Table of Contents
Case Study- 1.
Case Study- 2.
Case Study- 3.
The implication in this scenario is about the diagnosis of 'acopia', which is a medical condition where the patient is suffering from acute illness with a variety of comorbidities. As mentioned in the case study that Edith is 86-year older women diagnosed with acopia, which decrease the ability of an individual to manages daily activities and increase frailty among them. Frailty refers to the state with improved vulnerability to stress which affects the functional abilities of the patient (Acopia, n.d.). The normal ageing process will ultimately lead to frailty, and when frailty comes to older stages then it is more likely to exist with geriatric syndromes. These syndromes include acute confusion, falls and reduced mobility among patients, which require immediate assessment. But here, in this case, Edith after completion of acute interventions will wait for more than 8 hours in the corridor because the wards are completed. However, it should be noted that this medical condition should be diagnosed and treated as early as possible. An efficient way to address this issue among older patients is to use a comprehensive geriatric assessment (CGA). This process covers the mental health assessment of the patient, medication review, functional ability, medical diagnosis, and review of social conditions. Nursing care for older patients is most important to improve the quality of life of patients. Nursing diagnosis and care plans for Edith refers to the analysis of the risk for falls or injury, infections, impaired skin integrity, aspiration, reduced fluid volume, impaired gas exchange, constipation, hypothermia, adult failure to thrive, and disturbance in sleeping patterns (Martin, 2019).
Ageing comes up with lots of physiological changes in the body of an individual, which could develop the risk of pressure injury as well. These physiological changes can occur in all the organ system with ageing, which includes a decrease in cardiac output, decreased vital capacity, less expiratory rates, impaired gas exchange, increase in blood pressure or blood glucose levels, and development of atherosclerosis. In this case scenario, normal changes of ageing would increase the risk of Edith developing a pressure injury because aged people have limited mobility, due to which they feel constant pressure on their body parts. Their blood flow to tissues also reduced with age which increases the risk of pressure injury, because blood flow acts as an essential factor to deliver oxygen and other valuable nutrients to the tissues. The risk factors associated with developing pressure injury are immobility, incontinence, poor nutrition and hydration, lack of sensory perceptions, and the medical conditions that affect blood flow among older adults. In the context of this scenario, the role of a registered nurse is to provide care to the patient and manage to reduce the risk of falls and confusion. This could be made possible by shifting weight of patient frequently by repositioning her in every one hour, maintain her upper body strength by the help of exercises, allow patient to use a wheelchair to relieve her pressure, adjust her bed elevation by her head only, select a special mattress that relives her pressure and ensure the well-positioning of her body (Jaul et al., 2018).
Chronic and painful venous ulcer on the lower leg of Amita can impact on her ability to maintain a safe environment. Leg ulcers are associated with several stress factors like chronic pain, social isolation, loss of self-esteem, loss of emotions which could eventually lead to anxiety. Patients of leg ulcers frequently face difficulties of change in daily routines, and they feel shame, embarrassed, and depressed due to their skin appearance. Furthermore, they fear people reactions regarding their body image which makes them withdraw from social life (Department of Health & Human Services, 2014). In this case, also, Amita is of 76 years who lives alone in her house, which could impact her physical and mental health as well. Social withdrawal due to leg ulcers and adverse drug reactions can affect her mind and body adversely. The impact of Amiƚa ability to maintain a safe environment can be improved by the use of walking aids, satisfaction with life, community services, fear-avoidance beliefs, and self-rated general health. Moreover, the factors that impacts this risk are - being female, Increasing age, family history of venous disease, occupational risk, and high body mass index (BMI) (Marsh, 2018). The role of the nurse in facilitating Amita to achieve a safe environment is that nurse should be aware of the risk factors, such as skin change, lower-limb oedema, varicose veins, and routinely access them to implement prevention strategies before developing the risk of ulceration. Patient withdrawal from the treatment can become a barrier to nursing care. Community RN should advise patients how to reduce the risks that can be modified, for an instance, by advising them to lose weight and do skincare or do simple exercises (Dogra & Sarangal, 2014).
The most important transformation of the 21st century is population ageing, which is also becoming a challenge for the modern world. Along with ageing, comorbidities are associated which makes old people prone to polypharmacy. Polypharmacy is a significant health issue, particularly in old people, which arise from the use of 5 or more drugs that cause adverse drug reactions (ADR). Along with the ageing of a person, chronic disease arises which would require more drugs consumption. This is the major reason for mortality and morbidity among these populations (Atkin, 2019). Moreover, physiological changes affect the pharmacodynamics and pharmacokinetics of drugs that account for the majority of emergency hospitalizations and treatments among older people. These physiological changes refer to the functions of specific organs that cause more vulnerability to adverse drug reactions, particularly among aged people. Due to this, many people use potentially inappropriate medications (PIM) to get relieved from chronic diseases (Platsidaki et al., 2017). For an instance, decrease in renal functioning will enhance the risk of ADR, so it is critically important that special attention should be taken before prescribing any drug to older patients, as the drugs will excrete through kidneys of patient. As an older adult, Amita is being more vulnerable to adverse drugs events as it is mentioned that she takes multiples medications for chronic illness and codeine-based medicines for pain. In this case, community nurse must report about ADR and collect the valuable resources for spontaneous reporting of ADR in hospitals. The nurse acts as a central management system in pharmacovigilance activities, specifically in ADR that would be away from the reach of other healthcare workers (Dogra & Sarangal, 2014).
Several physiological changes occur in an individual along with ageing, which can affect the working of their body systems and organs. Effect of ageing is the same on almost all organs, as in respiratory systems. This effect usually refers to the decline in maximum functioning among older people. Respiratory changes include the change in lungs, which can be due to decreased airflow and gas-exchange, weak respiratory muscles, decrease in lung functioning, and decrease in the effectiveness and efficiency of lung defence mechanisms. These changes would eventually lead to the reduced ability of the patient to do regular physical exercises (Dezube, 2019). Moreover, they also have an increased risk of pneumonia, if they will get exposed to any kind of bacterial or viral infections. In this case scenario, Oliver, and 80-year-old patient with painful cellulitis from hand to shoulder which is due to the scratch during gardening. He would require hospital admission to get the treatment, but he had a high risk of getting affected by pneumonia. This is because he has cellulitis which allows the bacteria to enter his body. Cellulitis is a serious life-threatening bacterial infection that may spread rapidly into the body if not treated with an antibiotic. There could be several anatomical and functional changes occur in an 80-year-old Oliver, such as reduced functioning of the central nervous system, reduced airway reflexes, decreased salivation, and cardiovascular reserve decreased serum protein, increased rate of body fat reduced hepatic and renal functioning, and decreased pulmonary reserve. Nurse understanding about changes to the respiratory system can impact the care plan of Oliver positively. The nurse should maintain suitable interventions while providing holistic care to Oliver (Respiratory and Pulmonary Nursing Care Plans, n.d.).
Part 1- Mobility of an older adult is beneficial by improving their living conditions by improving their physiological and psychosocial activities. They would be independent enough to do their self-care if they are allowed for mobility during hospitalization. A registered nurse should include five major areas of self-care and mobility in their intervention plans, such as exercise, incidental activity, appropriate supervision, retraining activities of daily life, and modifications in the environment. Incidental exercise is the physical activities that could be conducted based on the daily living of patients, such as walking to the washrooms, dressing, etc. Moreover, increased physical mobility can lead to improved physiological and psychosocial outcomes, such as an increase in self-esteem, social role, functional improvement, and positivity enhancement in the daily living of the patients (Department of Health & Human Services, 2015).
Part 2- In this case, nurses must use certain preventions before going to improve the mobility of the patient, because Oliver has increased risk of pneumonia due to the bacterial infection by cellulitis. These preventions include long term oxygen, medications, treatment efficacy monitoring, community programs, accurate diagnosis, multidisciplinary interventions, and recognition of early warning signs. Moreover, community nurse can help the patient in their mobility by the help of using walking-aids or encouraging and assisting them to walk and exercise for their well-being. The rationale of these interventions is to provide efficient and effective care and treatment to Oliver for his early recovery (Wayne, 2019).
Acopia. (n.d.). Physiopedia. Retrieved October 14, 2020, from https://www.physio-pedia.com/Acopia
Atkin, L. (2019). Venous leg ulcer prevention 1: identifying patients who are at risk. Nursing Times, 115 (6), 24-28.
Department of Health & Human Services. (2014). Leg ulcers. Retrieved October 13, 2020, from https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/leg-ulcers
Department of Health & Human Services. (2015). Improving mobility and self-care in older people in hospital. Retrieved October 14, 2020, from https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/falls-mobility/mobility/mobility-improving
Dezube, R. (2019). Effects of aging on the respiratory system - Lung and airway disorders. Health Topics. Retrieved October 14, 2020, from https://www.msdmanuals.com/home/lung-and-airway-disorders/biology-of-the-lungs-and-airways/effects-of-aging-on-the-respiratory-system
Dogra, S., & Sarangal, R. (2014). Summary of recommendations for leg ulcers. Indian Dermatology Online Journal,5(3), 400. doi:10.4103/2229-5178.137829
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 Geriatrics,18(1). doi:10.1186/s12877-018-0997-7
Marsh, D. (2018). Risk Factors for Adverse Drug Reactions. Drugs. Retrieved October 13, 2020, from https://www.msdmanuals.com/en-nz/home/drugs/adverse-drug-reactions/risk-factors-for-adverse-drug-reactions
Martin, P. (2019). 10 Nursing Care Plans for the Elderly (Geriatric Nursing). Retrieved October 14, 2020, from https://nurseslabs.com/geriatric-nursing-care-plans/
Platsidaki, E., Kouris, A., & Christodoulou, C. (2017). Psychosocial Aspects in Patients with Chronic Leg Ulcers. Wounds. Retrieved October 13, 2020, from https://www.woundsresearch.com/article/psychosocial-aspects-patients-chronic-leg-ulcers
Respiratory and Pulmonary Nursing Care Plans. (n.d.). Nurse Labs. Retrieved October 14, 2020, from https://nurseslabs.com/category/nursing-care-plans/pulmonary/
Wayne, G. (2019). Impaired Physical Mobility – Nursing Diagnosis & Care Plan. Retrieved October 14, 2020, from https://nurseslabs.com/impaired-physical-mobility/
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