NRSG266 Nursing Interventions for Older Patients Assessment Sample

Principles of Nursing: Contexts of Ageing

Case Study 1 (Part 1)

With the growing age and increasing number of in-hospital older patients with acopia, may impact the behavior and quality of care by the registered nurses towards older patients. Acopia is an asymptomatic condition occulting as a result of aging in which a person fails to manage everyday activities. The normal aging process will consequently lead to frailty and impaired physical abilities, impacting their quality of life (Davis & Zajac,2015). Various negative attitudes and lack of basic knowledge will reflect stereotypical behavior towards aging. Older persons labeled with acopia and inability to cope as an asymptomatic illness with no history of any medical illness are often considered inappropriate hospital admissions. This patient may show any geriatric illness as part of aging like reduced mobility, fluctuating heart rate, and others. In this case, a patient with acopia was not given preference to stay inside the ward rather kept in the corridor owing to a lack of sufficient beds (Oliver,2011). The labeling will avoid the delivery of proper care by the registering nurses owing to existing negligence which they should not otherwise apply while in their clinical practice. However, the patients with acopia should be treated using the Comprehensive Geriatric Assessment to treat the general geriatric symptoms of falls and delirium. The tool focuses on mental health and 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 related to various physical and psychological changes in older patients and includes reduced cardiac output, impaired lung functioning, cardiovascular illness, reduced muscle strength, and others. The non-clinical symptom related to aging is immobility due to loss of muscle strength and skin fragility which give rise to various pressure injuries in older patients. Pressure injuries are or pressure ulcers develop due to prolonging compression of the skin 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 of the trolley room in the emergency department. Apart from immobility incontinence and poor nutritional risk gave also been considered as the rising cause for pressure injuries in older patients. Pressure injuries can increase the pain, medical complications, and consequently, impair the quality of life. Moreover, increased pressure injuries can also increase the hospital stays cost of treatment as well. The proficient nurses must be able to identify the ulcer to begin early with effective treatment (Tadiparthi et al.,2016). Nurses can introduce various interventions for managing pain injuries including correct positioned 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 creams 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, 76years old women is suffering from a venous ulcer that is responsible for her chronic leg pain. Leg ulcers are painful and debilitating which significantly impact patient life quality. The only way to treat the symptomatic conditions is proper diagnosis followed by medication for pain management. 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, excessive medication along with chronic illness is another common factor that contributes to falls 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 increasing falls (Travalgia et al.,2014). These factors create an unsafe environment for older persons, impairing their everyday activities including walking. Nurses should introduce effective interventions to create a safe environment for older persons like easy reach, safe walking. Important strategies adopted by the nurse practioner to reduce the fall incidences in older patients and include, physiotherapy to maximize leg muscle strength also, advice for the floor up-gradation and right placement of the furniture at home, and paying special home visits (Travalgia et al.,2014). All these strategies will help them to create a safe environment also, supporting her mobility as well. 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 process of growing old and consequently leads to a decline in the fitness mechanism of the older person. The common physical changes that occur in older patients include diabetes, renal impairment, indigestion, pulmonary failure, and all these conditions that can be experienced by them at the same time. In this case, a patient with a venous ulcer takes multiple medications and a codeine-based medication for managing her chronic pain. It has been observed that poly -medication is a common cause of adverse drug reaction(ADR) among the older population (Classen et al.,2015). Adverse drug reactions are an unpleasant or harmful reaction resulting from the intentional use of medication and the ADR risk is commonly associated with older patients with falls. It is a preventable factor which otherwise increases the treatment and 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, distribution owing to impaired immune systems, and chronic illness (Kaushal et al.,2014). Aging is considered to be associated with a chronic illness which is co-related with multiple therapeutic regimes. Nurse are the frontline caregivers of the geriatric population who can plan a road map by introducing effective care interventions. The proficient nurses should be able to judge the adverse reaction is the result of polypharmacy and should prior verify the drug before administration. A nurse practitioner can have a team-based discussion before prescribing the medication to avoid ADR. ( 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 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 collective effect of aging is responsible for diminishing the role of the respiratory systems giving rise to various anatomical and physiological changes. The major changes associated with respiratory systems include a decrease in gas exchange and peak airflow, weakening of air muscles, and a decrease in the lung defense mechanism. Therefore, older persons are more prone to pneumonia owing to bacterial and viral infections (Meyer,2010). Exercise and other physiotherapy have significantly shown beneficial results to maintain the lungs functioning, however, age related changes like impaired mobility contribute to the reduced ability to follow exercise. In this case, a patient with reduced mobility has an increased risk for pneumonia owing to reduced mobility and the use of pulmonary intravenous catheters. The proficient nurse can determine the changes to normal respiratory functioning through heart rate, blood pressure, and lung infection with sputum assessment. The nurses should be well educated to understand the impact of disease treatment including both pharmacological like intravenous drug therapy and other non-pharmacological interventions as well on the changes in lung functioning (Meyer,2010) The intravenous antibiotic given to teat cellulitis to the patient creates a space for bacterial entry as pneumonia is caused by a bacterial infection which can otherwise be avoided by the early identification of the respiratory changes owing to vitals. 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). Cellulites in the shoulder 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 Nursing Interventions for Older Patients

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.

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

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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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