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NRSG266 Principles of Nursing Contexts of Ageing

Question

Answered

Question:

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

Each case study has two questions

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.

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.

  1. 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.

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.

  1. 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.

  1. 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.

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.

  1. 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.

  1. 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.

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