Case Study Essay For the purpose of this case study, the patient will be referred to as (Mrs S.

A) to safeguard patient privacy and confidentiality in accordance with NHS Code of Practice on Protecting Patient Confidentiality (2010). WHAT ABOUT NMC? (Mrs S.A) is a 69 -year-old European female, who has been admitted to the intensive care unit with chest pain (angina) and arrhythmia. She has been a smoker for more than 40 years and worked night shifts at the local factory until she has been diagnosed with osteoporosis at the age of 60. Osteoporosis is a skeletal disorder that compromise bone density hence bones become more porous which increase risk of fracture. (Gass et al 2006).She was a single parent and now she lives alone in a block of flat house?? On the second floor and had no history of heart disease, hypertension, or cancer in her family. Before the admission to the hospital, she noticed that her feet and ankles swollen. Mrs Johnson was complaining that she wakes up in the middle of the night with acute shortness of breath (dyspnoea) and lately these symptoms were occurring more often. In order to fall asleep she had to use a few pillows to elevate her body position so she can feel comfortable. In addition, she mentioned that she felt tired (fatigue) most of the time and experienced severe pain in both legs when walking uphill or up the stairs. Recently she was diagnosed with Coronary artery disease (CAD) and old scaring showed signs of untreated myocardial infarction (MI) which made significant damage to the heart muscle. Ultimately, once the heart muscle has been damaged, it cannot regenerate and forms a scar. The portion of heart muscle damaged attributed to (MI) has an impact on the heart performance and can result in arrhythmia (irregular heartbeat), congestive heart failure, or death. Myocardial infarction cause irreversible necrosis, of heart muscle (myocardium), when the part of the heart muscle dies, and is associated with ischemia. (Zafari 2012) This usually results from an insufficiency in myocardial oxygen supply and body requirements, which is most often caused by sudden plaque rupture with blockage (thrombus) formation in a coronary vessel, it result in severe reduction of blood supply to a part of the myocardium. (Lilly, 2011)

Accordingly, to statistics of coronary heart disease (2010) there are around 124,000 heart attacks in England and Scotland every year .More than 191,000 died from coronary heart disease in 2008, where 12,500 people were under age of 65. After examination, (Mrs S.A.) vital signs, her oxygen saturation level was 90%, systolic pressure was 89 over diastolic 66 it considered as low (hypotension). Her heart rate was 67 bits per minute, which is low (bradycardia), this suggests heart valve problems. Heart failure can result on very low blood pressure, typically because the heart is unable to pump enough blood to keep the pressure up with respiratory rate. (A.D.A.M. Medical Encyclopaedia.2012) The chest-x-ray detected pronounced abnormality of left ventricular border. Moreover, ST-segment showed persistent anterior wall elevation and magnetic resonance imaging (MRI) indicated that the left ventricular cavity was massively enlarged. (Mrs S.A) Medical diagnosis was congestive heart failure. The term heart failure is a condition where the heart is unable to pump blood well enough to meet the body's requirements (Greenwood et al 2009). When the heart muscle is damaged, it cannot pump sufficient amount of blood hence has to work harder, after a period of time it becomes enlarged (hypertrophy) and inefficient. Consequently, fluid accumulates in the lungs causing difficulty breathing (dyspnoea) when lying down as in the case of (Mrs.S.A.) Furthermore, an inadequate supply of oxygen made her to feel fatigue and poor circulation of the blood and an extra fluid accumulated in the extremities causing oedema. (Falvo. 2005) (Word Count 622) The chosen patient has been introduced . Confidentiality is maintained however you should cite NMC as this is the guidelines we adhere to as professionals. The introduction is slightly disjointed in parts and this affects the flow of work MARK GIVEN = 8/10 Topics identified

Firstly, considering the age of Mrs S.A. it will be appropriate to explore in depth ageing processes and because she is a smoker and worked night shifts it is important to investigate effects of poor health choices on health and vice versa. Additionally, this essay will define the term palliative care and describes the main purpose of Palliative team in the care of dying person and his/her family. Topics clearly stated and rationale for choice presented. MARK GIVEN = 3/3 (word count 68) Topic 1 (Older Adults-ageing processes) Ageing is a complex process; human being has to undergo inevitable changes such as decreasing rate of cell mitosis, elasticity of connective tissue and increased rigidity. I in addition, ageing processes can cause some sensory and perceptual changes such as vision, hearing, taste, and smell and pain perception. Changes in cognitive abilities and risk of developing Alzheimer, Parkinsons condition also increased with age. (Stein. et al. 2008) Accordingly, to a World Health Organization report (2007), Alzheimers disease affects 24 million people .The rate of ageing is different from person to person and it is influenced by many factors. For example, the most important is genetic makeup, lifestyle of individual may contribute to delay or accelerate the ageing processes. Attitude? Lifestyle includes dietary habits, exercise pattern, level of stress, and how well the person is responding to it, sleeping habits also smocking ?? Spelling or substance abuse can contribute to the ageing process in what way. In addition, environmental factors also influence our ageing processes. Physiological changes also occur in respiratory system, due to descries elasticity and tone of muscle most older adults experience a deceased functional respiratory reserve capacity (Daniels et al 2006).There are changes in gastrointestinal and genitourinary tract .Many people experience decrease in height, muscle size and tone also decreases. Regarding the case, one of (Mrs.S.A.) diagnoses in addition to the heart failure and untreated myocardial infarction was osteoporosis. Osteoporosis is degenerative chronic condition, which decrease bone density and considered one of the ten most important conditions along with cardiovascular disorder, stroke, and diabetes mellitus. (AIHW 2012). Risk factor is the age of the patient as it is closely related to the ageing processes, oestrogen level

starts to decrease after the menopause hence female, are at greatest risk of developing the condition than males. Moreover, osteoporosis is one of a major cause of morbidity as it eventually leads to deformity and disability which poor outcome and low quality of life for the elderly. (AIHW 2012). More than three million people in the United Kingdom have osteoporosis. It is one in two women and one in five men over the age of 50 are affected be this disease. (Cembrowicz and Allain 2007) Because of ageing process, function of the cardiovascular system also becomes less efficient. Reduction in elasticity in blood vessels and a heart muscle itself will leads to an increase in systolic blood pressure. High level of cholesterol, which also increases with age, builds fat deposit in the blood vessels (arteriosclerosis). Building up over the years, this fat deposit can cause narrowing (stenosis) of the vessels, reduction of oxygen supply and can be the cause of myocardial infarction, such as in the case of (Mrs.S.A.) Risk of high cholesterol level is cardiovascular disease is a major cause of morbidity and mortality in people age 65 and over. (Daniels et al, 2006) Structural and functional changes related to ageing, such as increase in the thickness of the left ventricular wall and hypertrophy of myocardial and cause overflow due to obstruction and further increase in afterload. Moreover, diastolic function decrease and can lead to development of diastolic heart failure. (Cardiol 2010) (Word Count 515 ) Again please watch the logical flow of your work. Lacks detail at times Tas an example, how is taste affected by ageing? here is an attempt to relate to chosen patient but this could have been done more. Be careful to support what you say at all times with relevant evidence MARK GIVEN = 7/12

Topic 2 (Effects of poor/good health choices) Health is seen as a physical, social, and mental state of well-being, not just the absence of illness or infirmity. World Health Organization 1946). Is this a primary or

secondary reference? Health is holistic and includes different dimensions such as physical, mental, spiritual, sexual, and emotional. (Naidoo .2009) Aspects of wellness factors such as gender, race, genes, and genealogy are nonmodifiable, however can be influenced by the life choices. I do not necessarily agree with gender Lifestyle is seen as habits of an individual or group of individuals and the risk they may take in order to enhance or intensify wellness. For example, way of life is the term for dietary habits, physical activity/inactivity, or use of substances as alcohol or drugs and smocking. Accordingly, Scottish Government Reports (2010) there is clear evidence that alcohol misuse increase the risk of physical and mental health harms. However, mild-to-moderate, alcohol consumption has been identified to have a beneficial effect on cardiovascular health and psychological and physiological well-being.(National Institute Of Health 1992). Old reference The way individuals live is closely related to four most prominent noncommunicable (lifestyle diseases) such as cardiovascular, chronic obstructive pulmonary disease, diabetes and cancer. The factor associated with those conditions is individuals unhealthy lifestyle and considered as preventable. (Chan. 2010). Unhealthy choices, such as smoking, bad diet, misuse of substances and alcohol consumption, which mistakenly associated as coping mechanisms for depression, have very serious consequences for health .To say more, health is not just the outcome of nonmodifiable factors as genetic or gender, health outcomes also greatly influenced by the social ,economic and personal factors. Diet in high calories content includes excessive amount of saturated or trans-fat ingredients and considered as one of the major risk factors for coronary heart disease.reference A diet high in saturated fat causes cholesterol, to build up in the arteries. Eventually, the arteries harden and narrow, the main cause of atherosclerosis reference. Consequently, it results in increase of the blood pressure in the arteries as well as strain on the heart to maintain sufficient blood flow throughout the body and can cause myocardial infarction, heart failure. In addition, high calorie diets increases risk of obesity. Obesity is another risk factor for developing heart disease, diabetes. You need to cite evidence to support what you are saying

Emotional response to socio-economic factors, such as low or loss of income or any other stressful events can cause stress and mental health problems. The World Health Organisation (WHO 2001) predicts that depression or depression-related illness will increase by 2020. Emotions have an effect the choice, for example, disappointment or anger, low-esteem will most likely to lead to unhealthy options, and vice versa. Despite the fact that, positive emotional well-being is strongly linked to physical good health with positive cognitive and social behaviour. (Huppert . 2005). The studies also show that negative emotion could cause coronary heart disease. (Smith.2001). Coronary Heart Disease (CHD) is the largest single cause of death in Scotland due to lifestyle and social inequalities. For example, accordingly to Black Report (2009) ???? individuals in the lower socioeconomic status is often associated with healthdamaging behaviour and poor life choices .For instance, alcohol and tobacco use, fats food, stress, less education, low paid mostly manual jobs as factories and other health risk behaviour habits. The risk of death of myocardial infarction, stroke or diabetes rises when smoke. Furthermore, smokers who smoke more than twenty-one cigarettes a day more likely to die of heart attack, stroke, or diabetes than non-smokers. (Bandolier 2007). Report for the Countryside Recreation Network (2003) states, that physical activity can greatly decrease chance of developing heart problems, diabetes, hypertension and cancer. It enhances mental wellness, fosters healthy muscles, bones and assists in keeping health and independence in older adults (Pretty et al 2004). Department of Health Report (2004) also describes importance of exercises such as physical activities help people to feel better about themselves and built self-esteem. There is strong indication that, physical activities improves emotions and reduce state of anxiety. It also decreased physiological respond to stress and have beneficial effect on sleeping habits. (UK Chief Medical Officers report (DoH 2004) Despite given knowledge and power to make the right choice in order to live longer and healthier life, not everyone have equal access to nutritious food, clean and healthy environment, safe workplaces or exercise environments or affordable quality health care( for example dentistry). However, risk factors associated with good

health mostly modifiable and can be controlled by a person through the healthy choices. (Word Count 722) You did not relate the above explicitly to your patient.. MARK GIVEN THEREFORE = 5/12 Topic 3 (Palliative care) With regard to the case study, due to advanced stage of heart failure the treatment was no longer possible Mrs (S.A) has been offered palliative care. Definition from the Latin pilliare means to cloak. (Dying Matters,2012) Palliative care uses an approach that improves quality of life of terminally ill patients. It focuses on suffering prevention and comfort for the dying person .By assessing and identifying the physical, psychosocial, and spiritual needs of the person and provides help for their families facing difficulties associated with life-threatening illness of loved one. (WHO,2012). Accordingly, to Maslows hierarchy of needs, palliative care assessing physiological needs first, breathing, eliminating, nutrition, and comfort such as pain relief. Psychologically it may be hard for the person to accept the fact of death and it may cause a disturbance in mental state. The palliative care members should demonstrate compassion and respect for the dying person and offer support if needed to discuss the ways to meet psychological needs of the person.(Daniels et al 2004) The ultimate goal of palliative care is to provide relief from pain and other distressing symptoms. Palliative care does not intend to treat, speed up, or postpone death and consider dying as a normal process. Palliative care emphasis is to improve quality of life .The aim to increase comfort for the terminally ill person until death occurs, by promoting dignity, avoiding a prolonged dying process, and providing support. (Health Policy, 2011) It is also aim to help the families and relatives to cope with distress of knowing that the person they love is going to die and later with bereavement. Palliative care

combines the psychological and spiritual aspects of a patient care and offers a support system to help patients live as actively as possible until death. (Becker, 2009) Palliative care uses multidisciplinary team approach in decision making about treatment and care to aim patients needs and wishes of their families, which may include bereavement counselling. Moreover, palliative care intent to improve quality of life and may have positive effect on the illness development. Members of the multidisciplinary team generally include doctors, occupational and physiotherapist, nurses and social workers as well as pharmacists and dieticians and other medical staff. (Doyle.2008) Excellent and open communications at the end of life is important in order to provide good end of life care. If interaction breaks down, doubt and issue can occur, leading misunderstanding to a degree of giving a hope to a dying person. Some physicians may have problems informing the finish fact about a terminal diagnosis. After a person passes away, family members and friends will experience grief and bereavement. Some people find that seeing the body helps them to accept the fact that their loved one died. Palliative care members can assist in organizing a private and enjoyable atmosphere as well to prepare the body for family viewing. At the time of death palliative care provides invaluable support to the family members and assists in coping with death of the person.(Daniels et al 2004) Unfortunately, not long after Mrs (S.A) was admitted to home-based palliative care, she died shortly afterwards she was discharged from the hospital. (Word Count 532) There is some attempt to relate topic to patient but this could have been more throughout MARK GIVEN = 7/12 Conclusion In summary, this paper described close relation between negative lifestyle practices and it contribution to the majority of morbidities and mortalities. It also discussed the impact of positive lifestyle on health and quality of life associated with it, the aging

process including sensory deficit and how the normal aging process might be affected by the lifestyle choices. In addition, there is chronic condition case study which is also great degree depends on making the right decision. You have summarised new learning but have not explored implications for practice MARK GIVEN = 3 (Word Count 76)

Reference list A.D.A.M. Medical Encyclopedia. (2012) Arrhythmias.Dysrhythmias :Abnormal heart rhythms. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002091/ [Accessed on 10 August] Becker R (2010) Fundamental Aspects of Palliative Care Nursing: an evidence based handbook for student nurses. 2nd Ed. Quay Books, London Cembrowicz,S.,Allain.,T (2007) Osteoporosis.Class Publishing .2 edition.(London) Chan.M. ,(2010) Global Status Report on noncommunicable status diseases. World Health Organization.Available from: http://www.who.int/nmh/publications/ncd_report_full_en.pdf [Accessed on 15 August] Chronic diseases summary (AIHW) (2012) Available at: http://www.aihw.gov.au/chronic-diseases-summary/ [Accessed on 7 August] Daniels.R.,Grendell,R.,Wilkins.F(.2006),Nursing Fundamentals.Caring and Clinical Decision Making.Delmar.UK Daniels.R.,Grendell,R.,Wilkins.F(.2006),Nursing Fundamentals.Caring and Clinical Decision Making.Delmar.UK you have cited twice Doyle.D.,Woodruff.R.,(2008).The Manual of Palliative Care. Available at: http://www.hospicecare.com/manual/IAHPCmanual.htm [Accessed on 22 August]

Effective Health Care.(1998) Cholesterol and CHD: screening and treatmentCholesterol and coronary heart disease. 4(1).Available at: http://www.medicine.ox.ac.uk/bandolier/booth/hliving/Lifedeath.html [Accessed on 12 August] Falvo.D.(2005) Medical and Psychological Aspects of Chronic Illness and Disability, 3 edition. .Johns and Barlett Publishers .London Greenwood.M.,Seymour.R., Meechan .J(2009) Textbook of human disease in dentistry. Blackwell. Gass M, Dawson-Hughes B .(2006) Preventing osteoporosis-related fractures: an overview. Am J Med.119(40)1. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16563939 [Accessed on 5 August] Huppert . F. (2005). Positive emotions and cognition: Developmental,Neuroscience and Health Perspectives . Department of Psychiatry, University of Cambridge .Available at: http://cambridgewellbeing.org/Files/UNSW_Huppert_Chapter.pdf [Acessed on 20 August] Karavadas.A.,Lazaros.G., Tsiachrs.D.,Pyrgakis.V Hellenic J Cardiol.(2010) Department of Cardiology, Athens General Hospital, Greece . Aging and the Cardiovascular System.online Available on: http://www.hellenicjcardiol.com/archive/full_text/2010/5/2010_5_421.pdf [Accessed on 6 August ] Lilly.,L.( 2011 ) Baltimore.Pathology of Heart Disiease:A collaborative Projet of medical students and faculty. 5 edit. Place of publication Lippincott Williams and Wilkins. Maziar.A., Zafari(2012) Myocardial Infarction.Available at: http://emedicine.medscape.com/article/155919-overview [Accessed on 5 August] Peacock.J.,Hine.R.,Pretty.J., Willis.G (2007). Science Report The Health Benefits of Environmental Improvements. Available at: http://scientiascripta.co.uk/wp-content/uploads/2010/01/SCHO0707BMXW-e-e.pdf [Accessed on 20 August] Scotish Government.(2010) Alcohol and its impact on health . Available from: http://www.scotland.gov.uk/Topics/Health/health/Alcohol/health [Accessed on 15 August] Steinbach.R.( 2009). Equity and Policy: Inequalities in the Distribution of Health and Health Care and its Access. Available at: http://www.healthknowledge.org.uk/publichealth-textbook/medical-sociology-policy-economics/4c-equality-equitypolicy/inequalities-distribution [Accessed on 15 August]

Smith.D. (2001).Negative emotions and coronary heart disease:Causally related or merely coexistent? Scandinavian Journal of Psychology, 42 pp.57-69 Available at: http://www.blackwellpublishing.com/content/BPL_Images/Journal_Samples/SJOP00 36-5564~42~1~214/214.pdf [Accessed on 20 August] Jackson.R.,(1994) National Institute on Alcohol Abuse and Alcoholism. 16(4)pp. 315 Available from: http://pubs.niaaa.nih.gov/publications/aa16.htm [Accessed on 18 August] references should be listed alphabetically

Overall, referencing is as recommended MARK GIVEN = 4

Online assessments
Assessment 1 Topic:3 : Healthy Adults and effects of ill health across the life span. Part 1 Accordingly, scenario since (S.J) was diagnosed with asthma, the condition was maintained effectively. She had the knowledge to recognise the symptoms in order to be able to take preventative measures. The primary goal of asthma management is to control it. However, to gain control over asthma she had to stay on long-term medication. Research shows that in the UK, 5.4 million people currently undergo treatment for asthma, it is 1 adult in 12 and 1 child in 11(NHS Choices, 2010). On the self care continuum which can be described as the sliding scale, starting with pure self-care or individual responsibility on the right side along the opposite end where

care provided entirely by health professionals, she was in the slightly to the left side of this scale. She required some assisted management because of minor ailments. Minor ailments include chronic conditions that require from an individual to take responsibility to make daily choices to delay onset and minimise complication. (159words) in part 1, is Stacey not self-managed/ MARK GIVEN = 2/3 Part 2 After (S.J) developed a bad chest infection, an assisted management and shared care was temporary required, hence she changed position on the self care continuum from self management to shared care. For the next two weeks, because of asthma sudden onset she had to rely with her daily activities on her mother and friends. In addition, it has affected her employment and education; hence, it can lower her self-esteem. Further, in order to ease up the symptoms and move closer to the centre of self-care continuum, she had to visit her doctor to arrange further treatments and regular follow-ups appointments. Additional steps will be required to determine the cause of asthma exacerbating; it might be environmental or physical. Identifying the sources of asthma exacerbating could make easier to take steps to prevent and manage future occurrence of symptoms. According to (the American Academy of Paediatrics), asthma affects various aspects of health such as general well-being, physical, psychological, and social aspects. (160 words) MARK GIVEN = 3/3

Part 3 This section will focus on four aspects within the scenario described above and the effect of each aspect on self-care continuum. Accordingly, to Roper et al (200) Activities of living, each person performs in life in their own way, which is influenced by the level of independence/dependence continuum. Many factors influence activities of living and equally affect persons wellbeing. For example of (S.J), a social economical aspect such as income is essential factor to be taken into consideration. In order to maintain asthma episodes some home environment improvement may be required. Since, her condition had affected employment and education, hence had an impact on the budget of the family. It has

been accepted that poor health is associated with poverty, or low income. (Benzeval et al 2000) On the self care continuum, she moved from maintaining her well-being by preventing the onset to where, she had to seek help from professionals in order to reduce the progression and complications of asthma. Environmental cause, such as living in cold, damp, and badly maintained housing, where there is a greater risk of catching, respiratory disease, and flu like symptoms. Poor health can decrease income and the other way round. (Benzeval, et al 2000) Enhancement to the property atmosphere can most importantly reduce pet substances and decrease rate of event of bronchial asthma periods (Environmental Triggers of Asthma 2007). (S.J) moved on the self-care continuum from desirable position, where she can manage her daily activities to where she requires medical care. Furthermore, parents may often feel stressed, guilty, frustrated, or feel anxiety, fear, or even anger concerning their childs illness, which might have negatively, affect emotional aspect on the family. Parents, in this case (S.Js) mum, had to deal with her own emotions in order to help her daughter. Family support is one of key elements in order to help children to adapt despite that the response to the state of health of asthma expands across all socioeconomic levels. (Gizynski & Shapiro, 1990).It has been found that bronchial asthma can possibly increase amount of stress and anxiety (Ryan-Wenger & Walsh, 1994) which, in turn, may exacerbate bronchial asthma episodes and lead to depression. Depression is recognised to be a risk factor for a range of chronic physical illness, including asthma, (Pretty et al 2005). Asthma could also have psychosocial effects as due to physical stress such as coughing and coughing; the ability to focus might be seriously decreased, followed by sleeplessness and restriction of activities. (Naidoo,J and Wills.J 2009). (Word Count 426) (Total word count 752) 4 aspects that have changed Staceys position on the continuum are discussed MARK GIVEN = 10

Reference list
NHS Choices (2010). Asthma. [Online]. Available at: http://www.nhs.uk/Conditions/Asthma/Pages/Introduction.aspx (Accessed: 25 th June 2012) Environmental Triggers of Asthma. Case Studies in Environmental Medicine (CSEM) Agency for Toxic Substances and Disease Registry. [Online]. Available at: http://www.atsdr.cdc.gov/csem/asthma/docs/asthma.pdf (Accessed: 27 th June 2012)

Benzeval, M., Taylor,J. (2000) Evidence on the relationship between low income and poor health .Fiscal Studies . 21( 3) pp. 375 Ryan-Wenger,N., Walsh,M.(1994) "Children's Perspectives on Coping With Asthma," Pediatric Nursing (20) pp .224-228 Asthma UK. Facts for journalists.(2012). [Online].Available at: http://www.asthma.org.uk/news-centre/facts-for-journalists/ (Accessed:23 rd June 2012) Bleil,M., Sujatha,R.,Mille,B.,Wood.,B (2000) The Influence of Parent-Child Relatedness on Depressive Symptoms in Children With Asthma: Tests of Moderator and Mediator Models, Journal of Pediatric Psychology 25(7)pp.481-491 [Online] Available at: http://jpepsy.oxfordjournals.org/content/25/7/481.full.pdf [Accessed 23 rd June 2012) Naidoo.J., Willis,J.(2009).Foundations for Health Promotion. 3rd edt; place of publication Bailliere Tindall Pretty.J., Griffin.M., PeacockJ., Hine.R, Sellens.M.,South.N.(2005) Countryside for Health and Well-Being:The Physical and Mental Health Benefits of Green Exercise. Report for the Countryside Recreation Network. Department of Biological Sciences and Department of Health and Human Sciences,University of Essex, Colchester.[Online ]. Available at: http://www.essex.ac.uk/ces/occasionalpapers/Kerry/CRN%20Report%20FINAL%20 Feb14.pdf [Accessed on 28 August] Pretty.J., Peacock.J., Sellens.M., Griffint.M. The mental and physical health outcomes of green exercise International Journal of Environmental Health REFERENCING MARK GIVEN = 2/2

Assessment 2

Topic 2. (Sensory deficit.)

Accordingly to The Code: Standards of conduct (2008) Nursing and Midwifery Council (NMC) the name used in this case study has been changed in order to protect patients confidentiality . Mr. (I.B), a 69-year-old male turned up for an examination at the local optician complaining of reduced, blurry vision, the appearance of rainbow-colored circles

around bright lights and excruciating eye and head pain accompanied with dizziness. After examination, Mr. (I.B) was referred to an ophthalmologist for further examination and diagnoses in order to initiate medical treatment. Results of examination as follows, Mr.(I.V) has elevated intraocular pressure, major changes in the blood vessel and characteristics of optical nerve damage which cause visual field loss .By careful evaluation of the signs and symptoms he was diagnosed with present of Chronic open angle glaucoma(COAG). Open-angle glaucoma is the most common type of chronic glaucoma, which is potentially blinding condition. (Jerald. 2012) Generally, glaucoma has no signs or significant symptoms at the beginning and may go undiagnosed for a long time, and often diagnosed when serious damage has already been done. Elevated pressure, inside eyes, is caused by excessive fluid that being made due to a blockage to the drainage area of the eye. The stress in the eye creates up progressively. Glaucoma usually develops in both eyes and without treatment, it cause irreversible blindness. In Glaucoma at some point, the optic sensor is broken as a result part of perspective (peripheral vision) is missing. Without treatment, possibility loss of sight completely is very high. In the same way, people with open angle glaucoma will not encounter any signs until they start to lose vision. (National Glaucoma Research 2012) For better understanding of preventions and further deterioration of the eyesight, it is important to investigate relevant documents and guides. For example, National Institute for Health and Clinical Excellent (2009) has a quick guide on how to diagnose and provides an advice on how to manage condition. In addition, it helps to understand how to monitor glaucoma and describes different types of treatment options for open angle glaucoma. National Institute for Health and Clinical Excellence (2009) in research of white Europeans states that somewhere around 10% of UK loss of sight customers linked to glaucoma. About 2% of individuals over 40 years old have developed glaucoma (COAG) and it increases by 10% in individuals over 75 years of age. The result claim that there are over a million glaucomarelated outpatient visits recorded annually. Glaucoma has been proven to be major cause of loss of sight globally .The number of individuals with primary glaucoma in the world by 2000 was approximated at

nearly 66.8 thousand with 6.7 thousand experiencing bilateral loss of sight. Glaucoma is the second major cause of loss of sight after cataract (16 million) Worldwide. (Medical Chanel 2011) The well-being of an individual is determined by perception, understanding, and knowledge gained through our senses. This enables a person to encounter and communicate with its surroundings. A sensory deficit such as loss of vision is a change in the perceptions of sensory stimulating elements. Aspects impacting sensory functions are age, significant stimulating elements, amount of stimulating elements, social connections, ecological factors, and social factors. (R.Daniels 2009) incorrect referencing An individual usually experience discomfort or anxiety when subjected to a change in the type or amount of incompletion stimuli. In addition, sensory deficiency may lead to cognitive alternation as well as be a cause of physical symptoms, such as nausea and head pain. Glaucoma can have negative emotional and psychological impact on the individual, when first diagnosed. To improve Mr (I.V) quality of life he will have to undergo a trabeculectomy (surgery to remove part of the drainage tubes) which is the most common form of surgery for acute glaucoma. As a result he will have to use eye drops such as Prostaglandin analogue. Prostaglandin analogues increase the flow of fluid (aqueous humour) out of the eye, which reduces the pressure within the eye (the intraocular pressure). These eye drops are usually used once a day. In addition, he may need to arrange further appointments every 1 to 4 months or up to 12 to 24 months apart. These will either be with an optometrist who will examine and test vision defects or ophthalmologist. The ultimate goal of early detection of glaucoma is to lessen the impact of the diagnosis of glaucoma and prevention of blindness in order to improve the patients quality of life. (NIHR 2012)

Case is outlined and deficit identified MARK GIVEN = 3/5 Relevant documents related to deficit identified. Please remember to support what you say with relevant evidence.

MARK GIVEN = 5/7 There is insufficient references throughout. Services equipment and care required for this person is not explained MARK GIVEN = 0/7 Referencing MARK GIVEN = 1/2
(Word Count 757)

Reference list:
Daniels.R., (RN.) 2009 Nursing Fundamentals: Caring & Clinical Decision Making. Thomson Delmar Learning. Carla, J., Siegfried, M. (2012). Symptoms of Glaucoma. American Health Assistance Foundation. Available online: http://www.ahaf.org/glaucoma/about/symptoms.html [Accessed on 18 August] NHS. (2009) National Institute for Health and Clinical Excellence. Quick reference guide..Glaucoma. Available at: http://www.nice.org.uk/nicemedia/live/12145/43791/43791.pdf [Accessed on 18 August] Jerald .A.(2012) Primary Open-Angle Glaucoma.Available online: http://emedicine.medscape.com/article/1206147-overview [Accessed on 19 August]