HACC CASE Study rosa PDF

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Case study for Rosa and ageing population...

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Case Study

Unit code and Title:

NUR2402 Healthy Ageing and Chronic Conditions

Lecturer:

Sheridan Read

Student Name:

Alexandra Kenyon

Student Number:

10493814

Date of Submission:

26/04/21

Word Count:

2166

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Table of Contents Introduction..............................................................................................................................3 Multicultural ageing................................................................................................................3 Functional Consequences Theory...........................................................................................4 Vision impairment....................................................................................................................5 Chronic pain.............................................................................................................................6 Dementia care...........................................................................................................................7 Elder Abuse...............................................................................................................................8 Falls risk....................................................................................................................................8 Palliative care...........................................................................................................................9 Conclusion...............................................................................................................................10 References...............................................................................................................................11

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CASE STUDY Introduction Australia’s older demographic (aged 65 and older) consists of a multitude of ethnocultural groups, contributing to a vastly diverse and multiracial society (Wilson et al., 2020). Elderly Australians from culturally and linguistically diverse (CALD) backgrounds represent a great proportion of the population (Wilson et al., 2020). Nurses are essential to assessing and managing the care of older adults to maintain quality of life (QOL) (Wallace & Murphy, 2015). This case study analyses Rosa Rossi, an 83-year-old woman with a multitude of comorbidities, with limited independence to taking care of herself. It outlines her medical history of congestive cardiac failure (CCF), cognition impairment, NIDDM for 20 years with associated neuropathic pain, and depression. The role of the nurse is integral to improve Mrs. Rossi’s QOL as her progress notes outline her history of malnourishment, neglect, high falls risk with limited mobility, and possibly dementia. This case study is substantiated with current evidence-based literature from peer-reviewed medical databases.

Multicultural ageing Populations in Australia are rising numerically and structurally. Consequently, it is expected in Australia that from 2012 to 2032 that the demographic of elderly adults aged 65 and over will increase by 82% (Crisp, 2016). The Australian Bureau of Statistics (ABS) highlighted that 49% of the population in Australia were born overseas or a parent or both parents were born overseas (ABS, 2017). Older people are generally more susceptible to vulnerability and can experience barriers to receiving culturally appropriate care (Crisp, 2016). Nurses must provide person-centered care to people from CALD backgrounds to prevent patients from feeling isolated from their heritage (Crisp, 2016).

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As Mrs. Rossi has a rich Italian heritage and is accustomed to living independently, the nurses need to be culturally competent in her transfer to aged care. Nurses should establish a trusting relationship with Rosa and her daughters by gaining an understanding of her care plan. Nurses should communicate with Rosa and her family by gaining an understanding of her values and attitudes, language abilities, behaviours, and culturally specific needs (Crisp, 2016). This ensures Mrs. Rossi’s autonomy, physical, psychological, and psychosocial health needs (Crisp, 2016).

Functional Consequences Theory The Functional Consequences Theory (FCT) is an essential framework for nurses that uses a holistic assessment of the older adult to determine nursing interventions that should be implemented to promote positive functional consequences (Hunter & Miller, 2016). The FCT embodies principles including person-centred nursing care. This involves evaluating the patients’ aspirations and incorporates interventions to empower their body, mind, and spiritual wellness (Hunter & Miller, 2016). The FCT is useful to aid in health promotion by improving QOL for elderly adult by providing health education, creating a nurturing and safe environment, and lifestyle modifications that promote health and wellbeing for the older adult (Hunter & Miller, 2016).

Regarding Mrs. Rossi’s situation, the nurse can practice following the FCT to improve her wellbeing. As Rosa is from Italy and has suffered from memory loss, it’s important for the nurse to clearly communicate to eliminate any language barriers and avoid confusion (Hunter & Miller, 2016). The nurse should establish a safe and comfortable environment for Rosa in her new aged care home. The RN can do this by making her room homely and involving 4

Rosa in social activities with other residents (Hunter & Miller, 2016). The RN should also provide education to Rosa about her vision impairments including wearing glare-reducing glasses and sunglasses to prevent deterioration of her eyesight. The RN should help familiarise the grounds of the home for Rosa and make assess environmental conditions that could worsen her vision (Hunter & Miller, 2016). As Rosa is accustomed to living independently before her accident, the RN should coordinate a physio to address mobility limitations and determine risk factors that could worsen her physical and mental health (Hunter & Miller, 2016).

Vision impairment Glaucoma is distinguished by an increased intraocular pressure that is greater than 1220mHg (Craft, 2016) and is indicated by gradual death of retinal ganglion cells (Zhao & Chen, 2017). Diabetes mellitus (DM) has been found as a risk factor to developing glaucoma and Rosa’s history of diabetic retinopathies make her at greater risk of developing glaucoma (Zhao & Chen, 2017). Kiziltoprak et al. (2019) state that “cataracts are the leading cause of blindness worldwide”. Several studies have found that those who have DM, are at significant risk of cataract formation (Kiziltoprak et al., 2019). Another risk factor is patients over the age of 65 have an increased risk of developing the disease (Kiziltoprak et al., 2019). To people like Rosa who are frail and susceptible to injury and illness, Cataracts are detrimental to her health as they can lead to severe vision impairment which can jeopardise her health (Kiziltoprak et al., 2019).

Diabetic retinopathy is a form of retinal ischaemia occurring from inflammatory processes and genetic factors (Baumal & Duker, 2017). In cases such as Rosas, Type 2 diabetes causes hyperglycaemia, thus upregulating the mechanisms of certain factors that 5

generate apoptosis, inflammation, changes in vascularity, and angiogenesis (Baumal & Duker, 2017). As Rosa has had NIDDM for 20 years, she is susceptive to her disease to deteriorate, which can lead to blindness or mortality (Baumal & Duker, 2017). If Rosa’s hyperglycaemia is poorly controlled and BGLs are regularly unstable, this can cause the disease to worsen, leading to blindness or further vision impairment (Baumal & Duker, 2017).

Chronic pain Chronic pain is defined as pain that is continuous for 3 months or longer and interferes with an individual’s daily life (Cash & Glass, 2019). Rosa’s pain is related to her diabetes, suffering from neuropathic pain and developing venous/arterial ulcers. She also suffers from inflammatory pain associated with osteoarthritis and experiences compressive pain as a result of her THR surgery (Cash & Glass, 2019). To acquire the right treatment to reduce pain for Rosa, several assessments need to be undertaken including retrieving subjective and objective data (Cash & Glass, 2019). Subjective data includes using PQRST to assess the pain, obtaining family and social history, previous medical history, and using a self-reporting pain assessment tool (Cash & Glass, 2019).

When the RN completes the self-reporting pain assessment, it may be useful to have Rosa’s daughters there to ensure she is not confused and help validate the answers. Verbal, numeric, or faces scale are easy to comprehend and would eliminate confusion for Rosa as she has a mild cognitive impairment (CI) (Cash & Glass, 2019). The RN should liaise with Rosa’s multi-disciplinary team (MDT) and consult her doctor to formulate a suitable treatment plan (Cash & Glass, 2019). Non-pharmacological treatment could include cognitive behavioural therapy (CBT), exercise with an occupational or physical therapist, hot or cold 6

therapy, hydrotherapy, transcutaneous electrical nervous stimulation (TENS), or massage (Cash & Glass, 2019). If Rosa is bed-bound, it is important for the RN to reposition her in bed every 2 hours to prevent pressure injuries (Cash & Glass, 2019). Pharmacological treatment for chronic pain would include administering NSAIDs, corticosteroids, anticonvulsants for neuropathic pain, topical agents, and opioids (Cash & Glass, 2019).

Dementia care Dementia is a syndrome classified by the deterioration and eventual loss of cognitive functioning (Levett-Jones, 2017). After a person turns 65, the chance of developing dementia doubles every five years (Levett-Jones, 2017). The ability of the individual to function independently is greatly impacted as memory, thinking and judgement are weakened (LevettJones, 2017). This has detrimental impacts on decision-making, behaviours, mental health, swallowing, walking, and speaking (Levett-Jones, 2017). Dementia carries a high mortality rate as there is no cure and is the second leading cause of death in Australia (Levett-Jones, 2017).

It is estimated that 1 in 10 people over 65 years have dementia, and once turning 85 years old, the incidence increases to 3 in 10 people (Levett-Jones, 2017). The MDT must use person-centred care as standard practice for every interaction with the elder adult (Fazio et al., 2020). The literature from Hamiduzzaman et al. (2020) states that “personalised dementia care is multidimensional”. The research reveals that several factors are key to quality care including resident and family centredness, evaluation and holistic planning, informative training to staff, emotional and physical safety for patients, and an organised workplace culture attained by reliable leadership.

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Elder Abuse The World Health Organisation (WHO) has found that between 2000-2050, there will be an immense change in global demographic with individuals over the age of 60 will increase from 11-22% of the population (WHO, 2016). Nurses are key in preventing harm and eliminating determinants that facilitate a harmful environment (Myhre et al., 2020). Nurses need to be adequately trained with clinical skills and competencies, knowledge in supporting the elderly, and how to build therapeutic relationships with elderly patients (Phelan, 2018). Elder abuse can come in various forms including physical, psychological, financial, and sexual abuse (Myhre et al., 2020). This abuse can come from patient to patient, relatives to the patient, and from healthcare staff (Myhre et al., 2020). Nurses are critical in identifying elder abuse and taking actions to eliminate the abuse (Phelan, 2018). RNs should also establish an environment that doesn’t enable ageism and ensures QOL for every patient. The RN should uphold integrity and build a therapeutic connection with patients, to empower those who feel like they need to disclose reports of abuse (Phelan, 2018). In institutionalised care, whistleblowing should be encouraged in risk management to foster a safe environment (Phelan, 2018). Fostering an ageism-free environment protects the elderly, ensures equity of treatment, and the right to self-determination and equality (Phelan, 2018).

Falls risk According to Australia’s Health Report in 2018, falls were the leading cause and accounted for 37% of injury deaths in Australia (Australian Institute of Health and Welfare [AIHW], 2018). Various factors can lead to falls, which can lead to serious morbidities or mortality. High-risk medications such as opioids, skeletal muscle relaxants, NSAIDs, benzodiazepines, antidepressants, and antipsychotics all increase the risk of falls (Boltz et al., 2016). The RN should take into account if the patient has functional disabilities, forms of CI 8

(delirium or dementia), presence of osteoporosis, osteopenia, or sensory neuropathy (Boltz et al., 2016). Any history of falls or fractures largely increases the risk for the patient to fall again (Boltz et al., 2016). Assessing for poor balance or weakness related to conditions such as Parkinson’s or postural hypotension, visual impairments, and recognising unstable balance/ gait is imperative.

The RN should assess the aged care environment for Rosa for any hazards that could put Rosa at risk for a fall (Boltz et al., 2016). Action plans to reduce falls include utilising a mobility aid, protective equipment such as hip protectors, floor mats, or helmets, and appropriate footwear for the patient (Boltz et al., 2016). Limiting equipment that can clutter the environment, ensuring the floor is not slippery or wet, have bright lights or visual aids for the patient, and mobility aids in the rooms such as grab rails (Boltz et al., 2016). Other interventions include lowering bed heights, having bed rails up if the patient is physically unstable, and supplementing vitamin D and calcium to manage osteoarthritis.

Palliative care End-of-life nursing care is provided to patients and families and encompasses promoting QOL by providing person-centred care ensuring their goals of care are met (Crisp, 2016). The RN should clinically assess the physiological, mental, social, spiritual, and cultural wellbeing with the family and the patient. Pain management is essential for palliative patients and can be administered PRN medications or regular opioids as indicated (Crisp, 2016). The RN should provide skin and hygiene care to prevent skin tears, and reposition the patient to prevent pressure injuries (Crisp 2016). Another common symptom in palliative care is dehydration, and therefore the nurse should continual oral care including ice chips, mouth swabs, and encouraging fluid intake (Crisp, 2016). To maintain effective breathing, the nurse 9

can use supplemental oxygen, medications for inflamed airways, sitting the patient upright, and encourage deep breathing. Most importantly, building and maintaining a therapeutic relationship by showing empathy, compassion, and genuine attentiveness to the patient and family is integral to building rapport and upholding QOL for the dying patient (Crisp, 2016).

Conclusion Older adults are seen in almost every clinical setting frequently and are universally the fastest-growing demographic group. Gerontological nursing requires eliminating ageism in healthcare settings, overcoming health challenges, health promotion, and promoting a safe environment of care for elderly people. In this case study, Mrs. Rossi has several debilitating disorders that impact healthy ageing. Nurses should always act following current evidencebased policies and frameworks that establish the standard of high-quality care that older adults should receive. Whilst it is imperative to conduct thorough health assessments and apply critical thinking, it is essential that nurses uphold the fundamental principles of ethics whilst caring for the elderly. This includes adhering to the principles of justice, nonmaleficence, accountability, fidelity, autonomy, beneficence, and veracity. Many of the ageing population are highly vulnerable to discrimination and elderly abuse as they lose independence over time. Therefore, nurses need to practice person-centred care that promotes healthy ageing and independence that is attainable for the patient.

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References

Australian Bureau of Statistics. (2017). 2016 Census: Multicultural. ABS.

Australian Institute of Health and Welfare. (2018). Australia’s health 2018 (Australia’s health series no. 16. AUS 221.). Canberra: AIHW. https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihwaus-221.pdf

Baumal, C., & Duker, J. (2017). Current management of diabetic retinopathy. Elsevier. Cash, J., & Glass, C. (2019). Adult-Gerontology Practice Guidelines, Second Edition (2nd ed.). Springer Publishing Company.

Department of Local Government, Sport and Cultural Industries, 2020. Ageing in Multicultural Western Australia A Longitudinal Study of Diversity Trends, Challenges and Policy Imperatives.. Perth.

Hamiduzzaman, M., Kuot, A., Greenhill, J., Strivens, E., & Isaac, V. (2020). Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes. PLOS ONE, 15(5), e0233450. https://doi.org/10.1371/journal.pone.0233450

Huang, H., Sharifian, F., Feldman, S., Yang, H., Radermacher, H., & Browning, C. (2018). Cross-cultural conceptualizations of ageing in Australia. Cognitive Linguistic Studies, 5(2), 261-281. https://doi.org/10.1075/cogls.00021.hua

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Hunter, S., & Miller, C. (2016). Miller's Nursing for wellness in older adults (2nd ed.). Lippincott Williams & Wilkins.

Kazer, M. W., & Murphy, K. (2015). Nursing Case Studies on Improving Health-Related Quality of Life in Older Adults [E-book]. Springer Publishing. https://ebookcentral.proquest.com

Kiziltoprak, H., Tekin, K., Inanc, M., & Goker, Y. (2019). Cataract in diabetes mellitus. World Journal Of Diabetes, 10(3), 140-153. https://doi.org/10.4239/wjd.v10.i3.140

Levett-Jones, T. (2017). Clinical Reasoning: Learning to Think Like a Nurse (2nd ed.) [Ebook]. Pearson Education Australia. https://ebookcentral.proquest.com

Myhre, J., Saga, S., Malmedal, W., Ostaszkiewicz, J., & Nakrem, S. (2020). Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect. BMC Health Services Research, 20(1), 1–6. https://doi.org/10.1186/s12913-020-5047-4

Phelan, A. (2018). The role of the nurse in detecting elder abuse and neglect: current perspectives. Nursing: Research and Reviews, Volume 8, 15–22. https://doi.org/10.2147/nrr.s148936

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Tan, F., Chen, Q., Zhuang, X., Wu, C., Qian, Y., & Wang, Y. et al. (2019). Associated risk factors in the early stage of diabetic retinopathy. Eye And Vision, 6(1). https://doi.org/10.1186/s40662-019-0148-z

Wilson, T., McDonald, P., Temple, J., Brijnath, B., & Utomo, A. (2020). Past and projected growth of Australia’s older migrant populations. Genus, 76(1). https://doi.org/10.1186/s41118-020-00091-6

Zhao, Y., & Chen, X. (2017). Diabetes and risk of glaucoma: systematic review and a Metaanalysis of prospective cohort studies. International Journal Of Ophthalmology, 10(9). https://doi.org/10.18240/ijo.2017.09.16

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