Question

You are a RN working in ED, looking after Edith, an 87-year-old with an admitting diagnosis of Acopia. All acute interventions have been completed for Edith, but the wards are full, so she will spend the next 8 hours (+) on an ED trolley in a corridor.

1. What is the impact of a diagnosis based on the labelling of a patient?

Answer this using online learning materials provided and other peer reviewed evidence. Acopia itself is more of a symptom of underlying changes than a diagnosis. 'Acopia' refers to decreased ability to cope/ manage activities of everyday life and is a symptom of increasing frailty. Edith is 87 years of age. Normal ageing process eventually leads to frailty. We studied frail aged in week 8 tutorial (review recording if you have forgotten) and in week 6 online material. Nurses role - Include an analysis of how this labelling impact the care Edith receives. (250 words)

2. How do normal changes of ageing increase the risk of Edith developing a pressure injury in this scenario?

Here you need to consider normal physiological changes that occur as part of ageing to body systems that increase the risk of developing pressure injury. We covered this in week 6 and week 10 online learning and in additional readings. You could easily relate at least 3 systems to this answer. Nurses role - Also analyse the role of the nurse to prevent pressure injury for Edith. Remember the scenario context. (250 words)

You are a RN working in community care, visiting Amita, a 76-year-old with a chronic and painful venous ulcer on her lower leg. She takes multiple medications for chronic illness, and a codeine-based medication for pain. Amita lives alone in her own home.

3. How would Amita’s chronic pain impact on her ability to maintain a safe environment?

Consider how chronic pain, particularly a leg ulcer may make it difficult for Amita to maintain a safe
environment. Key points - chronic pain, what is a ‘safe’ environment and the impact on Amita’s ability to maintain safe environment given this scenario. Falls is only one concern, but what impacts this risk? Nurses role – analyse the nurse’s role in facilitating Amita to achieve a safe environment and consider facilitators, barriers and what you can do as a nurse. (250 words)

Answer 1

Case 1

1.Diagnostic labels help define the problems their children face and allow for greater understanding.For example in this women's case , she is labelled as 'acopia' because she is unable to do the daily chores with ease like normal people. .It helps to understand the condition of the patient in a much better way. They also provide a convenient means for describing patients that includes the presentation of symptoms and may imply the expected course and prognosis.It can affect negatively too. Nearly all older adults labelled with ‘acopia’ or ‘inability to cope’ have another primary medical diagnosis on presentation to the acute hospital in addition to high levels of dementia/cognitive impairment, frailty and polypharmacy. Increased attention to teasing out the natural complexity underlying the acute presentation and clinical history of older patients and the avoidance of all-encompassing terms such as ‘acopia’ or ‘inability to cope’ is warranted, not least to avoid therapeutic nihilism and adverse outcomes for older adults. We should take advantage of increasing knowledge of cognitive impairment/dementia, frailty and polypharmacy and avoid such terminology to avoid diagnoses being missed and overlooked. In short, our older patients deserve better than such ageist and pejorative descriptors.

So i feel in dehumanizing to label older people with terms like these since it can cause more underlying psychological problems which we would not be aware of. Nobody likes to be called weak. Even it immensely helps to understand the diagnosis of the patient, we also need to keep the mental health of our patient as the top priority. Patients with acopia can be nurtured mentally with encouragement and hope to increase their life span.

Case 2

Edith being 87 years old is prone to pressure injuries easily. Pressure injuries are more likely to happen if people are frail or have to stay in bed or a chair. They also happen because of normal changes that can come with ageing, such as skin becoming more fragile and thinner. Other reasons include multiple health conditions. Loss of movement, Frailty of the skin and Failure to hyperaemia can be termed as the major causes of pressure injury.

As a nurse, I would encourage her to move as much as she can with the assistance of equipment. I would adjust her bed positions in order to redistribute pressure. I would maintain good hygiene of her skin and prevent it from exposure to friction by using delicate beddings. I would put her on a good nutritious diet with a lot of fluids and essential macro and micronutrients. As we know that moisture can make her situation worse, I would make sure her skin is always dry, but not too dry as it can also create problems.