Nursing Standard of Practice Protocol Essay

To complete Reflect on atypical presentations of disorders in geriatric patients in your practicum setting. Many disorders manifest themselves in a way that would be considered an atypical presentation—most likely different from the way a textbook would describe the disorder’s possible presentations. Consider geriatric patients that you have observed with atypical presentations of disorders. Describe a patient case including how the patient was diagnosed and strategies that were used to overcome the atypical presentation. If you did not have an opportunity to evaluate a patient with this background during the last 5 weeks, you can select a related case study or reflect on previous clinical experiences

Journal Entry # 5

Atypical presentation of illness refers to when an older adult presents with a disease state that lacks some of the traditional essential features of disease manifested among younger patients. Atypical presentations normally encompass three features; unclear presentation of illness changed the presentation of disease, or non-presentation termed as underreporting (Hofman et al, 2017). Nursing Standard of Practice Protocol Essay.

Case Study

An 80-year-old patient presented to the health facility complaining of a productive cough and chills that had started the previous week. The client also complained of anxiety, nausea, and pain with deep breath, headache, hyperventilation, and pain on chest palpation. The patient’s vital signs were pulse rate 97, blood pressure 142/115, Respiration 14, Temperature 97.2°F (36.2°C), and SpO2 98%. ECG was interpreted as normal as well as the neurologic and mental status exam findings. In addition, the chest x-ray results were normal as there were ‘no infiltrates and the heart size was normal, while the electrolytes, CBC and BMP were within the normal limits.  The patient was discharged with a prescription of acetaminophen/hydrocodone and naproxen. Five days later the patient presented to the emergency department in full cardiac arrest. In spite of the earlier findings that the patient had normal ECG and initial troponin, autopsy indicated a 95% atherosclerotic narrowing of the LAD.

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Strategies used to overcome the Atypical Presentation

In this patient, it seems atypical presentation of the illness was not assessed. However, strategies used in assessing atypical presentation of an illness consist of; vague presentation; changed presentation and non-presentation of an illness.

Vague presentation of an illness: Some non-specific symptoms like confusion or falls may indicate a looming acute illness for the elderly. Reduced appetite, behavior changes or reduced function such as the inability to carry out activities of daily living may be indicative of an imminent disease. Accordingly, prompt identification of acute illness that presents vaguely is important because it facilitates early treatment leading to improved quality of life and decreased fatality rate among the elderly (Hofman et al, 2017).

Altered Presentation of Illness: Some symptoms among for the older population may be confusing due to their changed presentations. For instance, presentation of common disease in general population like chest pain during heart disease or sadness in depression does not imply the same among the older adults. Therefore, healthcare providers should utilize various interventions to prevent or alleviate the altered presentation of illness among the elderly (Venkatesh et al, 2015). Nursing Standard of Practice Protocol Essay.

Non-presentation of an illness: Disease symptoms among older adults may not be recognized for a long time. Therefore, it is important for healthcare providers to perform comprehensive assessments in order to identify any unrecognized symptoms or disease (Leonard et al, 2018).

References

Hofman M, Hanenberg F, Sierevelt N & Tulne C. (2017). Elderly patients with an atypical presentation of illness in the emergency department. The Netherlands Journal of Medicine. 75(6), 24-246.

Leonard S, Bueno H & Ahrens I. (2018). Optimized care of elderly patients with acute coronary syndrome. European Heart Journal. 7(3), 287-295.

Venkatesh C, Kiran H, Murthy S & Gowdappa B. (2015). Clinical Profile of Atypical Manifestations of Diseases in Elderly Patients Admitted to Critical

Care Areas. International Journal of Scientific Study. 3(7), 254-258.

Traditional education of health care clinicians hinges on typical presentations of common illnesses. Yet, what is often left out from medical training is the frequent occurrence of atypical presentations of illness in older adults. These presentations are termed “atypical” because they lack the usual signs and symptoms characterizing a condition or diagnosis. In older adults, “atypical” presentations are quite common. For example, a change in behavior or functional ability is often the only sign of a new, potentially serious illness. Failure to recognize atypical presentations may lead to worse outcomes, missed diagnoses, and missed opportunities for treatment of common conditions in older patients. This paper will look at atypical presentation disorders in the elderly and strategies to improve identifying these symptoms.

Case Study

AG is a 90-year-old female who fell in a Skilled Nursing Facility. She sustained a visible wrist laceration but was otherwise asymptomatic. Vital signs were stable, except for EKG reading that showed sinus tachycardia. The patient was sent to the Emergency Department for further evaluation and laceration repair and was found to have a significant Pneumothorax.

Discussion: Pneumothorax

A pneumothorax may be spontaneous, iatrogenic or traumatic. However, in the case of the patient presented in the scenario, her case is more likely that of spontaneous pneumothorax (SP). A typical symptom of pneumothorax in individuals is chest pain. However, in the geriatric population, this only in less than 20% of the elderly compared to two-thirds of the younger patients (Shankar, Magauran and Kahn, 2016). The most common finding is usually sinus tachycardia in the elderly. Nursing Standard of Practice Protocol Essay. According to Shankar, Magauran and Kahn (2016), the incidence of secondary SP increases in the elderly because of increased comorbidity.

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Strategies to Identifying Atypical Presentation of Disorders in the Elderly

Because illness in older adults is complicated by physical changes of aging and by multiple medical problems, it is essential for nurses to recognize more commonly seen atypical presentations of illness in older adults. For example, subtle changes like a decrease in function or a diminished appetite very often are the first signs of illness in an older adult. Accurate training of clinicians is necessary to recognize geriatric patients to ensure proper clinical monitoring and timely treatment. Three strategies to assess for atypical presentation of illness include:

• Vague Presentation of Illness: Some non-specific symptoms, such as falls, confusion or other symptoms that may signify an impending acute illness in an older adult., especially for frail older adults. It is essential to take reports seriously from patients, family and non-professional care providers as to subtle symptoms. Timely identification of acute illnesses with vague presentation enables early treatment of illness resulting in reduced morbidity and mortality and an enhanced quality of life in older adults.
• Altered Presentation of Illness: The presentation of a symptom or a group of symptoms in older adults may present a confusing picture to health care providers. For example, a change in mental status or functional status (falls) is one of the most frequently presenting symptoms at the onset of acute illness in older adults. It is important that clinicians to research or getting training to identify these atypical presentations in the older adult population.
• Under-reporting of Illness: Several illnesses in older adults may go unrecognized for many years and significantly impact quality of life. It is important that the clinicians document and communicate each patient’s altered presentation of illness on chart and between levels of care, as well as increase their knowledge on atypical presentations in the elderly. Nursing Standard of Practice Protocol Essay.

Conclusion

The most common medical conditions can sometimes present in an atypical manner in geriatric patients leading health practitioners astray in their work-up of the patient. Recognition of these atypical presentations and considering a longer list of differential diagnoses in the geriatric population is crucial to arriving at the correct diagnosis as quickly as possible and preventing any potential complications that may arise from delayed treatment, including: increased morbidity and mortality, longer hospital stays, hospital readmissions, and overall increased healthcare costs.

References

Betancourt, G., Hames, E., & Rivas, K. (2015). Atypical Presentation of Common Conditions in Geriatric Patients. The Journal of Post-Acute and Long-Term Care Medicine. Retrieved from http://www.jamda.com/article/S1525-8610(15)00008-0/pdf

Flahert, E. & Zwicker, D. (2005). Nursing Standard of Practice Protocol: Atypical Presentation. Retrieved from https://consultgeri.org/geriatric-topics/atypical-presentation

Shankar, K., Magauran, B., & Kahn, J. (2016). Geriatric Emergencies: An Issue of Emergency Medicine Clinics of North America.  Retrieved from https://books.google.com/books?isbn=0323459625 . Nursing Standard of Practice Protocol Essay.