Question

1.) Name one psychological change and two physiological changes that can occur in older adults

2.) Describe the difference between Dementia and DeliriumOlder Adult Case Study:

Mrs. K is an 81-yr old female patient that has been admitted for a mechanical fall that resulted in a right hip fracture. Mrs. K had to undergo emergency hip repair surgery yesterday. She has a past medical history of Hypertension, Hypothyroidism and Anxiety. She takes Hydrochlorothiazide and Levothyroxine. Her past surgical history includes bilateral knee replacements 25 years ago. She is a retired book-keeper and a widow that lives alone. Her husband passed away 10 years ago. Mrs. K is usually very active with her social circle of friends and her church community. She plays cards weekly and attends religious services twice per week. She wears glasses, has cataracts bilaterally and walks with a 1-point cane. It is post-operative day #1 (day after surgery occurred) and RN Susie has been assigned to care for Mrs. K. Per the off-going RN from night shift Mrs. K has been experiencing a lot of post-surgical pain in her right hip (ranging from 5-8); and has been taking Oxycodone every 4-6 hours PRN for breakthrough pain. She is receiving continuous IV fluids to help hydrate her after surgery. Mrs. K also has an indwelling urinary catheter. RN Susie received report/nurse handoff from night shift nurse who lets her know Mrs. K has been restless all night, didn’t sleep much, and that they had to put on the bed alarm last night as well as checking on her every 30 minutes as Mrs. K kept trying to climb out of bed during the night.

Upon morning assessment RN Susie observes Mrs. K “picking at the air”, with her right hand, mumbling incoherently to herself as she is sitting up in bed with her breakfast table in front of her, and continually spooning “something” into her mouth with an empty spoon in her left hand (there is nothing on her tray table). She is not wearing her glasses either (RN Susie is not able to find her glasses in the room after looking for 10 minutes). RN Susie assesses Mrs. Ks’ level of consciousness and finds she is A/O x 1 (alert to self only) as she can tell only RN Susie her name when asked. As RN Susie proceeds further through the shift she becomes concerned that Mrs. K might be exhibiting symptoms of delirium and is unsure how to proceed.Case Study Questions:

1.) Identify pertinent assessment data gathered on Mrs. K that points toward a diagnosis of Delirium.

2.) Create two nursing diagnoses for this new secondary diagnosis of Delirium and ensure your diagnoses are directly related to your assessment information (1x Problem-Focused and 1x Risk For nursing diagnosis)

3.) Indicate 2 nursing interventions based on your 2 nursing diagnoses. Write 1x goal statement and 2x expected outcomes that are connected with your nursing interventions.

Answer 1

1. Name one psychological change and two physiological changes that can occur in older adults

Some Psychological change in older adults are

a. Impaired cognitive function

b. Loss of memory

c. Depression

d. Grief reaction

e. Loss of logical reasoning skills etc…

Some Physiological changes in older adults are

a. Arthritis

b. Osteoporosis

c. Heart diseases

d. Diabetes

e. Stroke etc…

2. Describe the difference between Dementia and Delirium

DEMENTIA	DELIRIUM
Dementia affects mainly memory	Delirium affects mainly attention
Dementia is typically caused by anatomic changes in the brain, has slower onset	Delirium is typically caused by acute illness or drug toxicity
is generally irreversible	is often reversible
Dementia typically begins slowly and is gradually	Delirium is usually a sudden change in a condition
the ability to express themselves gradually deteriorates	ability to speak coherently or appropriately will be impaired
A person's level of alertness is typically not affected	The ability to focus and maintain attention to something or someone is very poor

3. Identify pertinent assessment data gathered on Mrs. K that points toward a diagnosis of Delirium.

According to the data given in the question above Mrs. K is showing first signs of delirium they are

a. Sudden confusion

b. Incoherent speech

c. Fluctuating level of consciousness

d. She is can tell only her name

For further diagnosis the nurse can plan assessment using CAM (confusion assessment method) a gold standard 10-item tool which helps to identify delirium.

4. Create two nursing diagnoses for this new secondary diagnosis of Delirium and ensure your diagnoses are directly related to your assessment information (1x Problem-Focused and 1x Risk For nursing diagnosis)

Nursing diagnosis

a. Impaired thought process related to delusional thinking related to post surgery as represented by failure to recognise (Time, place and thing)

b. Impaired verbal communication as represented by mumbling of words related to loss of cognitive impairment

c. Risk for injury related to illusions and confusion due to post surgery blues

d. Risk for other directed violence due to less cognitive thinking related to suspicion.

5. Indicate 2 nursing interventions based on your 2 nursing diagnoses. Write 1x goal statement and 2x expected outcomes that are connected with your nursing interventions.

Nursing Diagnosis	Goal	Intervention	Expected outcome
Impaired thought process related to delusional thinking related to post surgery as represented by failure to recognise (Time, place and thing)	To improve thought process	1. Periodical assessment of the patient 2. Assess anxiety level 3. Provide an safe environment 4. Maintain low level of stimuli 5. Interrupt periods of unreality and reorient 6. correcting misinterpretations of reality 7. tranquilizing medications and soft restraints, as prescribed by physician 8. relaxation exercises	1. helps keep track of patient 2. to keep record 3. to calm the patient 4. to avoid anxiety 5. to improve thought process 6. to reorient 7. to treat 8. to bring down anxiety
Risk for injury related to illusions and confusion due to post surgery blues	To reduce the risk for self-inflicting injuries	1. For patients at risk for falls, provide signs or secure a wristband identification to remind healthcare providers to implement fall precaution behaviors	1. Signs are vital for patients at risk for falls
2. Transfer the patient to a room near the nurses’ station	2. Nearby location provides more constant observation and quick response
3. Move items used by the patient within easy reach	3. Items that are too far from the patient may cause hazard and can contribute to falls
4. Use side rails on beds,	4. to prevent fall
5. Familiarize the patient to the layout of the room.	5. to keep oriented
6. Collude with other health care team members	6. to keep track on progress of health
7. Provide high-risk patients with a hip pad	7. to protect