NUR2402 -Healthy Ageing and Chronic Conditions Case Study

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

Dolores Rizzo is an 83-year-old lady with a rich Italian background. She migrated to Australia when she was 53 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 Genina and Dana who live nearby and are fully involved with the care of Dolores. Mrs. Rizzo presented to ED via ambulance following a fall in her home. She had fractured her Right NOF and has been to operation theatre (OT) for total hip replacement (THR). Mrs. Rizzo is now day 6 post op.

Mrs. Rizzo has a medical history of osteoarthritis and had a major stroke 6 years ago but managed to recover well after months of rehabilitation. She has moderate congestive heart failure, a mild cognitive impairment, NIDDM for ~ 15 yrs, with pain associated to neuropathy. She has had two recent transient Ischaemic attacks (TIA’s) at home and managed to recover well after few days of staying in bed. Since she lost her husband, Mr Rizzo 5 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. Rizzo is:

– Underweight with a BMI of 13

- 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 which resolved after treatment and hydration

After ten days in acute care ward and four weeks in rehabilitation ward, Mrs. Rizzo was not able to return home and care for herself. After a long discussion with Multi-disciplinary Team (MDT), her daughters Dana and Genina reluctantly agreed to transfer Mrs. Rizzo to an Aged Care Facility where she will receive 24hrs 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. Using information from your weekly readings and wider research, discuss the impact of the ageing population to the health care system in Australia. Discuss multicultural ageing in Australia, and in your discussion consider the case study of Mrs. Rozzi and explain why nurses need to be culturally competent to care for older adults in Australia (Approx. 200 words)

2. Upon discharge, Mrs Rizzo 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 (Approx. 150words)

3. Identify the conditions that lead to hearing impairment of Mrs. Rizzo and discuss the associated challenges for her as an older adult. (Approx. 150 words)

4. Consider Mrs Rizzo’s chronic pain. What assessments will you undertake and what actions will be implemented to reduce/eliminate the pain. (Approx. 150 words)

5. The occurrence of dementia, delirium and depression are common in older adults as seen in the case study of Mrs. Rizzo. Explain in detail why the nurse needs to be able to distinguish between the three conditions. (Approx. 200words)

6. Mrs. Rizzo’s 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. (Approx. 150words)

7. Considering frailty of Mrs. Rizzo, it is possible that she might enter her palliative/end of life care phase in the near future. Discuss the nurse’s role in end-of-life care. (Approx. 150words)

Important details about your assessment

· This essay requires a standard essay introduction and conclusion

· There is a word limit of 1400 words (+/- 10%) as per SNM Presentation and Assignment Guidelines).

· Marks will be allocated as per SNM Assessment Rubric.