Principles of Nursing: Contexts of Ageing

Case study 1 (Part 1)

Acopia can be defined as the inability of older patients to cope up with everyday activities. Such patients may not be linked with any clinical conditions and therefore such admissions are often categorized as individuals. The term is not a part of diagnosis and the labeling may impact the quality of patient care. The normal aging process will consequently lead to frailty and impaired physical abilities, impacting their quality of life (Davis & Zajac,2015). Negative attitudes by nurses and lack of knowledge will reflect stereotypical behavior towards aging which otherwise are most likely to suffer from various medical illnesses like dementia, incontinence, and falls. Older persons labeled with acopia without any asymptomatic illness with no history of any medical illness are often considered inappropriate hospital admissions. In this case, a patient with acopia was not given preference and asked to stay outside the ward and kept in the corridor owing to a lack of sufficient beds (Oliver,2011). The labeling of the older patient should not be considered a factor for diagnosis Moreover, the patients with acopia should be treated using the comprehensive geriatric assessment to treat the general geriatric symptoms of falls and delirium. The tool will focus on mental health and help during the medical diagnosis of older patients which is essential before starting the treatment process (Oliver,2011). However, the term acopia is inoffensive and should not be used in the healthcare systems and such patients should be provided equal care for improving patient outcomes.

Case study 1 (Part 2)

Aging is a natural phenomenon and reflects all the changes including both physical and psychological that occur during life. Aging is associate with various changes like reduced cardiac output, impaired lung functioning, cardiovascular illness, and reduced muscle strength. There are various non-clinical symptoms associated with aging in which weak muscle strength and skin fragility give rise to various pressure injuries in the body. Pressure injuries are also called pressure ulcers developing as a result of prolonged compression of the skin against a hard surface at a particular point (Rosen et al.,2017). It majorly occurs when the bony part under the skin is triggered by a hard surface like a mattress or the bed. In this case, the patient was kept in the corridor on a trolley with a hard surface. Apart from immobility and incontinence, poor nutritional risk also has been considered as the rising cause for pressure injuries in older patients. Pressure injuries can increase the pain and other medical complications which consequently impair the quality of life. Moreover, increased pressure injuries can also increase the hospital stays and cost of treatment as well which increases additional health burden on older patients. The proficient nurses must be able to identify the ulcer to begin early effective treatment (Tadiparthi et al.,2016). Nurses can introduce various interventions for managing pain injuries including correct positioning of the patient to redistribute pressure and continuing it every day for balancing sheer force and pressure. Provide a soft mattress to the patient to minimize the stress of pressure on the skin. Use of pH balanced topical ointments to keep the skin hydrated without rubbing it vigorously (Rosen et al.,2017). These preventions can help to minimize the occupancy of pressure injuries among older patients.

Case study 2 (Part 1)

The patient suffering from venous ulcer forms a part of her chronic pain making her dependent on everyday activities. Leg ulcers are painful and debilitating which significantly impact patient life quality. The most effective way to treat symptomatic conditions like pain starts with a proper diagnosis which is further followed by medication. One of the major risk associated with chronic pain is fall and can lead to physical fractures, brain injuries, and even death (William,2019). Moreover, polypharmacy along with chronic is another common factor that contributes to falling incidences among older persons, resulting in loss of self-confidence and self-efficacy. The patients living alone are more vulnerable to falls owing to consistent chronic pain. Apart from physical factors, there are certain environmental factors like low light, furniture, and uneven floor surfaces that contribute to the falls incidences among older patients (Travalgia et al.,2014). The environmental factors along with increased fall incidences create a space for the unsafe environment, impairing their everyday activities including walking. Nurses should introduce effective interventions to create a safe environment for older persons like easy reach, safe walking. Physiotherapy to maximize leg muscle strength also, advice for the floor up-gradation, right placement of the furniture at home, and paying special home visits are best to care interventions leading towards a safe environment by supporting the mobility process (Travalgia et al.,2014). Effective communication will encourage a strong therapeutic relationship which will support to provide holistic care to the patient by knowing her treatment preferences and needs.

Case study 2 (Part 2)

Aging is a natural progression that leads to eventual deterioration of the body mechanism. Diabetes, indigestion, renal impairment, and pulmonary failure are common physical changes occurring in older patients. In some cases, all these conditions can be experienced by them at the same time. In this case, the patient with a venous ulcer who is having multiple medications including a codeine-based medication for managing her chronic pain. The continued use of multiple medications results in adverse drug reactions in older patients (Classen et al.,2015). Adverse drug reactions are unpleasant or harmful reactions resulting from the intentional use of medication and the ADR risk is commonly misunderstood with falls in older patients. ADR is commonly a preventable factor which if not identifies and corrected increases the treatment, laboratory cost, and health burden as well. The risk of ADR significantly increases with age-related pharmacodynamics and pharmacokinetics changes with the growing burden of polypharmacy. The older patients will have various issues related to drug absorption and distribution owing to impaired immune systems, and chronic illness (Kaushal et al.,2014). Aging is often associated with a chronic illness that is supported by multiple therapeutic regimes. Nurse are the frontline caregivers of the geriatric population who can plan a road map by introducing effective care interventions. The competent nurses must identify and evaluate adverse drug reactions, a result of polypharmacy which can be avoided by prior verifying the drug ( Buckley et al.,2014). Nurse practitioners should guide the patient regarding the dosing frequency, dosage time and frequent face to face meetings can help to create a strong therapeutic relationship

Case 3 (Part 1)

The collective effect of aging is responsible for diminishing the role of the organ systems giving rise to various anatomical and physiological changes. The respiratory system has many functions including gaseous exchange, maintain blood pressure, and blood pH. Apart from these roles, lungs play an important role in non-specific immune mechanisms. However, the major changes owing to aging are associated with respiratory systems and include a decrease in gas exchange, peak airflow, weakening of air muscles, and an overall decrease in the lung defense mechanism. Therefore, older persons are more prone to pneumonia owing to more susceptibility towards bacterial and viral infections (Meyer,2010). Exercise and other physiotherapies have significantly shown beneficial results to maintain lung functioning although, reduced mobility factors lead to contribute to lack of adoption of exercise in everyday life. In this case, a patient with reduced mobility and lack of everyday exercise has an increased risk for respiratory infections(pneumonia) owing to the reduced lung defense mechanism. The proficient nurse can determine the changes to normal respiratory functioning. Nurses can identify the illness through heart rate, blood pressure, and lung infection with sputum assessment. The nurses should be well acquainted with pharmacological understanding to track the impact of disease treatment including both pharmacological like intravenous drug therapy and other non-pharmacological interventions (Meyer,2010). The intravenous antibiotic given to teat cellulitis creates a space for bacterial entry which can lead to pneumonia, a bacterial infection that can otherwise be avoided by the early identification of the respiratory changes by regular monitoring. Nurses play an essential role to identify and the illness to avoid other major problems.

Case 3 (Part 2)

Rehabilitation plans are essential to improve the health conditions including both the physical and psychological of the patient. Patients with a chronic illness like respiratory illness and cellulitis create a health burden on the patient by impacting their mobility. Impaired mobility and lack of social contact will consequently move the patient towards isolation. (Cunliffe et al.,2011). Cellulitis turns the patient more susceptible to fall owing to restricted mobility. Increasing mobility is a major nurse intervention that will be able to act as a socio-ecological model to improve the health of in-hospitalized patients by providing holistic care (Alanko et al., 2019). Increasing mobility will help to improve the quality of life of the patient by increasing the muscle strength, flexibility, anxiety reduction. Pain management is an essential benefit of the exercise and helps to improve the mood and create a positive outlook in patients. Moreover, triggering everyday activities is an important point in older patients to initiate treatment and exercise focus to evaluate barriers in performing activities and general mobility. Increasing mobility intervention will help to reduce the fall incidence by 40% in older persons. (Cunliffe et al.,2011). In this case, the registered nurse will choose the incidental exercise which can act as a major intervention for a patient with chronic illness. Moreover, the patient is having a peripheral intravenous catheter for intravenous drug administration and therefore incidental exercise can prove beneficial by supporting their everyday activities like supporting during getting up from bed, going to the washroom, and eating. Incidental exercise will also help to recover the normal functioning of the lungs thereby helping the patient to recover from respiratory illnesses.

References for Effective Nursing Interventions for Older Persons

Alanko, T., Karhula, M., Kröger, T., Piirainen, A., & Nikander, R. (2019). Rehabilitees' perspective on goal setting in rehabilitation: A phenomenological approach. Disability & Rehabilitation, 41(19), 2280–2288.

Aminzadeh F, Daniel WBB. Older adults in the emergency

Buckley, M.S., Erstad, B.L., and Kopp, B.J. (2014). Direct observation approach for detecting medication errors and adverse drug events in an intensive care unit. Journal of Pediatric Critical Care Medication. 8(2),145–152. 

Classen, D.C., Pestotnik, S.L, and Evans, RS. (2015). Adverse drug events in hospitalized patients: Excess length of stay, extra costs, and attributable mortality. Journal of the American Medical Association, 277(4), 301–6.

Cunliffe, A.L., Gladman, J.R.F., Husbands,.SL., Miller, P., Dewey, M.E., & Harwood, R.H. (2011). Sooner and healthier: A randomized controlled trial and interview study of an early discharge rehabilitation service for older people. Age & Ageing, 33(3), 246–252.

Davis, I.D., & Zajac, J.D. (2015). Can’t cope with ‘acopia’. International Medical Journal, 35, 1–14.

department: a systematic review of patterns of use, adverse

Kaushal, R., Bates, D.W., and Landrigan, C. (2014).Medication errors and adverse drug events in patients. PubMed. 285,2114–20. 

Med 2002; 39: 238–47

Meyer, K.C. (2010). The role of immunity in susceptibility to respiratory infection in the aging lung. Journal ofRespiratory Physiology 128, 23–31.

Oliver D. (2011), .' Acopia' and 'social admission' are not diagnoses: Why older people deserve better. Journal of Research of Social Medicine, 10, 168–174.

outcomes, and effectiveness of interventions. Ann Emerg

Rosen, T., Reisig, C., LoFaso, VM, Bloemen, EM, Clark, S, and Lachs, M.S. (2017). Describing visible acute injuries: Development of a comprehensive taxonomy for research and practice. BMJ. 23(5):340-345.

Tadiparthi, S., Hartley, A., Alzweri, L., Mecci, M., and Siddiqui, H. (2016). Improving outcomes following reconstruction of pressure sores in spinal injury patients: A multidisciplinary approach. Journal of Plastic Reconstruction Aesthetic Surgery. 2016 69(7),994-1002.

Travalgia, J.F., Debono, D., Spigelman, A.D., &Braitwait, J.(2014).Clinical governance: A review of key concepts in the literature. Clinical Governance, An International Journal, 16(1).62-77.

Williams, H.(2019). Preventing falls in older Australians. Retrieved from https://healthtimes.com.au/hub/aged-care/2/practice/hw/preventing-falls-in-older-australians/4462/

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