can elevate pain sensation (Gulinack &

Myers, 2014). Distraction is also a good tool to use temporary because it can

increase the pain threshold an individual is feeling. One of the relaxation techniques

I suggested to my client was deep breathing. For distraction, him and I discussed

things he could do to take his mind off his pain. He informed me he liked to read, so I

suggested when he was having some pain, to try reading for an hour or so to take his

mind off his pain.

While forming my teaching plan, it was important for me to include the client

as much as possible. One of the great aspects of the nonpharmacologic options for

my client to try was the fact that they were relatively inexpensive. Considering he is

unemployed and only receives a retirement check and social security, finding

inexpensive pain relief methods is important to have. I also made sure to include my

clients wife in the teaching because as the only other person in the home, I figured

she would be a good resource for my client.

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My clients short-term goal was somewhat met. He was able to engage I some

activities, but he also had increasing pain level during other activities. For instance,

he relayed to me that he was able to perform household chores without having any

increased pain, but when he was working on fixing his kitchen sink, he had to take

frequent breaks because of his back pain. However, my client did achieve his long-

term goal, which was to utilize nonpharmacologic methods of reducing his pain

level. My client informed me that he started using a heat pad for his lower back,

which he says helps decrease his pain temporarily. I encouraged my client to

continue to utilize these nonpharmacologic options because as he suffers from

chronic pain, this will likely be an ongoing problem for a while. My client and I

agreed that I would talk with him every couple of weeks to make sure that he was

utilizing the different pain management strategies and discuss any other options he

may have thought of to help manage his pain.

Evaluation

The nursing outcomes for my client were related to tertiary prevention

because he was actively trying to reduce his pain level. The use of the heating pad,

ice packs, and distraction proved to help my client reduce his pain level to a more

tolerable level in conjunction with the pain medicine he was prescribed by his

doctor. I believe my teaching was effective because my client continues to use these

methods to help alleviate some of his pain. Emphasizing the cost effectiveness of the

different methods was a great motivator for my client because he realized that he

did not have to spend a lot of money for these options and in fact could in some

cases make his own ice packs and heating pads with household items. As my client
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mentioned many times throughout our sessions, Ill admit to you that I am indeed

cheap, and I dont want to pay for a whole bunch of stuff if I dont need to.

One thing I would do differently with my teaching is I would have offered

more options for my client and maybe incorporate some exercises to help with the

pain management. Having my client try different things like stretching could make

our interactions more interesting instead of me just lecturing him on different

methods to reduce his pain. Overall, this project was a great learning moment, not

just for my client, but for me as well. Teaching my client allowed me to gain more

confidence with myself, and the knowledge I was able to give my client made me feel

more adequate as a nursing student. I believe this teaching project will help me

when I become a nurse especially during the discharge process in the hospital,

where it is my responsibility to teach all the information a patient must know before

they go home, where he or she will be in charge of their own care. It will be my

responsibility to make sure they are equip with the appropriate knowledge and

tools for the sake of their health.

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References

Gulinack, M. & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and

outcomes. Philadelphia, PA: Elsevier Mosby

Makris, U. E., Abrams, R. C., & Gurland, B. (2014). Management of persistent pain in

the older patient: A clinical review. JAMA, 312(8), 825-837.

doi:10.1001/jama.2014.9405

Nursing 2016 drug handbook. (2016). Philadelphia, PA: Wolters Kluwer.

Takai, Y., Yamamoto-Mitani, N., Yoshiki A. & Suzukie, M. (2015). Literature review of

pain management for people with chronic pain. Japan Journal of Nursing

Science, 12, 167-183. doi:10.1111/jjns.12065.