NRSG 266 Assignment 3 PDF

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This assessment is the third assessment of this unit in 2020....

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1. QUESTION ONE Acopia occurs when an individual is unable to cope (function psychologically and socially) with activities of daily living. It is an uncommon scenario for a patient with a decreased ability to cope with ADLs and social admission being admitted to the ED. However, this is not an exception and can be done. It has been found that many researchers and medical professionals imply Acopia as weakness or laziness of the patient hence, allowing the examining doctor to erroneously label the patient as social admission when in reality such patients potentially have a reversible acute illness (Beirne, D’Alton, Jeffries, & Dolan, 2018). Then again, many of these patients are presumably frail with comorbidities with an acute disorder which should be actively taken care of. Edith in this case has been diagnosed with Acopia which means that her labelling is solely for Acopia and not for any other issues. The RN, in this case, should educate and aware Edith about what frailty is and how this can be managed in the best way possible. They should provide positive encouragement to Edit and provide her with a sense of well-being. Psychological caring is very crucial for the well-being of patients with Acopia which will also help in the physical well-being of the patient (Pachana, 2016). Comprehensive geriatric assessment should be performed by the RN to assess symptoms of geriatric such as falls and delirium. While these steps should be taken, it is also crucial to keep in mind that labelling Edith with the diagnosis will lower her awareness about the need to seek medical help for other potential pathology she might be suffering from. It is crucial to keep in mind that older people hardly present with a single diagnosis and may have more than one problem (Beirne et al.,2018), 2. QUESTION TWO Multiple factors act together synergistically that puts the frail older population at higher risk of developing a pressure injury. Edith in this case will be spending the next 8 hours on a trolly. Pressure injury develops when capillaries supplying the skin and subcutaneous tissues are compressed enough to impede perfusion, leading ultimately to tissue necrosis (Jaul, Barron, Rosenzweig, & Menczel, 2018). Considering Edith's age and her current situation, she will most likely have minimum mobilization during those 8 hours which puts her at risk of developing a pressure injury. Pressure injury can develop between 2-6 hours depending on the health history of an individual (Latimer et al., 2019). The normal age-related changes to the cardiovascular system are one of the main causes for older people having the risk of developing a pressure injury. As people age,

the veins valves become less efficient which causes reduced blood flow to some organs. Atrial walls become stiff and thick causing ventricular and atrial hypertrophy. Sclerosis of atrial and mitral valves leads to common health issues such as high blood pressure which indicates reduced perfusion to tissues and organs. This also leads to diminished peripheral pulses and cold extremities hence, a risk factor for developing DVT, VTE or pressure injury. Similarly, changes in gastrointestinal system increase the risk ok NSAID induced ulcers in older people. Musculoskeletal system changes of decreased muscle mass and strength (sarcopenia) due to muscle fibre atrophy and neurological changes causes increased disability which increases the risk of developing pressure injury in older adults (Jaul et al., 2018). The nurses must, therefore, encourage or help Edith in repositioning or mobilising at least every two hours to prevent her from developing a pressure injury. They should encourage Edith to drink adequate water and check up on her time and again to assist her in going to the toilet. 3. QUESTION THREE Amita is at higher falls risk because of chronic pain on her lower leg. She may not be able to walk properly because the venous ulcer is located on her lower leg. This affects her mobilizing which will affect her ability to perform any kind of task safely. She does not have any help on her ADLs where she is at higher risk of having accidents while trying to do stuff. She may have a fall due to chronic pain while attempting to perform general ADLs such as getting up to eat, drink, bathe or go to the toilet. Performing any general task at that age is difficult itself, adding chronic illness and pain makes it more difficult for Amita’s ability to maintain a safe environment for herself. She takes multiple medications for chronic illness and a codeine-based medication for pain. She might take more dose of the pain medication than required if she experiences severe pain which can cause adverse drug reactions such as difficulty in breathing, sleepiness or dizziness putting her at more risk of falls (MIMS Australia, 2020). Other factors to be considered are the environment of her house itself such as her bathroom structure, kitchen accessibility, household furniture and house structure (Ashurst, 2020). As a nurse, it is their responsibility to provide education to Amita on all her medications so she will be aware of what medicines to not take together or not to overdose. Similarly, the nurse should help on maintaining a safe environment for her by moving furniture's to clear pathway if required, putting necessities such as a bottle of water, snacks, medications or cell phone near her so she should not get up and walk frequently.

4. QUESTION FOUR Various changes occur in the human body as they age. Some physiological change includes changes in the function of liver and renal, changes in the central nervous system, decreased body water, increased body fat, and decreased muscle mass. These changes increase the risk of adverse drug events in older people. With the increase in the burden of comorbidity, polypharmacy and inappropriate prescribing along with the age-related pharmacokinetic and pharmacodynamic changes, the ADR risks increases alongside. As people get older, the lean muscle mass and water content of their body decrease while there is an increase in the proportion of total body fat. These changes in the body impact the distribution volume of many drugs which can result in an increased risk of toxicity or adverse drug events (Gray et al., 2018). Chronic illness, malnutrition and dietary changes often result to decrease in serum albumin level in older adults which can often result in higher free or active drug fractions with greater potential for adverse effects (Layan & Gallagher, 2016). Liver mass and perfusion decline by as much as 40% with age thereby impacting on drugs with a high hepatic extraction ratio (Nagaratnam et al., 2016). Many drugs will therefore have reduced first-pass metabolism and as a result, have an increase in systemic bioavailability causing higher drug effect in elderly patients. The RN should, therefore, educate and Amita about all her medications, dosage and time. They should also educate Amita about adverse drug effects and tell her to call the hospital immediately if she feels unwell or experiences any symptoms. 5. QUESTION FIVE There is a decrease in respiratory muscle strength as people age; the chest walls become stiff with reduced compliance (Knight & Nigam, 2017). The alveoli in lungs lose elastic recoil which progressively enlarges and decreases in number. This results in increased residual volume and decreased vital capacity. Furthermore, A-P diameter increases due to flattening of diaphragm and elevation of ribs, there are changes in the atrophy of intercostal muscles and calcification/ossification of costal cartilage. All of these changes result in people having decreased efficiency of ventilatory exchange as they age. There is a decrease in cough and airway ciliary action that results to decrease in foreign matter being cleared due to decrease in mucus elimination (Marrie & File, 2016). The structural changes include chest wall and thoracic spine deformities which affects the total respiratory system compliance leading to increase work of breathing. The lung parenchyma loses its supporting structure causing dilation of air spaces: “senile emphysema”. Respiratory muscle strength weakens as people get older and can impair

effective cough, which is important for airway clearance (Toshie et al., 2015). Because of these changes to the respiratory system that happens with age, seniors can't always effectively clear secretions as well from their lungs. Those secretions can go down into bronchial tubes, causing the infection pneumonia. Oliver is 80-year-old which puts him at higher risk of catching pneumonia because of reduced immunity and reduced respiratory strengths (Bueno, Lord, & Jackson., 2017). Therefore, extra precautions should be taken by health care workers to prevent cross infections while caring for Oliver. Furthermore, Oliver should practice deep breathing and coughing exercises to keep his lungs active during his stay in hospital. 6. QUESTION SIX Lack of mobility during hospitalization can lead to an increase in the length of stay, increased dependence, and can result in suboptimal care (Czapluski, Marshburn, Hobbs, Bankard, & Bennett, 2014). Increasing the mobility of an older adult during hospitalisation decreases their risk of developing pressure ulcers and deep vein thrombosis, deconditioning or hospital-acquired-pneumonia (HAP) (Susan et al., 2018). It also assists in maintaining their lung function. Maintaining lung function is crucial to prevent HAP in older patients. Mobility helps in maintaining functional ability in an older adult. This helps in promoting a positive sense of well-being among older people which results in faster recovery (Merom et al., 2014). As a result, they will have a positive mental status and will less likely require institutional post-acute care assistance. The RN should encourage Oliver to perform basic activities such as washing face, brushing teeth or going to the toilet by himself or under supervision if required. This will help Oliver feel independent and positive about himself for still being able to perform basic tasks by himself. It will also prevent Oliver from developing complications such as pressure injury or deep vein thrombosis. The RN should also encourage Oliver to take short walks in the ward around his room for some exercise to keep him mobilised.

REFERENCE

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Beirne, A., D'Alton, M., Jeffries, G., & Dolan, E. (2018). 225; The Worrying Trend of Acopia as a Disease Entity in Older Patients Admitted to Hospital: An Observational Study. Age and Ageing, 47(Suppl_5), V13-V60.

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Gray, S., Hart, L., Perera, S., Semla, T., Schmader, K., & Hanlon, J. (2018). Meta‐ analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults. Journal of the American Geriatrics Society, 66(2), 282-288.

Jaul, E., Barron, J., Rosenzweig, J., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18(1), 305.

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Latimer, S., Chaboyer, W., Thalib, L., McInnes, E., Bucknall, T., & Gillespie, B. (2019). Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. Journal of Clinical Nursing, 28(21-22), 4119-4127.

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