Question

You are a RN working on an acute medical ward, looking after Oliver, an 80-year-old with painful cellulitis from hand to shoulder resulting from a small left hand scratch sustained while gardening. He is admitted for 7 days of QID IVABs via a right cubital fossa PIVC. Because of the cellulitis, PIVC and IVAB regime, Oliver’s mobility is limited.

5. Outline the normal changes of ageing on the respiratory system in predisposing Oliver to pneumonia during his hospital admission.

Here you could consider normal physiological changes that occur as part of ageing (Oliver is 80) to the respiratory system and other related systems. Consider functional and anatomical changes that will be evident in 80 year old Oliver. Nurse’s role - analyse how the nurses understanding of changes to the respiratory system impact care they provide for Oliver. (250 words)

6. What are the benefits of increasing the mobility of an older adult during hospitalisation? How should the RN encourage incidental exercise during Oliver’s admission?

This question has 2 parts.

Part 1 is straight forward. There is a lot of literature about the physiological and psychosocial benefits of increasing mobility of the hospitalised patient, but make sure you apply your discussion to Oliver.

Part 2 is also a straight forward question but again you must apply your nursing interventions and rationales to Oliver’s scenario. (250 words for Q 6 Part 1 and 2 combined)

Answer 1

1.

Cellulitis can range from mild to severe. Most cases are treated effectively with antibiotics. Prompt treatment is key. If severe, or when left untreated, cellulitis can spread to your lymph nodes, bloodstream and deeper tissues, rapidly becoming life-threatening and since Oliver is pretty old ,he has a decline in lung capacity: Alveoli can lose their shape and become baggy. The diaphragm can, over time, become weaker, decreasing the ability to inhale and exhale . So he can be more susceptible to pneumonia if not treated properly with antibiotics. To prevent this from happening the nurse could do the following interventions.

• Assess the rate, rhythm, and depth of respiration, chest movement, and use of accessory muscles.
• Assess cough effectiveness and productivity
• Auscultate lung fields, noting areas of decreased or absent airflow and adventitious breath sounds: crackles, wheezes
• Observe the sputum color, viscosity, and odor. Report changes.
• Assess the patient’s hydration status.

2.The lack of mobility in acute care rehabilitation hospitals results in patients losing strength and the ability to function independently. Wwe have to increase staff participation in order to combat patient’s loss or reduction of functional mobility. Research shows the recognition of regular physical exercise as a contributing factor to healthy aging. A loss of mobility causes a significant decline in overall health of older individuals. Staff participation proved that this quality outcome is a goal for all patients. Therefore, the plan of action is to disseminate this information by staff meetings, publication, and poster presentations.

The positive effects of physical activity on physical and mental health are well known and include weight control, improved balance, flexibility, strength, anxiety reduction and protection from ill health, as well as contributing to independent living and preventing falls. Being mobile and able to self-care and fear of falling are important to patients. A central goal of nursing care following fragility fracture is to maximise mobility. Individual patient goals are determined by their pre-fracture mobility and functional status. Recovery is often compromised for those with limited pre-fracture activity and cognitive impairment, low functional levels postoperatively, older age, polypharmacy, comorbidities, depression, poor nutritional status, lack of social support and not living independently. Many patients never recover their previous level of function after a fragility fracture and there is significant risk of institutionalisation, new fractures, disability and loss of independence.

When it comes to Oliver's case, because of his weak lung capapcity, incorporating walking can increase the lung capacity cause any physical activity makes one to inhale more air in each breath. This could help a lot. When it comes to Psychological benefits, it can help him feel less lonely and depressed being locked up in his room.

The NP plays a key role in reversing deconditioning and improving the physical activity and function of older adults like Oliver. Physical activity is essential for all older adults. All physical activity, no matter how small, can help to maintain or improve function and quality of life. Older adults should start at a level of physical activity that is appropriate for their current level of fitness and gradually increase their duration and intensity. There are significant benefits for older adults even at physical activity levels well below the recommended guidelines. Physical activity must be personally meaningful, fun, and something older adults can successfully do and incorporate into their everyday life.

Effective interventions for enhancing mobility in older adults include walking, aerobic exercise, and resistance training focusing on strength, balance, and flexibility. Group-based interventions show significant beneficial effects in increasing mobility.