Therapeutic Assessment Interview With Mr. Jose Machans
In this assessment, Mr. Jose Machans, whose initials are JM, is a white 76-year-old male Hispanic American. JM reveals that he has spent most of his life as a truck driver; he divorced at 58 years old and has two children. JM confesses that he lives alone, far away from his family, and earlier relocated to another state. The patient also says that he does not have any diploma or degree qualifications but possesses immense skills in driving from his years of experience. JM elaborates that he is currently unemployed and relies on social welfare funds and cash from his son Markos. However, he claims that his income is limited to cater to his needs adequately.
The patient discloses that one of the major positive times in his life was after his eldest son Markos whom he named after his father. Additionally, JM says that another positive time in his life was when he was nominated and certified as a Master Truck Driver after years as an accident-free driver while working for an IMTA member company. JM states that he has excelled in certain hardship situations; for instance, the patient claims that when he divorced his wife at the age of 58, it was difficult to meet his children and spend time with them. JM reveals that he managed the situation by communicating closely with the children and often visited them after his retirement. JM still identifies with one personal strength is his driving skills; the patient claims that he is still an excellent driver despite his age. Additionally, the patient claims that from his years of experience, he has traveled over different parts of the US, thereby gaining a real experience of America while creating strong bonds with geographically diverse people.
In the interview, JM was requested to identify healthy coping skills. The patient reported that healthy coping refers to skills that positively help individuals deal with adverse events. In contrast, unhealthy coping mechanisms negatively impact an individual’s health. The patient was further guided on some of the available healthy coping mechanisms like walking away from stressors, better time management, engaging in breathwork, developing a daily routine, body movement, exercise, and having quality sleep. The patient was made aware of non-healthy coping strategies like alcohol and drug abuse, oversleeping, impulsive buying, avoiding issues, over or under-eating, and isolating or overworking.
After the divorce, JM informs that the divorce affected his well-being significantly. He narrates that he kept his daily routine to avoid distracting thoughts from overwhelming him to deal with the situation. The patient additionally narrates that better time management strategies were also crucial when dealing with pressure to ensure no delay in delivering company supplies to target customers.
When requested to state at least three pieces of advice that he could give to his younger self, JM states that his first advice would be to have never sought divorce for his wife as he regrets separating from his family has brought loneliness in later years of his life. Additionally, the patient adds that being a lover of Hispanic foods, he would have advised himself to develop a savings account that would enable him to start a food restaurant business after retirement from driving. JM indicates that this business would be an essential source of revenue at this stage while keeping him preoccupied with negative thoughts of dreams not being achieved. JM also notes that another piece of advice he would give to his younger self is to avoid getting drunk too much to get over a certain issue. JM reports that these are some of the factors that accelerated his early job retirement and separation from his family.
Patient Response to the Geriatric Depression Scale Results
In this assessment, the patient was guided in taking the geriatric depression scale to measure the levels of depression of the client. The patient was also helped select the appropriate answer regarding his feelings for the past week. A score of 1 was awarded for each answer indicating depression. The patient complained that he does not feel satisfied with his quality of life; he also adds that he has dropped the majority of interests and activities. However, the patient does not feel his life empty while confessing that he often gets bored. JM indicates that he is not in good spirits most of the time. JM is constantly afraid that in a few years, he might be taken to an elderly care home which MJ states will “destroy” as he will not be able to have the freedom to “connect with the real world” as he currently does.
JM states that he does not feel happy most of the time while narrating that he often feels helpless by himself. The patient additionally notes that he does not prefer to stay at home but rather enjoys going out and doing new things. However, this has been challenging to undertake due to walking alone or even driving in busy traffic. JM reports that he has mild cognitive impairment and feels it is still worth being alive now. The patient does not entirely feel worthless in the state he is though he notes that he feels deprived of energy levels. JM states that his situation is hopeless and that another person is better off than him. The patient had a score of 10 on the geriatric depression scale, indicating an almost always indicative of depression.
Fulmer SPICES Assessment results
The Fulmer SPICES assessments help nurses obtain data crucial for preventing health alteration among older adult patients. The acronym refers to shared syndromes among older adults that need nursing intervention like sleep disorders, problems with feeding or eating, incontinence, evidence of falls, and skin breakdown. JM agreed to the prevalence of sleep disorders and difficulty eating or feeding. The patient agreed that incontinence was increasingly becoming a health challenge to him, while he experienced heightened confusion. The patient states he has had several bad falls and there are no cases of skin breakdown. The Fulmer SPICES assessment reveals that MJ suffers from the majority of the common elderly problems, thereby necessitating preventive and therapeutic interventions for the client.
Mini-Mental State Examination (MMSE) Results
The Mini-Mental State Examination (MMSE) provides a practical guide to grading the cognitive state of patients within a clinical study. When asked about the current year, date, season, day of the week, and month, the patient scored three marks. JM scored one score in naming unrelated objects and explained as he had numerous trials to comprehend the information. Additionally, the patient recorded a score of 1 when requested to count back from 100 by sevens or spell the word “world” backward. JM scored a 1 when requested to remember three things earlier mentioned in the assessment. When JM was requested to name two objects (pencil and wristwatch), he had 2 points score while he scored 1 in repeating the phrases “No ifs, and, or buts”.
The patient further scored only 2 points when subjected to a 3-stage command. JM scored one point when requested to read writing requiring him to close his eyes. Additionally, JM scored zero points when asked to write a sentence containing a noun and a verb while scoring zero when required to draw a certain image. The image of the patient completely lacked the ten angles while the two symbols failed to intersect. According to Dahbour et al. (2021), JM is at risk of severe cognitive impairment with increased odds of dementia. The reason is that the overall score for the patient out of the overall 30 points was 9.
Patient-Level of Integrity Versus Ego as Per Erik Erikson Psychoanalysis
According to Erik Erikson’s psychoanalysis, integrity versus despair happens at the eighth and final stage theory of psychosocial development. According to the theory, the stage begins at 65 years and progresses till death (Orenstein, 2021). During this phase, individuals evaluate their achievements and foster integrity if they see themselves as living successful life. JM scored three as desperation was common for the patient due to the prevalence of bitterness, regret, depression, hopelessness, and high rumination over mistakes. The patient showed a limited sense of success, acceptance, feeling whole, and failure to feel at peace.
Nursing diagnosis for JM
Diagnosis for the patient reveals that JM is suffering from depression and dementia. Some of the underlying subjective cues for depression include persistent sleep difficulties, poor appetite, and abuse of drugs and substances. The objective cues noted in the assessment that helps to diagnose depression also include the inability to meet personal needs or expectations, hopelessness, and fatigue. JM’s diagnosis of dementia is based on memory impairment, wandering, inability to engage in abstract thinking, disorientation, and language inability.
Plan Of Care for JM
To address dementia and depression complications associated with JM, the plan of care aims at realizing three goals; improving patient cognitive impairment, developing mental and physical functioning, and enhancing patient safety. In dealing with dementia, the nursing goal aims at enhancing cognitive impairment. Some nursing interventions to realize this goal include encouraging patients to use newspapers, calendars, television, and radio to enhance individual awareness of the environment and self (Vera, 2021). Another intervention to eradicate impaired memory includes adopting complementary therapies like meditation, exercise, and massage to alleviate stress.
Some of the nursing interventions to achieve the goal of realizing the developmental and physical functioning of the patient include initiating communication with the client, educating the patient about depression, and stressing the need for the patient to be compliant with medication. In improving patient self-care, the nursing interventions include encouraging bathing and self-care hygiene practices, managing constipation for the client to deal with eating disorders through encouraging fiber-rich foods, and evaluating the need for laxatives and enemas (Martin, 2019). Other interventions for improving self-care include encouraging relaxation sessions and avoiding physical or environmental factors that might act as stimulants in the evening.
Dahbour, S., Hashim, M., Alhyasat, A., Salameh, A., Qtaishat, A., Braik, R., & Alnimer, T. M. (2021). Mini-mental state examination (MMSE) scores in elderly Jordanian population. Cerebral Circulation – Cognition and Behavior, 2. Web.
Martin, P. (2019). 9 Major depression nursing care plans. Nurseslabs. Web.
Orenstein, G. A. (2021). Eriksons stages of psychosocial development. StatPearls. Web.
Vera, M. (2021). 15 Alzheimer’s disease and dementia nursing care plans. Nurseslabs. Web.