Reflect on geriatric patients from your practicum site. Consider frail elder patients that you have assessed for skin wounds such as bumps, bruises, shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome, etc. Explain the consequences of these types of wounds for frail elders. Then, describe a patient case including the care plan for assessment, diagnoses, treatment, management, and patient education. Explain whether the patient’s care plan was effective. Include how you might proceed differently in the future. If you did not have an opportunity to evaluate a patient with this background during the last 8 weeks, you can select a related case study or reflect on previous clinical experiences.
An advance directive is a legal document that defines a patient’s wishes for medical care. This document is a way for patients to share their wishes with family members and health care providers when their illness or mental capacity prevents them from making decisions. As an advanced practice nurse who has care discussions with patients and their families, you need to not only be familiar with the process of completing an advance directive, but also understand how this document might impact your role in patient care and treatment.
Journal Entry Part 1
For the first part of your journal entry, reflect on the Five Wishes presented on the Five Wishes website and PDF and complete your Five Wishes. Explain your state’s requirements for advance directives, including whether your Five Wishes can be turned into a formal document. Then, explain how your experience of completing your Five Wishes advance directive will help you guide discussions with patients and their families. Finally, explain how you might apply the Five Wishes advance directives to your nursing practice. Include how this advance directive might benefit patients in decision making for specialized areas of care.
Journal Entry Part 2
For the second part of your journal entry, reflect on geriatric patients from your practicum site with disorders related to specialized areas of care, such as oncology, nephrology, urology, gynecology, and neurology. Describe a case of a frail elder patient who must make decisions related to specialized areas of care. Then, explain potential patient outcomes and include whether treatments would be beneficial and how they would impact the patient’s quality of life. Finally, describe the patient’s wishes in terms of treatments and interventions for the disorder (Was there an advanced directive?) and how the patient might want to spend any remaining time. Include how environmental factors, such as family, caregivers, ethnicity, culture, religion, and/or personal values, might impact decision making for treatments and interventions. If you did not have an opportunity to evaluate a patient with this background during the last 9 weeks, you can select a related case study or reflect on previous clinical experiences.
For the first part of your journal entry, select and describe one of the following types of elder abuse: physical, sexual, mental/emotional/verbal, pharmacological, or financial. Explain strategies for identifying this abuse. Then, explain how you would proceed based on your local and state laws once you have identified this abuse in a patient. Describe resources in your community that assist victims of this type of abuse and explain how you, as the advanced practice nurse, might apply these resources for abused elders who are identified in the clinical setting.
For the second part of your journal entry, reflect on the different cultures—ethnic, religious, regional, or generational—of the elder patient population at your practicum site. Describe the cultures you have observed and explain the influence of these cultures on the prevalence and detection of elder abuse. Then, explain how culture might impact the way you would implement resources for preventing or addressing abuse.