Question

The following three (3) case studies are designed to demonstrate the integration of various principles of managing the care of older adults.

Each case study has two (2) questions attached.
Students are to answer all six (6) questions, remembering to include a critical analysis of the role of the nurse as

relevant to the question.

Answers are expected to be around 250 words for each, to a total of 1500 words.

All answers need to be written as academically structured paragraphs and supported by current, credible research with intext citations.

ase Study 1

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.

Case Study 1. The implication in this scenario is that a diagnosis of 'acopia' is a diagnosis based on functional abilities and is a form of labelling.

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)

Case Study 2

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)

4. Why is Amita, as an older adult, more vulnerable to adverse drug events?

We looked at this in week 7online learning. We also see normal physiological changes that occur as part of ageing to body systems and the impact of socio economic factors, polypharmacy. Consider the immune system, renal system and the digestive system (liver, stomach). Consider how the vulnerability may be related to the issues associated with changes in pharmacokinetics and pharmacodynamics of the older person’s body. Nurse role – analyse with respect to Amita being more vulnerable to adverse drug events. (250 words)

Case Study3

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. (part 1 and 2 500words)

Answer 1

Case study1:

1)Acopia is often used to describe a patient inability to cope with activities of dialy living.

Patient who were with acopia the following data are collected from patient case note ie, age, sex, pre admission, length of stay, admission and dischrge diagnosis, discharge destination.

Patient erroneously labelled with acopia or often have several comorbidities and usually have evidence of acute illness which should be actively sough. Fraility is a state of increased vulnerability to stressors such that even minor insult can cause problems with homeostasis or functional ability. Frail older people should be assessed by terms trained in comprehensive Geriatric Assessment (CGA). this is a multidusciplinary process that covers medical diagnosis, medications review mental helath assessment. CGA is a strong evidence base.

2)Keep the skin clean and dry.

Investigate and manage incontinence (Consider alternatives if incontinence is excessive for age)

Do not vigorously rub or massage the patients' skin.

Use a pH appropriate skin cleanser and dry thoroughly to protect the skin from excess moisture.Excellent skin care is an attribute of quality nursing care. The prevalence of skin breakdown and pressure injuries (PI’s) has become a standard by which hospitals are evaluated and assessed, with the development of PI’s recognised as a patient safety problem as they can increase morbidity and mortality. Most PI’s are preventable if appropriate measures are implemented

Improve their knowledge of the underlying physiology of PI formation.

Recognise factors which contribute to PI’s.

Identify high risk patients.

Implement and document intervention and prevention strategies.

Prevent complications as a consequent to PI’s.

Enhance pressure injury management.

Provide adequate parent and carer educationIn the prevention of PI’s, it is essential that patients at risk are identified and an individualised prevention plan is implemented. A risk factor is any element that either diminishes the skins tolerance to pressure or contributes to increased exposure of the skin to excess pressure.

Case study 2

3)The burden of chronic illness is increasing globally as a result of increased life expectancy, unhealthy lifestyles, and advances in medical interventions and treatments. Therefore, people living with chronic conditions, and their families, will have to assume greater responsibility in managing such conditions. However, to do so they require appropriate support from healthcare services. Nurses have a role in enabling patients to optimise their self-management skills, but organisational constraints in healthcare services, as well as constraints in nurse training and nursing roles, may mean that nurses are unable to fulfil this role.

Factors which will affect patient education include physiological, psychological, sociocultural and environmental. In Pain Management, the patient is enabled to understand pain mechanisms in order to reconceptualise their pain experience. Pain is "a multiple system output activitated by the brain based on perceived threat."

4)For many older adults, the ability to remain independent in one’s home depends on the ability to manage a complicated medication regimen. Nonadherence to medication regimens is a major cause of nursing home placement of frail older adults.The guidelines do not address the specific intervention of medication prescribing. However, the interventions are applicable to professional nurse providers whether they are prescribing or not. Older adults are more prone to adverse events due to the clinical complexity of their care rather than age-based discrimination. A study of older adult outpatients who took five or more medications found that 35 percent experienced adverse drug events. In addition, individuals with complex regimens had difficulty naming and explaining the purposes of medications and appeared to be at high risk for nonadherence. The greater the medication complexity, the less likely the older adult is to adhere to the medication regimen.The larger the number of medications, the more likely the older adult will be nonadherent. It is not only the number of medications but also the number of doses per day and actions related to taking medications that contribute to complexity of a medication regimen.

1. Assess the patient’s or caregiver’s ability to procure medications.
   1. Identify how and where the patient obtains and refills prescriptions.
   2. Assess how the patient pays for medications.
   3. Assess if medications doses are ever missed due to lack of funds.
2. If the patient or caregiver has difficulty obtaining or refilling prescriptions, assist the patient with creating a system to procure medications via
   1. Pharmacy delivery.
   2. Refill reminders or automatic refill service.
   3. Scheduling family or friends to pick up medications.
3. If funds to purchase medication are a problem
   1. Refer the patient to a social worker to obtain Medicare Part D coverage, other insurance coverage, or participation in drug company programs.
   2. Consult with the pharmacist regarding use of generic drugs.
   3. Consult the prescribing pysician about availability of drug sampl.

Case study4

5)

Cellulitis spreads rapidly all over the body, yet cannot spread from one person to another.

• Cellulitis is a common, potentially serious bacterial skin infection.
• It indicates a non-necrotizing inflammation of the skin and subcutaneous tissues derived from acute infection.
• Cellulitis may appear as a swollen, red area of skin that feels hot and tender.

Certain symptoms can indicate that the infection has spread from your skin to other parts of the body, such as the blood. These include vomiting, fever, rapid breathing and confusion or disorientation. If you experience thesesymptoms,, call for an ambulance.

6)a) increasing mobility is important tohospitalized patients, to respiration, prevent complications of being in  bed, and speed rehabilitation.

b) Leg elevation and can improve venous return and reduce venous pressure and this may help to improve the skin.