ASSESSMENT 2 A BRIEF:
Subject Code and Title: POA304 Positive Ageing.
Assessment : Response to a Case study presentation: a) Case Study and Care Plan
Individual/Group: Individual
Length: 2000 words (+/- 10%)
Weighting : 40%
Learning Outcomes: The Subject Learning Outcomes demonstrated by successful completion of the task below include:
a) Examine evidence related to concepts of health, and positive ageing within a lifespan perspective and diverse population.
c) Apply concepts of ageing to core professional tasks, such as clinical and needs assessment, ethical decision-making or practice.
d) Interpret and apply policy, legislation, and different approaches to ageing.
f) Evaluate Consumer Directed Care approaches and develop applications for positive ageing in place.
h) Apply a variety of risk assessment tools as outlined in the National Safety and Quality Health Services (NSQHS) Standards into care planning.
POA304 Positive Ageing Assignment -Torrens University Australia.
Task Summary:
In this assessment task, you will be required to
1.read the case study detailing an older person with complex comorbidities,
2. identify and discuss the individual’s clinical problems that need to be addressed and
3. develop a plan of care identifying evidence-based practice strategies to care for this individual who is being discharged from an acute care setting into a their own residence in the community.
The word limit for this task is 2000 words (+/- 10%). This includes the case study and the care plan. This is an individual task.
Please refer to the Task Instructions for details on how to complete this task.
Context :
Although many older people age well and remain active participants in communities, older people accessing health services usually do so because of acute illness or changes in long-term chronic disease states. These are the individuals you are most likely to see accessing health services.
As people age there is an increased risk of the development of multiple comorbidities, geriatric syndrome, and dementia that significantly affect their quality of life. The registered nurse requires an understanding of the sometimes-complex health needs of older people and how to develop a holistic, person-centred care plan. The registered nurse must also be able to implement strategies and identify resources that can support the older person to return to and remain in their own place of residence, under a Consumer Directed Care model of service delivery.
Task Instructions :
To complete this assessment task, you must…
1. Read the case study below.
2.Refer to the Comprehensive Health Assessment of the older person in the health care system: Assessment template (Victorian Department of Health, 2014) as the guide for the assessment information collected.
3.Using your critical thinking and clinical diagnostic skills, examine the information obtained from the patient and determine whether any other assessments may need to be conducted.Using the assessment data available, determine the goals and nursing diagnoses for this individual.
4.In your discussion, provide some background and justification to explain: why you have identified that symptom, the relevance of that symptom to older people, and the frequency in the older population.
5.This person is to be discharged home within the next 24 – 48 hours. Develop a plan of care that is person-centred and considers both the current acute needs and needs for discharge planning.
Suggested structure :
Introduction:
1. Introduce Eva and provide a brief background to her case.
2.Provide background information on ageing, multiple comorbidities in an Australian context and their impact on quality of life for older people.
3. Discuss function of comprehensive assessment and the importance of person-centred care in older people.
4. Define any terms used in the body of assessment
5.Provide the reader with an overview of the body of the assessment.
Body assessment:
A.What other assessments may need to be conducted based on your evaluation of the current available data about the patient?
B. What nursing diagnoses are evident based on your evaluation of the data provided?
C.What can be done to assist Eva physically, psychosocial, emotionally and spiritually, both now and on her return home (what are the goals of care)?
D. Are there any risks to Eva if these problems are not addressed?
E. What nursing interventions and other strategies could be implemented to help Eva to stay in her own home under a Consumer Directed Care Model?
Nursing Care Plan:
1.Develop a nursing care plan to address the problems you have identified from the data, using evidence-based best practice strategies.
Conclusion:
Provide an overview of your case study discussion that draws together your findings, analysis and conclusions of this case study.
POA304 Positive Ageing Assessment-Torrens University Australia.
Case Study:
Eva Myers is 81 years old (DOB 22/05/1938) widow of Italian descent, with multiple chronic diseases, hypertension, osteoarthritis, Diabetes Type II, urinary incontinence, vision impairment (wears glasses for reading) and cataracts, mild hearing impairment (wears hearing aids) and mild cognitive impairment. She was admitted to the hospital after having a fall at home that left her with significant bruising to her face and arms and a laceration to her head, which required 15 stitches, but there were no fractures. On admission to the hospital (five days ago), it was discovered that she had a severe urinary tract infection which was treated with IV and oral antibiotics and has now resolved. She lives in her own home. According to her medical history, she is independent with her ADLs and can shop and cook for herself and volunteers two – three times a week for two – three hours in a local charity shop and is active in the Italian community. She has one son who lives overseas with his wife and three children.
POA304 Positive Ageing Assignment -Torrens University Australia.
Assessment information:
Contact details have been supplied. Not ATSI. Speaks English well and Italian very well. Her son’s name is Mario Meyers; contact details are available. Eva does not have an advance care plan but is aware of what their purpose is. Son has been nominated as financial power of attorney.
Eva understands about the presence of the UTI and that the severe infection was the potential cause of her fall.
Allergies – Penicillin – rash, morphine – nausea and vomiting.
POA304 Positive Ageing Assessment-Torrens University Australia.
Current medications –
Ramipril 2.5mg per oral Daily.
Panadol Osteo – 665mg x 2 per oral TDS. Though she says sometimes when the pain is bad in her legs after her outings, she takes a couple of extra tablets.
Glibenclamide 5mg per oral daily
Norfloxacin 1 tablet BD
OTC medications – occasional Mylanta for reflux (when had too much wine)
Multivitamin supplement one a day and Fish oil tablet three times a week.
Nurofen 2 tablets PRN for pain flair ups (maybe takes two times a week).
Movicol 1 sachet PRN
POA304 Positive Ageing Assignment -Torrens University Australia.
Observations:
HR 82bpm at rest, regular, normal
BP 150/87mmHg, lying
RR 20 bpm normal and regular
SaO2 96% RA
T 370C
BSL 5.2 mmols
Drinks two glasses of red wine daily and one or two others once or twice a week whilst with friends.
Non-smoker.
Sleep 6 hours but up 2/3 times a night for the toilet. Sleeps on either side, with one pillow. Rests in the afternoon on the couch for approx. 1 hr.
POA304 Positive Ageing Assignment -Torrens University Australia.
- Immunisations up to date.
- Pain – 6/10 even with Panadol osteo, there all the time in hands, elbows, knees and hips. Nowhere else, no radiation. Aching pain. Little bit aching pain in her face since the fall 6/10.States she expects to be in pain as she was a chef and did a lot of standing and cooking. Pain is worse in hips on movement up to 9/10 but stops on rest. Heat pack helps knees and hips.Tablets help a bit.
- Eva is conscious and cooperative. But she states that she feels that her memory is getting worse. Was diagnosed with mild cognitive impairment by GP 1 year ago. She thinks her concentration is worse and forgets: to eat, where she has put things, that she was making a cup of tea or has taken her tablets (medications are not in dosette boxes). Making small mistakes at the charity store where she helps out, which is not like her. Normal otherwise – swallowing, speech, tendon reflexes. Taste fine. Smell normal.
- Can hear whispered voice test with hearing aid in. Unable to hear when aide out. Has regular review with audiologist. Other areas of assessment normal. Ears are clear and normal.
- States she is getting a little anxious about changes in her memory and now the fall, the incontinence is getting worse and being at home on her own. Her son lives far away and she has no other family here. But her neighbours and church friends are helpful to her, take her shopping and she sees them once or twice a week only. Though lately she has been declining to go out with her friends some of the time because of the incontinence, pain, and hearing problems in the noisy cafes.
- Wears glasses just for reading. Eyes tested regularly. Has cataracts developing in both eyes but they are not bad enough for surgery. PEARRLA. Eyes are normal (no discharge, swelling, redness) except for bruising from the fall around the left eye.
- Walks unaided. Can independently move in bed. But struggles to get up from lying down to sitting and then standing. Feels a bit unsteady on her feet. The pain in her knees and she states she sometimes experiences weakness in her legs which makes her feel unsteady. Can move from bed to chair but uses furniture, this has also been observed whilst she has been in the hospital. Can manage own personal hygiene and dressing but states she takes a long time up to an hour and has trouble with small buttons.
POA304 Positive Ageing Assessment-Torrens University Australia.
- CVS assessment – normal skin and mucous membranes colour, warm and well perfused, no oedema. Nails normal. Cap refill < 3 secs. No varicose veins. Pulses normal at all points. Normal sounds on heart auscultation and JVP.
- RESP – no abnormalities detected. Mucous membranes pink, skin temp normal, normal posture, no use of accessory muscles. Normal respiratory effort. Normal nails. Lungs clear no abnormal sounds. No cough.
- GIT – Dentures top and bottom, loose fitting. Mouth gums etc well moistened, no lesions, lips slightly dry. Abdomen normal size, shape, soft and colour. Bowel sounds normal and present.No pain on palpation. Weighs 76 kg and is 167 cms. Normal BMI, normal waist circumference. At home, she states she eats twice a day and has a poor appetite. Eva states it is hard getting enthusiastic about cooking for one. Often just has egg on toast for tea. Has lost a few kilos within the last few months due to not eating as much as she used to and her dentures are loose. Diabetic diet. Does not like tea or broccoli. Suffers from constipation regularly. Uses prunes and pear juice to help sometimes needs some Movicol. Drinks a litre of water a day plus two coffees and two glasses of red wine.
POA304 Positive Ageing Assessment-Torrens University Australia.
- Skin – slightly dry over whole body. Bruising on head and arms from fall, and suture line on head from head wound laceration, clean and dry. Been doing own nail care on her feet but struggling to reach toes now.
- Continence – U/A NAD. Incontinent – urge. Uses sanitary items. Can get herself to toilet. Struggles at night to get there on time. Hard to see. No faecal incontinence opens bowels every three days. Hard. Strains a bit.
- Musculoskeletal – normal posture when sitting. When observed walking around bed and ward noticed unsteady gait, grabs furniture to move around the bed. Slow to turn around and does so unsteadily. Romberg test negative. All muscle assessments normal except for legs where there is slight weakness. Crepitus and pain present in knees and hips. Swelling and pain in hands, fingers, and elbows. This recent fall is the only one in the last few months but Eva says she has had a couple of near misses. This recent fall was because she felt dizzy all of a sudden (not vertigo) but she is concerned it will happen again.
POA304 Positive Ageing Assessment-Torrens University Australia.
- Eva is Catholic and attends mass twice a week. Holds a Certificate related to cooking but hasn’t cooked in a restaurant kitchen for 10 years. Loves the days when she goes to help in the charity store as this gives her a reason to get up. Less motivated on the other days. Meets up with friends on a Wednesday for coffee but does nothing on the weekend apart from church. Sits at home. Reads books. Unable to do other tasks because of pain in her hands. Misses her family but has regular contact via Skype. No pets. Finds accessing activities difficult outside of church and the charity shop to which she can walk. Eva states she would like to be more active with her friends, the church, and the charity shop and become more physically active so she can do these things. She understands that she is not eating well particularly to manage her diabetes, but she does know what to do.
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