Technology For People With Dementia Health And Social Care Essay

Around 570,000 people are enduring from dementedness in England and this figure is expected to lift drastically over following few decennaries. The people age 65 and above are more prone to dementia, and the opportunities of developing dementedness additions with older age. There are four different types of dementedness, Alzheimer ‘s disease, vascular dementedness, dementedness with Lewy organic structures and fronto-temporal dementedness. Fronto-temporal dementedness is the rarest type of dementedness while as Alzheimer ‘s disease is the most common type. Though dementia affects critical procedures like thought, understanding and memory, self attention is extremely recommended for such people. Apart from ego attention and support from the household, organisations like NHS provide specialised support to the patients ( NHS Choices, 2009 ) . Rolling – a term used to mention to walking behaviors that represent a hazard for an person ( Banty et al. , 2010 ) enduring with dementedness. Such people are difficult to take attention of. Apart from occupational healers, recent advanced in engineering have seen assistive engineering being developed for the people with dementedness. The assistive engineering has sparked a argument amongst the research workers. While some support it and see it as a measure frontward to healthcare of people affected from dementedness, many see it as an violation to the patients ‘ liberty. How successful this assistive engineering proves to be, nevertheless, remains to be seen. â€Å" The usage of the term ‘technology ‘ in relation to dementia attention provokes conflicting reactions. For some, ‘technology is a Jesus, the manner to paradise? ? ? ; others are profoundly leery of engineering and size up its advocates carefully for any tell-tale Markss of the Beast? ? ‘ † ( Cash, 2003 ) . Dementia costs the UK over ?17 billion per twelvemonth. Apart from the consequence this unwellness has on the economic system, the affect on the lives of the people that have dementia and the people associated to the sick are reeling. It has a serious impact on communities. With increasing figure of aged people in the society, the figure of people enduring from the unwellness besides increases. The figure is estimated to be over a million by 2025. This can overpower the wellness and societal attention services, which are already unable to get by with the challenge posed by dementedness ( Alzheimer ‘s Society, 2007a ) .Literature ReviewThe figure of older people aged 65 and over is lifting at an accelerated gait, it is the fastest turning section of the population worldwide and life anticipation is increasing every bit good as length of service over clip. Whilst people are populating longer, the sustained growing of the older population brings every bit considerable wellness, ec onomic and societal challenges ( Li et al, 2007 ; Kinsella and Wan, 2009 ) . Harmonizing to the World Health Organization – WHO, 2001 dementedness presents an unprecedented challenge to the society and is one of chief causes of disablement in ulterior life, impacting chiefly older people. At present, there are about 700,000 people with dementedness in the United Kingdom and this figure is predicted to lift by 154 per cent to over 1.7 million people by the twelvemonth 2051 ( Alzheimer ‘s Society, 2007a ; 2009 ) . The National Dementia Strategy for England – published in 2009 – set up 17 cardinal aims to better the quality of dementedness attention through intervention and direction of the disease. One of the aims highlights the demand for commissioners to see the proviso of options such as assistive engineering to assist people with dementedness to populate independently in their communities and to assist the direction of hazard every bit good as to detain the demand for intensive services including admittance to residential or nursing places ( Department of Health – Do, 2009 ) . In dementedness attention, assistive engineering can be described as a scope of devices and systems taking at back uping persons to keep their independency and authorising clients and carers to pull off more efficaciously their activities of day-to-day populating – ADL ( i.e. , functional mobility ) every bit good as their instrumental activities of day-to-day populating – IADL ( i.e. , community mobility and wellness direction and care ) every bit good as heightening wellbeing. ( American Occupational Therapy Association, 2002 ; Alzheimer ‘s Society, 2007b ) With the execution of specific intercessions including the proviso of assistive engineering, occupational healers may non merely lend to better wellbeing and independency of clients with dementedness, but besides to cut down dependance on their carers, and to protract independent life and detain the demand for intensive or inpatient services including admittance to residential or nursing places ( Graff et al, 2008 ; Chakraborty, 2009? ? ? ) . Dementia is a chronic and progressive organic encephalon upset taking to the diminution of cognitive working including memory loss, troubles with information processing, perceptual experience, spacial consciousness, every bit good as emotional and behavioral alterations ( WHO, 2001 ; Perrin et Al, 2008 ) . Rolling – a term used to mention to walking behaviors that represent a hazard for an single – is one of the most ambitious symptoms of dementedness. It is estimated that rolling occurs between 15 to 60 per centum of people with dementedness. While walking is a good activity, persons can go forth their places ( unnoticed ) and non be able to happen their manner back. Banty et Al ( 2010 ) highlights the hazards associated with rolling including hypothermia, desiccation and even mortality. It can convey hurt and anxiousness to both clients and their carers and it can take to the usage of physical restraint such as persons with dementedness being locked into their places, pharmacological traditional intercessions every bit good as an early admittance to residential attention places. ( Alzheimer ‘s Society, 2007b, Robinson et Al, 2007 ; Banty White et Al, 2010 ; Hope and Fairburn, 2004 ) Safer walking engineering – an alternate term used by Alzheimer Society in the United Kingdom – United kingdom which encompasses ‘electronic surveillance, labeling and tracking engineering and it will be used throughout this survey – might enable people with dementedness to keep their independency, to prosecute their occupational activities to increase liberty whilst understating hazard, accordingly lending to their wellbeing. These engineerings comprise of dismay and surveillance system which alert carers when a user cross over a set boundary within their environment, and tracking devices which enable a user to be located at any clip and topographic point ( Alzheimer ‘s Society, 2007b ) . Despite several progresss in research, evidence-based surveies back uping the efficaciousness of this engineering for people with dementedness with rolling behavior remains limited and inconclusive. ( Cash, 2003 ; Adams and Clarke, 2001 ) The writer of this survey intends to reexamine four recent research findings related to safer walking engineering and people with dementedness life in the community. In visible radiation of demographic, social-economic tendencies, the UK authorities is making enterprises and policies with the purpose of protracting independent life for people with dementedness in the community ( DoH, 2009 more mentions ) . Non-statutory administrations such as Alzheimer ‘s ‘ Society support the usage of this engineering. Both sectors nevertheless, strongly highlights the demand for farther research and evidence-based on the clinical effectivity of the usage of this engineerings ( DoH, 2009 ; Shoval et Al, 2008 ) . While there are possible positive and digesting benefits from utilizing safer walking engineering for people with dementedness and their carers ; there are nevertheless, of import factors to be considered such as ethical considerations and the hazard involved in utilizing and supplying these engineerings. In drumhead, there are an increasing figure of surveies on safer walking engineering which highlight the common subjects presented on their findings including the benefits and hazards for users and carers on utilizing its devices and systems every bit good as the ethical issues involved in the usage and development of this advanced engineering. The surveies besides greatly emphasise the demand of farther researches with the engagement of users and their carers ( Robinson et al, 2007 ; BMJ, 2007? ? Where is the mention? / ; Shoval et Al, 2008 ; Landau et Al, 2009 ) .Literature Review HighlightsRobinson et Al. ( 2007 ) say that the recommendations by the current authorities in England suggest a national attack to put on the line direction. But, in a litigious society, the balance between hazard direction and the person-centred attack in dementedness attention is difficult to keep. While rolling behavior in people with dementedness can be helpful, it is chiefly harmful and generates emotional hurt in the carers. The struggle between bar of injury and easing the individual ‘s right to autonomy frequently puts the carers into a quandary. The related issue is highlighted through the usage of assistive engineerings such as electronic tracking devices. The patients feel that these engineerings place them at greater hazards, i.e. as a mark to larceny. The patients besides express concern over their independency. There is a demand to develop practical tools for pull offing hazard within dementedness attention which allow both hazard direction to be managed and all other position negotiated. BMJ ( 2007 ) assesses the cost effectivity of community based occupational therapy compared with usual attention in older patients with dementedness and the caretakers. â€Å" Community occupational therapy intercession for patients with dementedness and their attention givers is successful and cost effectual, particularly in footings of informal attention giving. † Dementia is one of the major causes of disablement in aged people. The disease is degenerative and causes memory and behavioral upsets. It besides consequences in loss of independent operation, concluding and opinion. This causes jobs to the ill and load to the household and the caretakers. Occupational therapy tends to convey about an betterment in the day-to-day operation of the people with dementedness. It may besides cut down health care costs because of improved independency in patients and an enhanced sense of competency in the attention takers. Shoval et Al ( 2008 ) stress on the most common behavioral manifestations of upsets related to dementia, i.e. jobs with out-of-home mobility. Attempts have been made in the yesteryear to accomplish a better apprehension sing the mobility behavior. But, all the observations are based on the institutionalised patients and health professionals. There is a demand to do a significant part to basic every bit good as applied and clinical facets in the country of cognitive damage and mobility research. Landau et Al ( 2009 ) examined the attitudes of the household and professional health professionals towards the usage of electronic tracking for patients with dementedness. The health professionals were caught between caring for the safety of the patients and patient ‘s liberty. Family health professionals favoured the electronic trailing devices like the Global Positioning System ( GPS ) and the Radio Frequency Identification ( RFID ) . Both household and professional health professionals believe that determination on tracking the patients with dementedness should be an intra-family issue. These electronic devices are really of import for rolling patients as these people may non be recollect their memory to happen their manner back place. For older people with dementedness, rolling can be a potentially life endangering behavior. Sing the demand for assistive engineering for the roving patients, it is necessary to happen an reply to the undermentioned inquiry: What is the position of the occupational healers on the proviso of safer walking engineering with dementedness? Hence an interview to research ‘occupational healers ‘ position on the proviso of safer walking engineering for people with dementedness with rolling behavior in the community ‘ is both appropriate and feasible. To reply the above inquiry, the proposed research aims are: to look into participants ‘ consciousness of safer walking engineering to understand the importance of technological aid in safe walking techniquesResearch MethodologyDescription and Justification of Research DesignThe purpose of this survey is to research the occupational healers ‘ position on the proviso of safe walking engineering for people with dementedness with rolling behavior. For the intent of a deep survey into the issues, a qualitative research method was used. Qualitative research seeks to explicate the universe instead than step it. Qualitative research is holistic and blatantly interpretive. This sort of a research design trades chiefly with words ( Iorio, 2004 ) . Qualitative research workers examine the texts and artifacts in their work while entering everything they find in authorship or otherwise. These records are so analysed and interpreted to analyze a research job and happen suited decisions. A constructivist grounded theory research design was applied to come up with a conclusive statement. Constructivism is a theoretical attack to societal scientific discipline. The theory is based on the premise that people create their ain societal universe and acknowledges multiple worlds. It recognises the common creative activity of cognition by the research worker and participant. Therefore, constructivist attack necessitates a relationship with participants in which they can state their narratives in their ain footings while listening with openness to feeling and experience is every bit of import ( Charmaz, 2000 ) . Grounded theory is an attack to data aggregation and analysis ab initio developed by Glaser and Strauss in the sixtiess. The purpose of the grounded theory research is to develop theory from the informations collected by the research worker ( Halloway 1997 ) . A constructivist attack to anchor theory requires following a place of mutualness between the research worker and participant in the research procedure which requires a rethinking of the grounded theoretician ‘s traditional function of nonsubjective perceiver ( Mills et al. , 2006 ) . Position is ‘a mental position of the comparative importance of things ‘ ( oxford lexicon, 1990 ) , a subjective construct which can non be quantifiable, hence a semi-structured interview will be the chosen method of informations aggregation. Halloway ( 1997 ) says that interviews are the favoured method of qualitative research. While roll uping all the necessary theoretical informations, interviews give the research worker a opportunity to obtain positions of the participants/interviewees by giving them a opportunity to show their ain ideas and feelings. Interview method allows an in-depth history of participants ‘ experiences ( Domholdt, 2005 ) and their positions analysed for elicited subjects and classs associated to the relevant research inquiry. A semi-structured interview method is deemed appropriate for this survey, as it can be seen as a flexible attack to let possibility to research beyond the replies and potentially to come in into natural two-ways conversation with the participant. For the selected method, a set of open-ended inquiries ( Appendix 2 ) purpose to let for participants to give their sentiments without being restricted as deemed when utilizing structured interview or questionnaire methods to informations aggregation. While interview is the suited method for this survey, in peculiar in a semi-structure format where participants can research in deepness their position on safer walking engineerings and their positions on the incorporation of electronic surveillance of the patients ; there are restrictions including clip ( questioning, transcribing and analyzing informations ) , limited geographical distribution due to costs and clip, low dependability and possible prejudice ( Domholdt, 2005 ) . The research procedure would be completed in eight hebdomads ( Appendix 1 ) . Literature reappraisal is an of import portion of this research and it would be of import to maintain update of the new developments over the class of this research. The experimental design would be finalized in hebdomad 2 and 3 and submitted for ethical blessing of the concerned governments. Week 3 and 4 will see the enlisting of the practicians for the interviews, and the interviews will be held in hebdomads 4 to 6. The informations obtained from the interviews will be analysed and a study prepared by the terminal of 8th hebdomad.Indication and Justification of Required Number of ParticipantsAs the research is comparatively little graduated table, merely 10 participants will be interviewed. They will be qualified occupational healers with changing grades of station measure uping experience, employed by the National Health Services – NHS within Community Mental Health Teams – CMHT who work wi th people with dementedness for at least two old ages.Administration of Access to and Recruitment of Possible ParticipantsThe choice of the participants will be conducted utilizing a purposive sampling. This type of trying involves witting choice of certain elements by the research worker ( Grove, 2005 ) . The research worker will enlist the contact inside informations of all older people-community mental wellness squads ( CMHT ) in the greater London country. After ethical blessing has been gained from all relevant organic structures, the research worker will seek contact with service directors of each squad to obtain permission to reach occupational healers as possible participants to this survey. Additional permissions and blessing of the CNHT would be required to carry on these interviews within their office installations.Inclusion Exclusion Criteria of ParticipantsThe inclusion standards require that participants are qualified occupational healers, working with people with dementedness for at least two old ages in an older people mental wellness community squads. The participants might work as occupational healers specific and as a care-coordinator. The clip restriction will guarantee that research worker will derive a richer in-depth history of their experiences and position of s upplying or sing the proviso of safer walking. Geographic distribution will be limited to participants working in a NHS trust within the greater London country parametric quantities. The exclusion standards require that participants to hold no managerial place. The current state of affairs requires a direct interaction with the professionals involved in the attention of the people with dementedness. The sample will be chiefly guided to interview operational healers presently working straight with the patients.Indication of Ethical Issues Relevant to the ProposalThe undertaking would be submitted to the moralss commission of the Brunel University for their blessing. After acquiring the blessing from the university, the proposal would be submitted to the research ethical commission ( REC ) of NHS for their blessing.Discussion of Ethical Considerations Related to Participation and ConsentAn informed consent would be required from the occupational healers prior to the enlisting for this undertaking. If necessary, permission would be taken from the organisations like NHS the practicians are involved with earlier enlisting. The practicians ‘ would be kept good in formed about the work and its results.Indication of Any Risks and Benefits to Participants and/or ResearcherIn relation to the two out of four most of import ethical rules prolonging ethical pattern in most countries of wellness attention beneficence ( making good ) and non-malfeasance ( non making injury ) ( Beauchamp and Childress, 2001 ) ; the research worker, by questioning, and deriving information on the position and sentiments of participants in relation to the proviso of safer walking engineering to service users, endeavoured to advance the well being of the participants and to guarantee that no injury was experienced by them. Although this is a little survey with comparatively low risked involved, measuring the possible benefits against the hazard to both participant and interviewer will be an on-going consideration during the research procedure. Harmonizing to College of Occupational Therapists ( 2003 ) , â€Å" Research must hold intended value for participants, research workers, the profession, the research community and/or society. † While there is no direct benefits to take part in this survey, participants will hold an chance to show their sentiment about the issue of safer walking engineering where research is thin within occupational therapy and lending to the addition of research capacity within the profession ( College of Occupational Therapists, 2010 ) .Consideration of issues of confidentiality and informations securityThe results of the interviews would be kept confidential. While in some interviews it is of import to uncover the inside informations, nevertheless, the participants can take to stay anon. in this instance ( Driscoll, and Brizee, 2010 ) .Comprehensive description of ProceduresOccupational healers willing to take part in the research will have full information prior to make up one's minding to take part. After having informed consent signifiers back, participants will be contacted by telephone to set up a suited clip for interview every bit good as for booking an interview/meeting room at their office premises. Interviews will last about 60 proceedingss, nevertheless, it will be agreed with participants that interview/meeting room must booked for 90 proceedingss. The participants would be given all the inside informations of the research methodological analysis. Furthermore, the research worker will explicate to participants the processs for the interview including confidentiality issues. Measures would be taken to do certain that this research does non harm the participants in any mode. If necessary, names or any designation will be removed from records. To avoid personal sentiments impacting the result of the interviews, researched would be accompanied by his or her coach.Description and justification of the proposed pilot survey that would be carried out prior to induction of the full surveyA pilot interview will be conducted with one the occupational healers within the chief sample of participants. This step can supply an chance for the researcher/interviewer to reflect on and measure on his/her interview, verbal and non-verbal communicating every bit good as the participant reaction to the interview. In add-on, a pilot interview will ena ble the researcher/interviewer to obtain participant feedback on the suitableness of the informations aggregation methods including lucidity of the inquiries every bit good as become accustomed to the use of the recording equipment and informations security processs ( Domholdt, 2005 ) . To understate prejudice, the researcher/interviewer will work under his/her coach supervising. The feedback informations will be evaluated and analysed by both researcher and coach. Whether minor or major alterations are required, the research worker will set the original set of inquiries or either to supply a new set of inquiry harmonizing to the findings. The pilot interview will be incorporated into the chief survey if no alteration is needed otherwise the stuff relevant to the pilot interview will be destroyed.Justification of chosen method of Data analysisData analysis was coincident to the informations aggregation. For the analysis of informations, the grounded theory attack of Strauss and Corbin ( 1990 ) was used. As informations collected through qualitative research is constantly unstructured and frequently text based, the qualitative research worker has to supply some construction and coherency to the big sum of informations while retaining a clasp of the original histories and observations from which it is derived ( Holloway, 1997 ) . To ease this, the model analysis designed by Richie and Spencer ( 1994 ) was used. This method portions common characteristics with thematic analysis. Framework analysis is designed to ease systematic analysis of the information. It is an inductive attack and uses the changeless comparative method which is a cardinal characteristic of grounded theory. This attack was chosen because it is systematic, easy to follow and consistent with a constructivist position. Five cardinal phases to the procedure are identified: familiarization, placing a thematic model, indexing, charting and function and reading ( Ritchie and Spencer, 1994 ) . It is possible either for all the informations to be collected before analysis occurs or every bit for informations aggregation and analysis to happen at the same time. The changeless comparative attack was used so that in line with the constructivist nature of the enquiry some of the findings from earlier interviews could be fed into subsequent interviews by a procedure known as the hermeneutic rhythm ( Rodwell, 1998 ) .Appraisal of Resources required, including a Timetable for the Proposed Research.Cost will include travel disbursals within Greater London country with the usage of an oyster card ; printing and letter paper stuff and postage ; purchase of a new sim card to be used on the research workers ‘ Mobile phone. Fundss to cover the above costs will be provided by the research worker. Digital recording equipment, rechargeable battery and a laptop computing machine with suited applications including package for uploading the collected stuff are properness of the research worker ; hence no cost will be incurred on the use of the above equipments. The research worker intends to carry on interviews in an interview/meeting room at participants ‘ CMHT offices. Therefore no costs will be incurred on leasing installations for the intent of this survey. Human resources include both researcher and tutor clip and handiness.DecisionDementia affects the mental ability of the people enduring from it adversely. It is responsible for impairment of the cognitive abilities like opinion and apprehension. In many instances, dementedness leads to a status called roving, where the patients go on lone walks and bury the manner back because of the medical status. The debut of electronic surveillance and community based attention are recent developments in the field of dementedness attention. Dementia is one of the most cost incurring diseases in the UK. The new facets of attention claim to admit the comparative issues of the disease and do it economically feasible. Although new schemes are being devised and implemented on a regular basis, dementedness continues to be a serious economic and wellness attention job. There have been claims of rolling being good to the wellness of people holding dementedness ; the grounds is non strong ( Robinson et al, 2007 ) . The electronic trailing devices are wild put to inquiry by the professional health professionals for attaching on the personal liberty of the people holding dementedness. This signifies a displacement towards a more person-centred attack to the direction of rolling. This displacement towards the individual centred attack may besides be reflected in the hereafter research surveies and the result steps selected to measure the effectivity of new schemes and intercessions. There is a demand to choose the result steps which are more meaningful to people with dementedness and their carers, such as quality of life, physical and emotional well being and serious inauspicious events alternatively of t rying to mensurate existent behavior ( Robinson, 2007 ) . This survey capitalizes on the positions of the occupational healers to spot a demand for individual centred attention in the hereafter. It has been established that there exists a demand to explicate a state of affairs specific tool for measuring all assortments of hazards. The survey has found that this aforesaid tool demands to non merely be a hazard estimating method but should besides function the demand for embracing a myriad of positions that will so be taken into history, evaluated and catalogued as mention stuff every bit good. Te survey highlights the function of helpful engineerings in authorising individuals get bying with assorted signifiers of dementedness and enabling them to populate a self-sufficing life. Adept sentiment dictates that while measuring the importance, utility and farther range of electronic devices aimed at helping people enduring from dementia the primary deciding factor should be the positions and sentiments of the people themselves, followed by find ings derived from scientific and academic researches.Appendix 1Figure 1. A Gantt chart explicating the timeline that would be followed during the class of the researchAppendix 2QuestionnaireHow serious is the issue of rolling in people with dementedness? How can this job be overcome? What is more of import – safety of the patient or patient ‘s liberty? Positions on assistive engineering. Does assistive engineering pose a serious menace to a patient ‘s liberty? How of import is patient ‘s consent for usage of assistive engineering? Keeping the drawbacks of the assistive engineering in head, how can this engineering be improved to do it more patient friendly? What is better – a patient centred healthcare installation or engineering based health care? Taking the pros and cons of rolling into history, is rolling good for people with dementedness? What is more of import – research on societal attention or research on engineering?

Case Study of Kathleen Johnson Samples

The report reviews the case study of Kathleen Johnson, a 45 year old woman with obesity and Type 2 diabetes. Due to the problem of overweight and challenges in managing appearance, she was admitted to the hospital for sleeve gastrectomy surgery. The report discusses about the etiology and pathophysiology of patient’s presenting condition (obesity) and then reviews her observation after 2 hours in post-anesthetic recovery room (PARU) to detect deterioration and the pathophysiology behind the deteriorating symptoms. Based on this justification, appropriate nursing management and role of interdisciplinary health care team to manage patient’s condition is provided. Since Kathleen has been admitted to the hospital for sleeve gastrectomy surgery, it is evident that obesity is main presenting condition in patient. Her BMI is 40kg/m 2 and due to weight gain and appearance issue, she had to undergo sleeve gastrectomy surgery. Obesity is a clinical condition leading to excessive deposition of fat or adipose tissue in the body of a person. Any person having a BMI of over 30 kg/m 2 is regarded as obese (Cummings & Cohen, 2016). The etiology of obesity involved multiple factors. For instance, metabolic factors, diet, genetic factor and physical activity level play a role in regulation of body weight. Although genetic factor also plays a role in risk of obesity, however behavioral, environmental, physiological and socio-cultural factors also increase energy balance and contribute to obesity. The most common behavioral and environmental risk factor obesity includes sedentary lifestyle, excess energy intake and poor physical activity (Saunders, Chaput & Tremblay, 2014). Social link to increase in weight includes impact of parent lifestyle and food habits on health behavior of children and youths Increase in weight is associated with other comorbidities such as insulin resistance, type 2 diabetes and cardiovascular disease (Bray 2014). Kathleen is a patient with type 2 diabetes and struggling to control her diet and blood sugar level. To prevent risk of other complication, weight loss surgery was important for her. From the etiology of obesity, it is understood that genetic as well behavioral factors increase the risk of excess fat deposit in patient. The adipocyte is the main cellular basis for obesity and increased in size or number of these cells contributes to obesity. Although in normal condition, fat is stored in the body for survival during starved state. However, when a person takes high energy food in large amount, it results in excessive storage of fat and the end result for which is obesity (Goossens & Blaak, 2015). Hence, the cause begin obesity is high calorie food and the cellular basis for obesity is the adipocyte. In case of Kathleen, her obesity was untreated before the surgery. Although she was gaining weight, she had not taken any preventive steps to control the condition. For this reason, opting for sleeve gastrectomy was a necessary option for her to manage her condition. Obesity mainly contributes to metabolic dysfunction and damages the function of cardiac, liver, endocri ne and intestinal gland if it left untreated (Saltiel & Olefsky, 2017). Hence, bariatric surgery is the best option for obesity management. Evidence has shown that bariatric surgery leads to weight loss and contributes to improvement in metabolic disorders like diabetes too (Reges et al., 2018). Sleeve gastrectomy is also one of the bariatric surgeries that promotes weight loss and improved gyclemic control in patient (Fuchs et al., 2017).   Therefore, by opting for surgical option, Kathleen can improve her symptoms related to diabetes too. Pathophysiology of patient’s post-operative deterioration Kathleen observation after two hours in the PARU revealed several deteriorating signs and symptoms. For instance, Kathleen respiratory rate was 28 breaths per minute whereas pulse rate was 130 beats per minute. By comparing these vitals signs with normal parameters, it can be said that respiratory rate of patient is abnormally high as normal respiratory rate is 12-20 breaths/min. His pulse rate is also an area of concern as it is above the normal value of 60-100 beats/min. Such abnormalities in Kathleen’s respiratory and pulse rate might have occurred due to the effect of obesity, smoking and alcohol consumption in patient. Obesity is highly associated with respiratory complication in obese patient. Obese patients tend to have higher respiratory rate because of the impact on lung function (Pepin et al, 2016). Abdominal obesity and lung dysnfunction affects systemic inflammation thus leading to respiratory disorder in patient (Oppenheimer et al., 2014). The review of Kathleenâ €™s history revealed that he was heavy smoker and consumed four bottles bear every night. Cigarette smoking is one factor that has an impact on pulse rate, breathing rate and oxygen consumption of an individual. This occurs because the chemical found in cigarette aggravates the cilia, leads to the deposition of tar and narrows the air passage. Such change in the lung is reason for abnormal respiratory rate in patient (Papathanasio et al., 2013). Hence, patient’s presenting condition exacerbated his vital signs post operation. The review of other vital signs in patient included blood pressure of 190/100 min. This clearly indicates that Kathleen was hypertensive. The likelihood of hypertension might have increased in patient due to the effect of surgery as well as due to obesity. Overweight and obese patients are more likely to suffer from hypertension. Such association between obesity and hypertension is seen due to the impact of obesity on metabolic functions. Other mechanisms linking obesity to hypertension includes endothelial and vascular impairment, neuro-endocrine imbalance, maladaptive immune response and dietary factors (DeMarco, Aroor & Sowers, 2014). This explanation confirms that obesity is the reason for deteriorating post-operative sign for Kathleen. Other factors that might have contributed to high blood pressure for patient includes smoking and diabetes. The link between diabetes and hypertension has been established because both have common pathways such as inflammation, oxidative stress an d insulin resistance. Low-grade inflammatory response and insulin resistant increased in type 2 diabetes patient thus contributing to hypertension (Lingam et al., 2018). As Kathleen had undergone sleeve gastrectomy surgery and effect of anesthesia and surgery might have also lead to hypertension in patient (Brethauer et al., 2015). Another sign of post operative deterioration found in Kathleen was low urine output and pain score in patient. Kathleen’s indwelling urinary catheter (IDC) volume was 5mls in the last hour, although the normal urine output per hour is 50-60 mL. Surgery is one of the reasons for low urine output. Surgical blood loss and dehydration in patient decreases urine output and lead to acute kidney injury on surgery patients. Poor renal perfusion and decreased urine output are common complication seen in the post anesthesia care unit (Canales & Hatch, 2014). Hence, the reason for such clinical deterioration in patient is clear. Another parameter that was affected for patient post operatively was her pain score. Kathleen’s pain score was 7/10 and the severity of the pain might also be the reason for presence of abnormal BP and respiratory rate. Blood pressure of Kathleen might have increased due to effect of pain. Pain promotes sympathetic activity thus leading to high blood press ure (Laquian et al., 2018).   Hence, while deciding treatment for patient, the effect of pain on other vital signs must be carefully examined. Based on analysis of post-operative deterioration in patient, the main care priorities for patient are management of abnormal vital signs of patient hypertension, pain score and respiratory rate and low urine output). Since Kathleen is obese and has diabetes, hence it is necessary to improve respiratory and vascular function as leaving these sign untreated may further complicate his condition (Mahajan, Lau & Sanders, 2015). The management of hypertension can be done by providing hypertensive medication to patient. After consultation with physician, the nurse can provide beta-blockers or angiotensive converting enzyme inhibitors to control his blood pressure (Wolf et al., 2016). To promote recovery in patient, the nurse also need to focus on dietary changes so that blood sugar level is maintained. Due to high pulse rate and respiratory rate, the patient may have ineffective breathing pattern. Hence, the care priority will be to assess respiratory rate and monitor ventilation status of Kathleen regularly. The rate and depth of respiration and need for oxygenation can also be examined. To provide comfort to patient, proper body alignment should be maintained too (Gordon, 2014). To address the issue of low urine output, there is a need to provide both fluid and drug therapy to prevent dehydration. During gastrectomy, some parts of her stomach were removed. Hence, it will be necessary to monitor wound healing and prevent signs of infection in patient. Apart from clinical intervention for management of vital signs, another care priority is to provide health education to patient so that Kathleen could be motivated to make changes in her lifestyle and eating habits. Since she is a smoker and consumer, making her quit both is necessary to maintain her health in the long term. Smoking has deleterious impact on obese patient and those with obesity (Lycett et al., 2015). Hence, the nurse needs to make Kathleen aware about the harmful effect of smoking on alcohol consumption on her metabolic and respiratory function. After this education, the patient can be supported to quit smoking by means of nicotine replacement therapy. Apart from nurses and medical team, the contribution of dietician is necessary to help Kathleen take low calorie foods and avoid food containing high amount of salt and sugar. Dietary intervention can reduce risk of diabetes related complication and prevent patient from gaining weight. Secondly, the involvement of physiotherapist is necessary as due to surgery, her mobility is affected. By collaborating with physiotherapist, Kathleen can learn to do exercise so that she can build her muscle strength. The role of a bariatric consultant is also necessary to educate Kathleen about her care needs and ways to manage her wound after discharged (Torti et al., 2017). The report discussed about the process of planning care for Kathleen by examining her medical history and discussing about the pathophysiology of obesity. The etiology and pathophysiology of obesity gives the insight that presence of various risk factors predisposed patient to obesity. The review of deterioration in vital signs and justifying them with the path physiology also helped to understand the mechanism by which Kathleen faced such clinical deterioration in patient. 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