Term Paper on "Gerontology and Gerontic Nursing Practice"
Term Paper 7 pages (2770 words) Sources: 15 Style: APA
[EXCERPT] . . . .
1. As she suffers from osteoporosis, several mechanisms are at play inMrs. Wood's condition. The basic elements result from poor bone mass
accumulation during childhood combined with an acceleration of bone loss
adulthood, when peak bone mass has been achieved. One half of bone mass is
made during pre-puberty, with only minimal accumulation of minerals in the
teens and peak bone mass in the 20s. Mrs. Wood's rate of bone loss is
based more upon her lifestyle than her genes. Dietary calcium, vitamin D,
protein and calories impact on her development of osteoporosis. If she had
poor calcium intake in her childhood, this directly impacts her likelihood
of fracture in adulthood (Heaney, 1998). Mrs. Wood's calcium intake is
directly associated with bone mineral mass at any age. Supplementation
reduces the rate of bone loss and will reduce her risk of fracture.
Vitamin D intake is necessary for bone mineral metabolism and the rate of
osteoclastic resorption. The addition of Vitamin D to calcium
supplementation reduces fracture rates. Other elements in Mrs. Wood's diet
impact on her osteoporosis. The degree of protein and caloric intake in
her daily diet will support fat and muscle that is covering bony areas.
There are several medications which may be associated with the
development in osteoporosis for Mrs. Woods. Chronic steroid use may have
contributed to her condition, resulting in the loss of trabecular bone
mass. It is estimated that 20-40% of bone loss occurs within the first
year of steroid use
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, especially in patients using doses greater than 7.5 mgdownload full paper ⤓
per day (Libinat and Baylinki, 1997).
The most common sign of osteoporosis is a skeletal fracture, and the
most common fracture will be seen in the vertebral column. Mrs. Woods may
remain completely asymptomatic even after compression fracture has
occurred. These usually happen in the course of the day with normal
activity. A cough or working in the garden is enough to cause a vertebral
compression fracture in the lumbar spine of a patient with osteoporosis.
Mrs. Woods may be asymptomatic, as noted, or she may note an acute episode
of back pain which resolves or becomes more chronic and dull in nature.
Should Mrs. Wood experience multiple vertebral compression fractures, she
may note a loss in height and eventual development of a Dowager's hump, as
is called the thoracic kyphosis resulting from the fracture. She may find
that her clothes no longer fit as they did before, she may notice a
thickening in the area of her waist, primarily because the vertical
dimension of the abdominal cavity disappears secondary to the vertebral
collapse and the abdominal contents shift toward the anterior region
(Kanis, 1994; Wasnich, 1993). Mrs. Woods may notice this causes a new and
very slow onset of shortness of breath because of the reduction in thoracic
volumes and poor lung volumes due to thoracic restriction.
Hip fracture after falls is also very common in patients who have
osteoporosis. Mrs. Wood may also note leg cramps, bone pain and tenderness
(not necessarily in the joints), abdominal pain, rib pain, tooth loss and
periodontal disease, fatigue and brittle fingernails. Pain and fractures
in joints are not always secondary to falls, but may occur due to
subchondral insufficiency in femoral head fractures. Another common injury
in patients who have osteoporosis is a Colles' fracture, in which there is
a fracture of the distal radius after the most minimal trauma. This often
occurs when the patient falls or trips and catches oneself against an
outstretched hand.
2. Mrs. Woods, I am sure you are concerned about the symptoms you
have been experiencing. It appears from your x-rays that you have
developed a condition which is called osteoporosis. Have you ever heard of
this condition before, or do any of your friends have this condition?
Well, osteo means related to the bone, and porosis is just as it sounds,
your bones are a little bit more porous and brittle appearing on the x-rays
than would perhaps be seen in a younger patient, or in a patient who does
not have osteoporosis. The cells which break down your bones are working a
little harder than the cells which build up your bones. While this can be
seen in some degree in all patients over age 50, in your case we are seeing
a little bit more of it than we would like, and as a result you are having
these symptoms. Osteoporosis can cause your bones to be brittle and break
more easily, so perhaps if you were to have a fall that would not have
caused more than a bruise in the past, you will now have to take care that
you observe that you have not caused a break in your bones. This can
sometimes cause quite a bit of pain, but in other patients only cause a bit
of a dull ache. In any case, when you have a fall or pain, we would want
you to come in so an x-ray could be done to make sure you have not done any
damage. The doctor and the medical team want you in the hospital right now
so we can take a look at your bones, see what degree of osteoporosis is
there, and perhaps even begin treatment. Luckily, there are some things
that we can do to make you feel better and improve the health of your
bones. We will also be talking about some things in your past, such as
medicines you have taken, which may have contributed to this condition
(Nolan, Davies, & Grant, 2001).
3. Education will be key to Mrs. Wood's recovery, since we cannot
reverse the osteoporosis which has already occurred. We may, however, be
able to preserve the healthy bone mineral mass she still has and for that
reason it would be good to have the pharmacist come in to speak to Mrs.
Woods about some medications which may be helpful in treating her disease.
The pharmacist will discuss some nutritional supplements which will be
helpful in preserving bone mass as well as medications which may help build
the bone she has already (Gray, et.al, 2000) .
Additionally, Mrs. Woods would do well to see the nutritionist. While
medication and nutritional supplementation will be helpful to her
condition, there are certain dietary choices she could make which would be
healthier for her, like dairy foods which are higher in calcium as well as
green vegetables which have calcium, especially if she has developed an
element of lactose intolerance as do many older patients. The nutritionist
will also be able to identify elements in her diet which are not good for
bone health, like high caffeine intake or alcohol.
Finally, it would be good for Mrs. Woods to see a physiotherapist.
Her pain from previous fractures may cause her to limit her range of motion
and activity, which will in turn complicate her osteoporosis. It would be
helpful were she to be instructed on physical exercise which will help her
maintaining range of motion to keep her joints flexible and maintain her
vertebral height as much as possible. Weight bearing exercise would also
modify the degree to which she experiences ongoing bone loss. A
physiotherapist would instruct her to be careful to follow an exercise
regimen which will be good for her and not cause a greater degree of
trabecular bone loss or deformation of her articular cartilage.
4. The physician would help in arranging for coordination of care for
Mrs. Woods. He or she will order bone mineral density testing to evaluate
the degree of bone loss, as well as metabolic testing to ensure 1) there is
not another physical condition which is causing her bone loss and 2) there
is no physical condition which would prevent her from taking some of the
medications she would need to treat her osteoporosis. I am thinking
specifically of issues such as hyperparathyroidism, history of renal
calculi and liver disease, a history of dysphagia or esophageal erosions.
The nursing staff will ensure that Mrs. Woods is clear regarding all
the testing and the results, and that she has a clear idea of the treatment
plan. It is also important that Mrs. Woods feels comfortable with the
treatment plan and understands what and why things are being done.
A pharmacist will evaluate the testing ordered by the physician and
give opinion on which medications, if any, would be helpful for treating
Mrs. Woods' condition. Additionally, the pharmacist can give Mrs. Woods
advice regarding the timing of the medication administration and side
effects she should be aware of.
A physiotherapist can set up an exercise plan for Mrs. Woods to ensure
she gets the appropriate type and amount of exercise to treat her
condition. The physiotherapist would be aware of possible co morbid
factors which would limit Mrs. Woods' exercise ability.
A social worker could evaluate Mrs. Woods' home situation to see if
any assistance would be needed regarding activities of daily living or
transportation needs. Additionally, the social worker may… READ MORE
Quoted Instructions for "Gerontology and Gerontic Nursing Practice" Assignment:
“Topic
You are the admitting nurse in the medical care ward of your local hospital. Mrs. Wood, aged 73, presents for admission for one of the following reasons.
Osteoporosis
Use a 'healthy model of ageing' approach.
Your answer should relate directly to Mrs Wood and her condition. Essay format is not required for this assignment. You will obviously dedicate more work to the area that has more marks allocated to it.
Question 1 - Pathophysiology - 600 worlds
Describe the normal ageing changes that would occur in Mrs Wood. (10 marks)[When asked to describe the normal ageing changes that would occur in Mrs Jones please describe the changes you would expect to see in an elderly patient with the condition you have chosen. In other words, how does her condition impact on her and the aging process. Is it normal to see this condition in the aged? If so, why and what signs and symptoms would you see. Essentially you are describing the pathophysiology of the condition, why we see it in the elderly and what S & S would alert you to the condition.]
Question 2 - Communication - 300 words
Discuss how you would present this information to Mrs Wood so that she was able to understand the reason for this admission. Give an example of your conversation using your own words. (5 marks)[Question 2 asks you to explain how you would present the reason for Mrs John's admission to her so that she is able to understand it. That is, explain the pathophysiology of ageing in layman's terms (not like in question one where you will have detailed aging in nursing terms). Please use the exact language that you would use. For example,
Mrs Jones, you have had to come into hospital today because you have a condition called hypertension. What happens in hypertension is that there is narrowing of your blood vessels so they go from being very wide to becoming very narrow. When they become narrow they can cause problems like those that you experienced today - dizziness and chest pain. This is becuase not quite enough blood and oxygen is getting to your brain and your heart. What we are going to do is to give you some medication to help make your arteries wider and talk to you about some ways you can help yourself feel better by watching what you eat and by doing a little bit of exercise.]
Question 3 - Education - 300 words
Outline what health education you would incorporate into Mrs Wood's plan for care while she is hospitalised. (5 marks/300 words)[Question 3 asks you to incorporate some health education into Mrs John's care plan and this education will be specific to the particular condition you have assigned to her. That is, the pharmacist will talk to her about her medication, the physio will talk about her exercise program, the dietian will talk about nutrition etc. Please specify the types of material you would expect each specialist to cover. This will highlight how the nurse can coordinate the pre-discharge information that needs to be passed to the patient so that they are able to help manage their care in the community.
Question three asks you to outline the health education you would incorporate into the plan of care whilst hospitalized. So you would discuss the reason why you would be incorporating that information into the education plan. Why would you include a dietian' referral, physio referral etc. e.g. A dietian's referral is important because nutrition is an identified risk factor in the elderly and particularly in those with diabetes and malnutrition. This is because of x, y and z factors.
Question 4 - Health Care Team -300 words
Outline the various health professionals you would involved in Mrs Wood's plan for care while hospitalised and discuss each of their roles in the team. (5 marks) NB: It is not sufficient to say "Podiatrist - works with feet." [Question four asks you to give the information of each specialist in more detail. This will examine what specific information each specialist will cover. When you are discussing pharmacological issues this will also flow into question 5.
Question 5 - Pharmacology - 300 words
Discuss the specific medication administration considerations that would be required for Mrs Wood. (5 marks)
Question 6 - Discharge Plan - 600 words
Develop a discharge plan for Mrs Wood. Include rationales for each aspect of the plan. Remember, discharge planning should commence at admission, so in your plan identify how the discharge plan relates to the plan of care developed for Mrs Wood's hospitalisation. The focus should be on 'healthy ageing'. (10 marks)
References must be used for each question. A reference list is to be attached at the end of the case study. You are expected to provide a minimum of 15 references for this assignment. These are to include but not limited to a mix of journals, books, internet sources and organizational policies and protocols.
Marks will be deducted for inadequate presentation and referencing.
Rationale
Students will be able to demonstrate an understanding of the normal aging changes that occur as people age as well as an understanding of the concept of healthy aging. This is necessary in nursing as historically the focus has been on the illness model of care rather than on the wellness model of care. As primary care givers in the health system nurses need to be able to provide care that is appropriate for the stage of life their patients/clients are at.
RESOURCES YOU COULD USE
Prescribed text(s)
Miller, C 2004, Nursing for wellness in older adults, 4th edn, Lippincott, Sydney.
Recommended reading
Abrams, W & Fletcher, A 1999, The Merck manual of geriatrics, Merck, Sharp & Dohme. (Any recent edition.)
Ebersole, P, Hess, P & Luggen, A 2004, Towards healthy aging, 6th edn, Mosby, St Louis.
Eliopoulos, C 2001, Gerontological nursing, 2nd edn, Mosby, St Louis
Gray, L et al. 2000, 'Geriatric medicine', A pocket guide for doctors, health professionals and students, 2nd edn, Ausmed; Melbourne.
Hudson, R (ed.) 2003, 'Dementia nursing', A guide to Practice, Ausmed, Melbourne. This is a wonderful resource, succinctly presented and well referenced. The principles covered in this package (it also comes with a CD ROM) pertain to all contexts of gerontic nursing, not just dementia care.
Nay, R & Garrat, S 2004, Nursing older people: Issues and innovations, 2nd edn, Churchill Livingstone, Sydney
Nolan, M, Davies, S & Grant, G, (eds) 2001, Working with older people and their families, Open University Press, Philadelphia.
Osterweil, D, Brummeis-Smith & Beck, JC 2000, Comprehensive geriatric assessment, McGraw-Hill.
Staunton, P & Chiarella, M 2002, Nursing and the law, 5th edn, Churchill Livingstone, Marrickville.
Stockslager, J & Schaeffer, L, (eds) 2003, Handbook of geriatric nursing care, 2nd edn, Lippincott Williams & Wilkins
Theobald, M 2003, Delirium risk management program resource kit, Ballarat Health Services, Ballarat, Victoria.
Students undertaking this subject are advised to read pertinent journals, such as
· Abstracts in social gerontology: current literature on aging
· Australasian Journal on Ageing
· Geriaction
· Journal of Gerontology
· Journal of Applied Gerontology
· Journal for Prevention and Healing: Advances in wound care
· Nursing Homes; long term care management
· Journal of Gerontological Nursing
Relevant Internet sites
· Aged and Community Services Australia
http://www.agedcare.org.au
· Aged Care Standards and Accreditation Agency
http://www.accreditation.aust.com
· American Geriatrics Society
http://www.americangeriatrics.org
· Australian Association of Gerontology
http://www.aag.asn.au
· Australian Institute of Health and Welfare
http://www.aihw.gov.au
· Canadian Association of Gerontology
http://www.cagacg.ca
· Commonwealth Department of Health and Ageing
http://www.health.gov.au
· Cota National Seniors
(previously Council on the Ageing and National Seniors Association).
http://www.cota.org.au
· Gerontological Society of America
http://www.geron.org
· Merck Manual of Geriatric Medicine
http://www.merck.com
· National Aged Care Alliance
http://www.naca.asn.au
· National Gerontological Nursing Association
http://www.ngna.org
· National Institute on Ageing
http://www.nia.nih.gov
· Older Women's Network
http://www.own.org.au
· SeniorNet Association
http://www.seniornet.com.au
Assessment 1: Marking Criteria
Value: 40% of final grade
Student Name_____________________________________________________
Criteria Grade:
E = excellent work
W = well done
S = satisfactory
N = needs improvement
P = poor
criterion meet to an exceptionally high standard
criterion meet to a high standard
criterion met but depth and/or breath somewhat limited
criterion met to an acceptable standard just, but there is much room for further development
criterion not met; either not addressed or treated very superficially
E
W
S
N
P
Presentation
No marks awarded but up to 20% of marks will be deducted from total mark for work poorly presented.
Legibility
Grammar/use of English
Format (page no's, title page, footers,
spacing 1 1/2 etc.)
Structure/Development
No marks awarded but up to 20 % of marks will be deducted from total mark for work poorly presented.
General Introduction
Body of paper is well organised
Paragraphing
Linking ideas/signposting
Content - 100%
1. Normal ageing changes (10 marks)
2. Presentation of information to patient (5 marks)
3. Education in care plan (5 marks)
4. Allied health team (5 marks)
5. Medication administration (5 marks)
6. Discharge plan with rationale (10 marks)
Academic Referencing Technique
No marks awarded but up to 40% of marks will be deducted from total mark for work poorly referenced and resourced.
APA referencing system correct in paper
APA referencing system correct in reference list
Appropriate use of nursing and other literature - at least 15 references are used as supporting evidence for the paper including own extra research
Appropriate systematic reference to subject readings and textbooks
Correct use of quotes
General Comments
Mark:___________
Lecturer signature:___________________
Date:_______
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