Case study
Mr. Johnson is a 75-year-old man, was brought to the emergency department (ED) by his daughter with concerns about his increasing levels of pain, intermittent periods of acute confusion and deteriorating overall general health.
Initial Assessment
Mr. Johnson is alert but disorientated to time and place. He appears dishevelled and malnourished, with a strong odour of urine. He was brought in a wheelchair and was guarding his L knee. Daughter stated Mr. Johnson took two (2) Ibuprofen (neurofen) tablets couple of hours ago with minimal effect.
BP – 140/93
HR – 96 bpm and regular
Peripheral pulses – Present
RR – 18 rpm
Temp – 37.0C (tympanic)
Sa02 – 98% RA
BGL – 9 mmol/L
Height -170 cm
Weight – 74 kg (weighed 80 kgs six months ago)
ECG – NAD
MMSE – 23/30
L Knee Xray- NAD
Urinalysis – dark concentrated yellow, clear urine, SG 1.010, pH 7, Leukocytes and nitrite- positive.
Medical history
Mr. Johnson has a history of multiple chronic medical conditions, including osteoarthritis, osteoporosis, hypertension, and diabetes. He is on several medications and has regular visits with his primary care physician.
Medications
Ibuprofen
Panadol osteo
Alendronate (Fosamax)
Norvasc
Cholecalciferol
Calcium supplements
Metformin Hydrochloride
Gliclazide
Hydrochlorothiazide
Patient history
Mr. Johnson lives independently in his own home and usually cooks his own meals at home. His daughter visits him couple of times each week. Mr. Johnson walks for an hour daily and catches up with his friends at the nearby park once a week. He enjoys spending time with his grandchildren. He never smoked and drinks a bottle of beer after dinner while watching TV. He wears glasses for long distance and bilateral hearing aids. Recently the daughter noticed Mr. Johnson increasingly neglecting his personal hygiene, nutrition, and household upkeep. Mr. Johnson has been socially isolated. and had multiple falls at home recently.
Admitting diagnosis: Early signs of dementia.
You are the registered nurse looking after Mr. Johnson, and you are required to plan her care guided by a clinical reasoning framework and the provided case study information. Sections you need to respond to include:
1. Patient assessment (500 words)
Provide an initial impression by identifying relevant and significant features from Mr. Johnson’s current ED presentation.Discuss the possible causes for Mr. Johnson’s intermittent cognitive impairment. Do you agree or disagree with Mr. Johnson’s diagnosis of an early onset of dementia. Justify your opinion and support your discussion with evidence from the case study.Evaluate the impact a misdiagnosis may have on the care provided for Mr. Johnson. Mr. Johnson’s intermittent confusion resolved after 3 days. He was assessed by the Aged Care Assessment Team (ACAT) and was eligible for a community care package. Mr. Johnson was discharged home with regular codeine for his chronic pain.
2. Physiological changes of ageing and identify patient issues (500 words)
Discuss how the normal physiological changes of ageing may increase Mr. Johnson’s risk of falls. Identify three (3) evidence-based nursing interventions with rationales that should be implemented for Mr. Johnson to reduce the risk of falls. (Do not include referrals in your answer).Evaluate how Mr. Johnson’s chronic pain would impact on his capacity to complete two of his activities of daily living (ADL’s) ensuring you have justified your choice of ADL’s.
3. Pharmacological management and nursing considerations (500 words)
Discuss why Mr. Johnson, as an older adult, is more vulnerable to adverse drug effects. Ensure you include factors related to the anatomical, physiological and behavioural considerations associated with ageing.Identify with rationale two (2) nursing interventions you would consider when caring for Mr. Johnson who takes multiple medications (polypharmacy). (Do not include referrals in your answer.)
