Principles of Nursing: Contexts of Ageing - Case Study 1

  1. Labelling is a process of describing something or someone in short phrases. In healthcare settings, patients are generally labelled with a shorthand description of their problem (Sukhera, Miller, Milne, Scerbo & Lim et al., 2017). By acopia it is meant that the patient is unable to cope emotionally or mentally and due to which he/she is experiencing or facing difficulties which are physical. Impact of a diagnosis based on labelling of a patient could be that a clinician could form biases towards already made assessment and this may lead to improper diagnosis (Ilgen et al., 2016). Other than this, labelling a patient could hinder the process of forming a therapeutic relationship between the patient and the doctor. This will create a barrier for patient-centred care and thus, appropriate care would not be given to the diseased individual. With this, labelling also biases healthcare team members or staff against the assumptions of how a patient with the specific disease should appear clinically and how they react to therapy (Ilgen et al., 2016). Labelling can impact the care of Edith as it provides resistance with the satisfactory provision of care by the nurse. It can also be the reason of stereotypes among the nurses which can lead to negative consequences. Labelling could also cause stigma in Edith and thus nurses have to first eliminate the stigma and would have to take care of the patient in a manner that Edith does not feel that stigma again. Therefore, this would increase the workload on nurses and it will also prevent the process of giving proper care (Benbow & Jolley, 2012).
  2. Age is a very big factor in developing a pressure injury in individuals who might spend prolonged time in bed. In the case study also, Edith was an 87-year-old lady restricted to trolley in emergency department. Therefore, she could develop pressure injury easily because of the decrease in the skin integrity can get damaged and the subcutaneous tissues which later on results into development of pressure injuries for example pressure ulcers which further lead to localized ischaemia, impaired lymphatic drainage, and deformation of cell and reperfusion injury (Jaul et al., 2018). These injuries could result in excessive pain, infection and also depression in Edith. In addition to that, if they are not identified, assessed and treated at proper time then Edith might have to stay for a longer period in the hospital itself which increases the cost of treatment. Pressure injuries could also lead to increased mortality among older adults like Edith due to her age and condition. Therefore, this problem directs towards heavy burden on the healthcare team and especially on the nurses (Jaul et al., 2018). The nurse can prevent pressure injury for Edith by properly gaining knowledge, prevention and treatment measures. This could be done by employment of evidence-based practice. With that, the nurse could also make use of pressure mattress, ointments or change in posture which helps in relieving the pressure. Also, the nurse could train other members of the healthcare team so that on a busy day in the department and someone would be present to assess Edith and take appropriate measure. This would result in the prevention and proper management of pressure injury (Ebi et al., 2019).

Principles of Nursing: Contexts of Ageing - Case Study 2

  1. Amita’s chronic pain would impact on her ability to maintain a safe environment by increasing the emotional and physical burden on her. Chronic pain impacts the quality of life of the patient (Dueñas, Ojeda, Salazar, Mico & Failde, 2016). Because of pain, she could fall and thus it could lead to further complications. However, the associated risks are cognitive decline with the age and also impairment in the balance of Amita. Amita could also feel an increased amount of stress which could further lead to problems (van Hecke et al., 2013). Therefore, the nurse can help in this case so that Amita could achieve a safe environment. The nurse could implement lifestyle changes which would help in pain management and it would create a safe environment for the patient. The nurse could suggest some physical activities which would manage the pain and it could mention techniques which would help in coping with stress. The nurse could also observe how Amita respond to pain and thus could provide interventions based upon her observations (Dean & Söderlund, 2015). In addition to that, the nurse should conduct falls risk assessment of Amita so that the risks can be identified and proper care could be given to her. Additionally, the nurse could check for cognitive impairment in Amita. The nurse could also provide patient education and can motivate the patient to involve in healthy activities which would reduce the risk of any danger as the patient lives alone (Guo et al., 2019).
  2. Adverse drugs reactions are very much common in older people such as Amita. The drug reaction could increase in patients like her because of their older age. There are multiple age-related changes in people which also affect the pharmacokinetics of the drug such as its absorption, metabolism, distribution and excretion. Age impact pharmacodynamics of drug as well. With a relative rise in the proportion of total body fat, there is a decrease in lean muscle mass and water content in older people body. This alteration leads to changes in the distribution volume of multiple drugs such as opioids, benzodiazepines and antipsychotics, which causes a rise in the danger of adverse drug events or toxicity (Lavan & Gallagher, 2016). In addition to that, older people like Amita develop drug reactions also because the drug is not able to get out from the body easily via kidney and also liver is unable to metabolize multiple drugs which conclude the reason of excessive drug reaction in older people (Alomar et al., 2014). A nurse could analyze that Amita is more vulnerable towards adverse drug reaction or event by the help of detailed documentation and routine review of the prescribed medication. The nurse could also identify the effect of multiple drugs effect on different organs of Amita and she could also check the efficacy of the drugs. With that, the nurse could assess if there are any other much safer alternatives of the medications that are being provided to Amita (Lavan & Gallagher, 2016).

Principles of Nursing: Contexts of Ageing - Case Study 3

  1. The pulmonary disease could increase in the population who are increasing in age. Therefore, it is important to understand how the respiratory system changes with a person's age. As people age, their intervertebral disk space lessens which leads to chest cavity reduction in size. As for the ribs, the angle of muscle fibres can also influence the effectiveness and reduces the movement of the lower ribs at the time of inspiration. The function and strength of the muscle get decrease with age as well (Lowery et al., 2013). Evidence is present which states that elderly people's muscle has a low amount of mitochondrial adenosine triphosphate reserves at the cellular level to support a sudden rise in metabolic demand. Therefore, older people became more vulnerable toward the pulmonary diseases as their respiratory system and immune system wane which leads them to become more susceptible to infection. In the sense of reduced respiratory muscle strength, reduced cellular energy reserves and overall function of the muscles, if an old individual becomes ill due to pneumonia, it would require more oxygen for metabolic function, which the person cannot fulfil, and thus it would result in respiratory failure in them (Lowery et al., 2013). For the case of Oliver, the nurse can observe and look at the factors which can cause hospital-acquired infections to most of the patients and can help in mitigation of them by appropriate measure. With that, the nurse can also pay attention to the ventilation of the room, its decontamination and cleaning (Mehta et al., 2014).
  2. The benefits of early mobilization of an older adult during hospitalization are that the quality of life of the diseased individual like Oliver would increase
    (Wald et al., 2019). The muscles of the patient would regain their strengths and would not weaken. Therefore, the functional status would be reclaimed by the individual (Heldmann et al., 2019). If a person starts to move, then the catabolism inside the body would also limit due to the underlying problem. The nutritious status would also be enhanced. Also, inpatient like Oliver, they would be able to perform their daily life activities which are required for normal functioning of humans. It would also lead towards healthy ageing as when mobility is loss there is a decline in patient autonomy also. With that, hospitalization duration and cost will also be reduced and the patients feel more satisfied and in control of their situation (Heldmann et al., 2019). RN should encourage incidental exercise while Oliver is being admitted in the hospital by educating him about the benefits of these exercises in the long run. In addition to that, nurses could also discuss the disadvantages of not performing the exercises with the patient, for example, the patient could be made aware that he could lose muscle mass and thus his muscles would weaken with time if he does not get involved in incidental exercises. Therefore, this could lead to a positive effect on Oliver and his disease condition (McCullagh et al., 2020).

References for Predicting Risk of Adverse Drug Reactions

Alomar M. J. (2014). Factors affecting the development of adverse drug reactions (Review article). Saudi Pharmaceutical Journal: SPJ: The Official Publication of the Saudi Pharmaceutical Society22(2), 83–94. https://doi.org/10.1016/j.jsps.2013.02.003

Benbow, S. M., & Jolley, D. (2012). Dementia: Stigma and its effects. Neurodegenerative Disease Management2(2), 165-172. https://doi.org/10.2217/nmt.12.7

Dean, E., & Söderlund, A. (2015). What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?. BMC Musculoskeletal Disorders16, 87. https://doi.org/10.1186/s12891-015-0545-y

Dueñas, M., Ojeda, B., Salazar, A., Mico, J. A., & Failde, I. (2016). A review of chronic pain impact on patients, their social environment and the health care system. Journal of Pain Research, 9, 457. ttps://doi.org/0.2147/JPR.S105892

Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses' knowledge to pressure ulcer prevention in public hospitals in Wollega: A cross-sectional study design. BMC Nursing18, 20. https://doi.org/10.1186/s12912-019-0346-y

Guo, J., Fu, M., Qu, Z., Wang, X., & Zhang, X. (2019). Risk factors associated with pain among community adults in Northwest China. Journal of Pain Research12, 1957–1969. https://doi.org/10.2147/JPR.S193773

Heldmann, P., Werner, C., Belala, N., Bauer, J. M., & Hauer, K. (2019). Early inpatient rehabilitation for acutely hospitalized older patients: A systematic review of outcome measures. BMC Geriatrics19(1), 189. https://doi.org/10.1186/s12877-019-1201-4

Ilgen, J. S., Eva, K. W., & Regehr, G. (2016). What's in a Label? Is diagnosis the start or the end of clinical reasoning?. Journal of General Internal Medicine31(4), 435–437. https://doi.org/10.1007/s11606-016-3592-7

Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics18(1), 305. https://doi.org/10.1186/s12877-018-0997-7

Lavan, A. H., & Gallagher, P. (2016). Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety7(1), 11–22. https://doi.org/10.1177/2042098615615472

Lowery, E. M., Brubaker, A. L., Kuhlmann, E., & Kovacs, E. J. (2013). The aging lung. Clinical Interventions in Aging8, 1489–1496. https://doi.org/10.2147/CIA.S51152

McCullagh, R., O'Connell, E., O'Meara, S., Dahly, D., O'Reilly, E., O'Connor, K., Horgan, N. F., & Timmons, S. (2020). Augmented exercise in hospital improves physical performance and reduces negative post-hospitalization events: A randomized controlled trial. BMC Geriatrics20(1), 46. https://doi.org/10.1186/s12877-020-1436-0

Mehta, Y., Gupta, A., Todi, S., Myatra, S., Samaddar, D. P., Patil, V., Bhattacharya, P. K., & Ramasubban, S. (2014). Guidelines for prevention of hospital-acquired infections. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine18(3), 149–163. https://doi.org/10.4103/0972-5229.128705

Sukhera, J., Miller, K., Milne, A., Scerbo, C., Lim, R., Cooper, A., & Watling, C. (2017). Labelling of mental illness in a paediatric emergency department and its implications for stigma reduction education. Perspectives on medical education, 6(3), 165-172. https://doi.org/10.1007/s40037-017-0333-5

van Hecke, O., Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology - where do lifestyle factors fit in?. British Journal of Pain7(4), 209–217. https://doi.org/10.1177/2049463713493264

Wald, H. L., Ramaswamy, R., Perskin, M. H., Roberts, L., Bogaisky, M., Suen, W., ... & Quality and Performance Measurement Committee of the American Geriatrics Society. (2019). The case for mobility assessment in hospitalized older adults: American Geriatrics Society white paper executive summary. Journal of the American Geriatrics Society, 67(1), 11-16. https://doi.org/10.1111/jgs.15595.

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