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22/08/2022
Aim of assessment
The purpose for this case study essay is to enable students to produce a nurse-led case discussion of an older adult, using evidence-based information relevant to nurses and up-to-date Australian statistics, for improving the health and quality of life for elderly persons who have multiple comorbidities and care needs. Content should include discussion on the questions provided in the case study using a holistic approach.
Case study
Maria Russo is an 83-year-old lady with a rich Italian background. She migrated to Australia when she was 51 years and ever since has lived and worked in Australia, she is a widow who lives alone in her unit and has been independent with her activities of daily living. She has two daughters Gianna and Bianca who live nearby and are fully involved with the care of Maria. Mrs Russo presented to emergency department (ED) via ambulance following a fall in her garden. She had fractured her left NOF and has been to operation theatre (OT) for total hip replacement (THR). Mrs Russo is now day 7 post op.
Mrs Russo has a medical history of osteoarthritis and had a major stroke 5 years ago but managed to recover well after months of rehabilitation. She has moderate congestive cardiac failure, a mild cognitive impairment, NIDDM for ~ 20 yrs, with pain associated to neuropathy. She has had two recent transient Ischaemic attacks (TIAs) at home and managed to recover well after few days of staying in bed. Since she lost her husband, Mr Russo 7 years ago, she cycles through depression if she forgets to take her antidepressants. She wears glasses for her vision impairment related to glaucoma, cataracts, and diabetic retinopathies. She also wears bilateral hearing aids.
During her stay in acute care ward, the nurses documented in her progress notes that Mrs Russo is:
Underweight with a BMI of 14
On admission looks quite dishevelled and dehydrated indicating possible neglect and poor care
Very frail with multiple skin tears on her lower limbs and stage 1 pressure injury to her sacrum
Old scars to lower legs with possible history of healed venous/arterial ulcers
Might have been on the ground for over 8 hours before a neighbour found her
Denies pain, but noticed to be grimacing and wincing during transfers and repositioning
No recollection of memory of her having used her bowels 4 days before she presented in ED
Developed delirium post-surgery that resolved after treatment and hydration
After nine days in acute care ward and three weeks in rehabilitation ward, Mrs Russo was not able to return home and care for herself. After a long discussion with multi-disciplinary team (MDT), her daughters Bianca and Giana reluctantly agreed to transfer Mrs Russo to an aged care facility where she will receive 24hr care. Health education during discharged included: medication compliance, hydration and nutrition, bowel management, skin care, prevention of skin tears as well as future advise on palliative care and end of life care.
Questions
1.Outline the statistics (incidence and prevalence) of contemporary ageing in Australia and the impact of the ageing population to the health care system. In your discussion explain why nurses need to be culturally competent to care for older adults in Australia.
2.Upon discharge, Mrs Russo and her daughters were given vital information and health education regarding her health issues and wellness. Explain why health promotion is important in the care of older adults
3.Identify the conditions that lead to hearing impairment of Mrs Russo and discuss the associated challenges for her as an older adult.
4.Consider Mrs Russos chronic pain. What assessments will you undertake and what actions will be implemented to reduce/eliminate the pain.
5.The occurrence of dementia, delirium and depression are common in older adults as seen in the case study of Mrs Russo. Explain in detail why the nurse needs to be able to distinguish between the three conditions.
6.Mrs Russos progress notes highlighted some possibility of neglect and poor care at home. From your weekly readings and possible experiences, discuss the risk factors of the older adults that makes them more susceptible to elder abuse.
7.Considering the transfer of Mrs Russo to an aged care facility, describe what attributes the registered nurse will need to have in order for Mrs Russo to adapt to her new and final home.
8.Considering frailty of Mrs Russo, it is possible that she might enter her palliative/end of life care phase in the near future. Discuss the nurses role in end-of-life care .
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