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NRSG266 Principles of Managing Care Of Older Adults: Case Study Assessment Task 3 Answer

NRSG266 Assessment Task 3 Student Tips

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.
Case 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 Study 3

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.

The term acopia is considered as a pejorative term which is used in the healthcare system where the geriatric population is admitted with long-term conditions of frailty and physical or psychological impairment due to ageing. In the case study 1, Ms Edith being an 87-year-old woman, is admitted where she has been diagnosed with acopia after being intervened with the acute care in the Emergency Department. The impact of diagnosis based on labelling of a patient is considered advantageous since it initiates a clear and precise communication as intended for caring of the patient by the healthcare workers in a hospital setting is fulfilled (Ilgen et al. 2016).  The practitioner nurses can easily identify the patient and can engage in the appropriate diagnosis required by the patient at the right time. 

The nurses in the emergency department have to cater to a long list of patients where exclusive attention towards an aged patient labelled with acopia might create a social and personal stigma for the patient. It is expected as the Code of Ethics state that every patient must be respected and need to tale informed consent for treatment and therapy (Code of Ethics, 2018). However, the role of the nurses may be criticized when they fail to follow the ethical consideration while interacting with the patients diagnosed with acopia (Gonschor et al. 2020). The impact created on labelling an aged patient may deter the rapport that needs to be established by the practitioner nurse to provide the best care irrespective of the age, gender or other aspects considered as biases among the nurses.

Answer 2.

 The co-morbidities present in the patient Ms Edith are aggravated due to the ageing process. The direct factors which cause pressure injury in the aged patients emerge due to immobility factors of the patient, status of existing or new pressure ulcers, and lack of perfusion. The indirect causes may be reduced moisture level in the skin, diabetes, low sensory perception, poor nutrition, and low albumin in the patient. As discussed by Jaul et al. (2018), the risk assumed due to normal changes of ageing that might increase pressure injuries in Ms Edith may result in localized ischaemia, impaired lymphatic damage, chronic body pain, the prolonged period of hospitalization developing bedsores and other complication like an infection.

The practitioner nurses need to be careful while attending Edith as she is vulnerable to co-morbidities due to her ageing process and the recently developed age-related health complications. The nurses being assigned with duties and responsibilities of emergency wards must be adequately literate on their professional skills to prevent the pressure injuries. It is contradicted that most of the fresher nurses are assigned their duties in emergency wards where experienced are demanded. The new joiners have little knowledge of handling and caring for aged people (Usher et al. 2018). It is essential for the nurses to have adequate knowledge on the pressure points like pelvic area, knee, hip, shoulder and elbow where right pressure would prevent injury whereas the incorrect way of handling may aggravate the pressure injuries.

Answer 3.

The chronic pain experienced by the patient Amita at 76 years old requires three aspects including her medication and diet management, adaptability to changing behaviours of age, and to be mentally flexible to accept roles to deal with emotional changes to manage her condition for a longer period with the safe and healthy environment (Budge et al. 2020). The chronic pain is excruciating for the patient, and she has to resort to physical exercises to keep her weight gain in control with proper dietary measures and medications (Dong et al. 2018). The co-morbidities like low mood and depression, anxiety, diabetes, cardiovascular disease or gastrointestinal disease, may aggravate her condition in maintaining a safe and healthy environment around her.  

The barriers that can be distinguished by the practitioner nurses in pain management is primarily the adherence of the patient towards following a given dietary and exercise plan. The barriers that are related to nursing can be recognized as a lack of knowledge of the practitioners in pain management, lack of time and increased burden of workload on the nurses (Al-Mahrezi, 2017). The nursing profession also highlights the experience of professional nurses who have adequate knowledge, skills, and experience to deal with the patients and consulting them on pain management.  As narrated by Varndell et al. (2017), the nurses need to involve the systematic structure of plan for medicines and care, interact with the patient to get an update on her current health status, and follow up on the medications by with proper counselling of the patient will help in achieving the desired results.

Answer 4.

The case study of Ms Amita suggests that her age is vulnerable to adverse drug events where every dosage of drugs must be measured and prescribed by the healthcare practitioner. The body organ functions and pharmacodynamics must be studied before prescribing any drug to the patient. The changes registered due to ageing among the geriatric population are fewer adherences to the requirements of the body and mind. The impact caused due to ageing is less absorption of food in the body which may lead to malnutrition, anxiety, and depression due to adverse drug events, impact on the metabolism rate, and several other functional impacts. 

 The nursing profession demands more care and compassion for treating the geriatric population as they tend to age and become vulnerable to drug events. The Code of Conduct helps the nursing professionals in practising respect towards the patients.  The nurses need to understand the pain of the ageing population while providing care for them. The nurses need to be compassionate in their practice and be professional to address the healthcare issues of the patients (Code of Conduct, 2019). It is evident from their experience and practice that they need to implement proper training and skills to support the geriatric population in administering drugs so that the patients are not completely vulnerable to the wrong dosage. The nursing professionals need to educate their patients and keep a constant follow-up on their medications. 

Answer 5.

 The case study of Oliver, who is a geriatric patient, is suffering from respiratory issues after being admitted in the hospital. He is diagnosed with painful cellulitis with limited mobility. Ageing will be creating an impact on the lungs and the nervous system of the patient. The bones of the patient become weaker; a part of the brain, which helps in controlling the breathing system, may lose its functions. The immunity of the patient may also get affected due to restriction in mobility (Drenth et al. 2020). The oxygen level may get lower; abnormal breathing may be witnessed, there may be bedsores, shortness of breath, swelling in some body parts, infections and other problems like a reduced rate of metabolism may be witnessed.  

 The nurses attending Mr Oliver can resort to chest physiotherapy with adequate skills and caution owing to his age. The respiratory status of the patient has to be assessed by the nurse after every two hours to ensure that prompt intervention in an emergency. The position of the head of the patient must be kept up so that there is no congestion in the breathing passage. The room must be sufficiently airy and lit to prevent any bacteria or virus infect the patient (Newstead et al. 2017). The patient must be counselled by the nurses on his medication and appropriate support to be given to help him with restricted mobility. The patient must be informed on his treatment and need to be calmed down when he gets impatient or anxious with his physical condition.

Answer 6. 

 The mobility of the patient is restricted for seven days since he has been diagnosed with painful cellulitis. The nurses need to support the patient while making him mobile for exercises which would help him recover from the respiratory issues that he has started to face in the hospital post his admission. The nurses need to be patient and compassionate to make the patient understand the importance of being mobile to cure his ailment. The physiological benefit that the patient will have is his respiratory problem will be reduced. The immobility of the patient may aggravate the bed sores, which can also be controlled when the patient starts moving. Moreover, the psychological impact will be positive for the patient. 

 The nurses need to encourage the patient with constant exercises since his mobility will be restored. The organ functions will be recorded normally. This exercise will help to make the patient remain immune to diseases like fever or antibody-forming due to chest congestion. The nurses need to motivate the patient to exercise for his admission day itself with the support of the nurses so that their organs are not affected due to prolonged immobility (Weyand & Goronzy, 2016). The patient will not experience fatigue or restlessness due to immobility. He can be exhausted with the pain and treatment with the injection through IV, which may cause mental restlessness. The functions of the body part will be restored with constant exercises.  

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