Stereotypes, Falls, and Pharmacological Challenges in Geriatric Nursing: A Case Study of Mr. Tran NUR4025

1. Initial Assessment of Mr. Tran in ED

Impact of Negative Stereotypes on the ED Nurses Initial Impression

There has been an increasing prevalence of stereotype associated with age. It is generally assumed that old aged people show signs of frailty, weakness, confusion and dependency (Barber et al., 2020). This can have a negative impact on the initial assessment and treatment for patients like Mr.Tran. He is a 75 year old man who is admitted to the emergency department after experiencing a fall. He appears disoriented, smells of urine and is constantly touching his right hip and pelvis area without complaining of pain. His MMSE score is 23/30 indicating a mild cognitive impairment and the presence of leukocytes and nitrites in his urine for urinary tract infection (UTI).
The nurses involved in handling the case of Mr.Tran might overlook his disorientation and his act of touching his hand over his right hip and pelvis area. This may not be critically evaluated by the nurses for any fracture or injury near the hip or the pelvis area as they may assume that old aged people are often confused about their medical condition. The mini-mental state examination score of the patient is found to be 23/30 which is perceived as a sign of mild cognitive impairment. As a result, the nurses might not refer to the patient for understanding his medical history, the medications previously prescribed to him and any known allergies. Even though the patient lives independently and has interest in politics, the nurses might develop a biased opinion towards him that he will not be able to explain his medical history in detail. This might lead to missing out on some critical points from the medical history which may have a negative impact on the treatment that will be prescribed to the patient.

Impact of Negative Stereotypes on the Nursing Care Plan of Mr. Tran

The nursing care plan designed for providing optimum quality of care to the patient can also have a negative impact due to the stereotypes in the nurses managing the medical condition of Mr. Tran. Firstly, the nurses may consider that Mr.Tran might be weak and frail due to him reporting to the hospital in a wheelchair. They may provide him with additional medical guidance and undermine his autonomy. However, in the case study, it has been mentioned that Mr.Tran lives independently and, is maintaining his own personal hygiene and up-keeping his household (Brothers et al., 2020). Secondly, the MMSE score of 23/30 points towards a mild impairment in the cognitive function. The nurses might assume that Mr.Tran is not mentally competent to understand his medical condition and take reliable decisions for improving his health. But, the case study mentions that Mr.Tran has been very interested in participating in online forums and politics which depicts that his mental stability is still retained and he can understand his medical situations to take appropriate decisions for his treatment under the guidance of his daughter and the doctor (Marques et al., 2020).

2.Pathophysiological Aspects of Ageing Related to Falls in Older People

A)Pathophysiolological Aspects Increasing the Risk of Fall

There are several factors which can increase the risk of fall for Mr. Tran, considering his advanced age and medical history. Old age is characterised by a progressive decrease in the muscle strength (sarcopenia) and ability to maintain balance (Oliveira et al., 2020). In addition to this, Mr. Tran is suffering from osteoarthritis which plays a significant factor in increasing the risk of falls for old aged patients like him. The muscle recovery of the old-aged people is also decreased which makes it difficult to recover from the injuries and fractures from the fall or the slip.

The MMSE score of Mr.Tran, as discussed earlier is found to be 23/30 which indicates mild cognitive impairment. This may impact his ability to carry out routinely activities such as walking, concentrating and maintaining balance which will ultimately increase his risk of falls (Cunningham et al., 2020). In the case study, it has also been mentioned that Mr. Tran uses glasses and bilateral hearing aids for obtaining assistance in the functioning of his vision and sensory skills. This may impair his ability to maintain balance or skip any obstacle while walking. In addition to this, the medical history of the patient reveals that he is suffering from Type-2 Diabetes which also affects the vision of the eye (Bellary et al., 2021). This may also increase his susceptibility for falls and associated injuries.

B)Evidence-Based Nursing Interventions

Nursing Intervention-1: To assess the potential environmental hazards, strength and mobility to reduce the risks that are associated with falls and come up with the plan to prevent the same. For this, the environment of the patient and the hospitals has to be changed in accordance to the needs of the patients. It should be ensured that there are less number of furniture or obstacles in the hospital ward and the house respectively. There is also the need to ensure that the rooms are availed with the right quantity of light. Besides this, it is recommended that Mr. Tran can use the walker or the cane while walked should used as a method of getting around.

Rationale: By making modifications to the patient's immediate surroundings in both the hospital and the home, less impediments will be in the way of their walk, hence lowering the danger of falls and the damage they may cause. Additionally, the patient can receive additional assistance when walking and lower their risk of falling greatly without compromising their mobility by using assistive devices like a walker or cane.

Nursing Intervention-2: To thoroughly examine the pain experienced by Mr.Tran near the right hip and the pelvis area. For this, diagnostic tests based on imaging such as X-ray can be recommended to the patient to clearly determine any fracture or bone injury near this area. As per the results obtained from the diagnostic tests, specific medications can be prescribed to the patient to provide symptomatic relief from the pain and then plan a specific treatment strategy for healing his injury.

Rationale: Considering the act of consistently touching the right hip and the pelvis area involves a detailed physical examination to ensure that patient is not suffering from any injury or fracture. This will also help in understanding the severity of the pain experienced by Mr.Tran and prescribe relevant medications for reducing it. The medical professionals will also be able to plan a personalised treatment strategy in accordance to his medical history and age related factors which will ultimately reduce the levels of the pain experienced by Mr. Tran.

3. Pharmacological Considerations for an Older Person

Anatomical Considerations

The ADME (Absorption, Distribution, Metabolism and Excretion) properties for an old-aged individual decreases in this phase. This is due to the progressive decline in the normal functioning of the liver and the kidney. As a result of this, any drug administered to the patient is not effectively metabolised and excreted from the body which increases the concentration of the drug in the bloodstream and leads to drug toxicity (Demeester et al., 2023). Considering the medical history of Mr.Tran with hypertension, type-2 diabetes and osteoarthritis, it is very important for the doctor to provide optimum dosage to reduce any potential risk of drug toxicity and side-effects.

Physiological Considerations

There are several critical physiological factors involved in processing the drugs that are changed in elderly people such as Mr.Tran. In old-aged people, an increase in the body fat percentage and decrease in the water content is observed (Uar et al., 2021). This shift can influence distribution and elimination of drugs inclusive of lipophilic as well as hydrophilic drugs. Furthermore, an aging person might also lose sensitivity in his or her senses, including vision and hearing which hampers their medication plan due to improper intake of medications (Alattar et al., 2019). This results in adverse drug event due to possible errors in dosing since they can fail to read the labels or hear the instructions given. Such physiological changes accentuate the importance of proper medications administration together with patient information for safe and efficient drug therapy.

Behavioral Considerations

The behavior problems that are common among the elderly people such as Mr. Tran affect how they use their medications. One big issue is polypharmacy, which refers to the use of multiple medications, simultaneously. This pose the risk of drug interaction and several side effects, as the processes require medical control to ensure proper dosage, timing and method of administration of the several drugs (Pazan & Wehling, 2021). In the same way, other conditions like mild cognitive impairment, which was evident in Mr. Tran, impact medication adherence. This drug-related issues stem from memory impairment, reduced executive abilities and attentiveness characteristic of elderly population. They include failure to observe the prescribed doses and times, misunderstanding of instructions or having a hard time with scheduling for multiple drugs (Burnier et al., 2020). These challenges require assistance and proper interventions like having the simple dosage of medications, call in/reminder of medications, and having caregivers in the lives of patients.

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