Case Study on "Elder Care"

Quoted Instructions for "Elder Care" Assignment:

8 pages total for 2 case studies with reference pages.

2 scenarios included

Scenario 1: 4 pages with 1 reference page

Mrs. Elli Baker is a 73-year-old female who is transferred to the emergency room after collapsing in her backyard. Just prior to this, while talking to her friend on the phone, she seemed confused and beside herself. Upon arrival to the ER, she complains of some dyspnea with an increase in her respiratory rate and pulse. Her previous history includes diabetes and hypertension. She has recently started a new blood pressure medication: lisinopril. Her other medications include metformin and hydrochlorothiazide. The nurse is able to ask Mrs. Baker a few questions, but she then becomes unresponsive and has a more difficult time breathing.

Reflect on your analysis of the geriatric patient in multisystem failure by doing the following:

A. Explain key immediate assessments you should make that would help assess the patient*****s homeostasis, oxygenation, and level of pain.

Note: Be sure to include physical observations and observations made through technology and in the laboratory.

B. Describe the technological tools you would utilize to assess and treat the patient.

1. Explain why you would utilize these specific tools.

2. Explain the benefits of the tools in determining the patient*****s status.

C. Discuss how you prioritized data collection in the scenario

D. Compare how you would assess pain in a geriatric patient who is alert and conversant to a geriatric patient who is not alert.

E. Discuss how you would manage pain in a geriatric patient experiencing multisystem failure and showing signs of pain (e.g., moaning, restlessness, grimacing) who is not alert enough to respond to questions.

Note: Assume you have standing doctor*****s orders to administer acetaminophen 500 mg by mouth or morphine 0.05 mg/kg IV or morphine 0.1mg/kg IM.

1. Discuss how you would know whether your choice of pain management was successful.

2. Discuss what you learned regarding assessment of the geriatric patient.

F. Identify the collaborative team members pertinent to the care of the geriatric patient in the scenario, including the emergency room nurse*****s response to changes in the level of consciousness and increasing respiratory distress.



Scenario 2*****¦4 pages with 1 reference page

Elderly patients have many needs that younger patients do not. Being discharged from the hospital after surgery can present additional issues beyond those associated with physical recovery. In this task, you will assume the role of a case management nurse who is responsible for determining the most appropriate discharge placement for an elderly patient named Mr. Trosack. The patient is to be discharged from the hospital after undergoing total hip replacement surgery.

Review the *****Elder Care Case Study***** (attached below) for information on your patient. You will use this information to complete this task.

Case Study

As a nurse in a high-risk obstetric clinic, you have just accepted the assignment of Mrs. Rita Trosack*****s case management. As such, you are responsible for determining how to best meet her needs for care upon the initial visit. From the patient*****s chart you are able to ascertain the following information:

CHART

Rita Trosack, a 43-year-old Caucasian woman, has been married for six years to her husband, Peter, a 46-year-old Caucasian man who is a financial consultant. She was raised in a small town in the Midwest where her Irish grandparents settled in the early 1900s.

Rita went to college in Chicago, where she received a bachelor*****s degree in finance, and has lived there ever since. Either her middle-class family, who still raise cattle on the family farm, visit her in Chicago, or she goes home for a visit at least once a year usually around the Thanksgiving holiday. After college, Rita was eager to move away from the farm, and she now enjoys the lifestyle in a big city.

Peter comes from Chicago. His family has lived there since his great grandparents emigrated from Poland just before World War I. His family still owns a bakery in the heart of the city where many members of Peter*****s family work. His mother died two years ago, and his father still lives in their apartment located over the store.

Rita and Peter live in a condominium in downtown Chicago, close to the lake, and both work an average of 60 hours a week in the financial district. They were both raised as Catholics; however, neither chooses to practice the religion at this time.

After about two years of trying to conceive a child, Rita missed her menstrual period, began feeling nauseated, and started dry heaving every morning. Her breasts became tender, and she was experiencing fatigue so severe that she had to cut down her hours at the bank where she worked as an officer. She performed an early pregnancy test, which was positive. Since her last menstrual period (LMP) began on April 20, 2008, she calculated her due date as January 27, 2009.

Rita attended her first prenatal visit with Dr. Zimmerly in early June. He confirmed the estimated date of delivery (EDD) as late January 2009. Due to advanced maternal age, the chorionic villus sampling (CVS) was recommended to screen for fetal genetic defects. Rita scheduled the test for early July, began taking prenatal vitamins, and has stopped drinking her usual glass of wine with dinner. Both Peter and Rita gave up smoking over 20 years ago, so they are happy that this is not an issue for the unborn child. The physician also gave her basic information about nutrition and exercise, education regarding the normal signs and symptoms of pregnancy, proper seatbelt use, as well as warning signs that might signal problems to report to a physician. Since Rita is of normal weight for her height and has always been in good health, she is very happy about her pregnancy

In July, the result of the CVS indicated that the fetus is afflicted with Tay-Sachs disease. The couple was given a referral to a high-risk perinatal clinic by the physician.

You are assigned as Rita*****s case manager. You are to meet with the couple to gain more information.

FAMILY INTERVIEW RESULTS:

Rita and Peter are very distraught that their child has inherited Tay-Sachs disease. They do not understand how this could have happened. They vacillate between denial and acceptance of the situation. Rita blames herself for working so hard that it *****affected***** the baby. Peter is very angry and usually denies that anything will happen to the child and that the *****test is wrong.***** At this time, they refuse to consider the possibility of abortion because of religious and personal beliefs.

During the interview you determine the following family history:

Rita*****s parents:

Rita*****s mother is 70 years old, alive and well. Her father is 72 years old, alive and well. Her two sisters are alive and well. Her maternal grandparents are deceased��*****"they had three children (two girls and one boy, who are all alive and well). Her paternal grandparents are deceased��*****"they had two children (one son who died at an early age of unknown causes, and another son who is alive and well).

Peter*****s parents:

Peter*****s mother died at 68 years old from pancreatic cancer; his father is 72 years old, alive and well. His maternal grandparents are deceased��*****"they had four children (three girls and one boy, the rest who are alive and well). His paternal grandparents are deceased��*****"they had three children (one son who died at an early age of unknown causes, another son who is alive and well, and a daughter who died at an early age of unknown causes).

Write an essay (suggested length of 4 pages) in which you analyze the case study information to complete the following:

A. Assessment of the Situation (suggested length of 2 pages)

1. Identify at least three healthcare issues that you, as the case manager, must address when working with an interdisciplinary team to determine the most appropriate discharge plan for Mr. Trosack.

a. Explain why these are important issues when planning for management of the elderly discharge patient.

2. Identify three to five members to make up an interdisciplinary team to determine the most appropriate discharge placement for Mr. Trosack.

a. Describe the role expected of each person on the team.

3. Analyze the issues from the safety assessment that could affect the determination of discharge placement.

Note: You may include any other safety issues you think might be a problem if this patient returns home upon discharge.

B. Discharge Plan of Care (suggested length of 2 pages)

1. Explain to the family what care Mr. Trosack needs and how he should be discharged based on the interview data and the safety assessment. Your explanation should include the following:

a. Discuss the ability of the family to adequately care for Mr. Trosack if he is discharged home.

b. Discuss how social isolation affects an older adult*****s recovery from surgery or illness.

c. Discuss the ways psychological factors play a role in the recovery process.

2. Recommend a discharge placement for Mr. Trosack with supportive documentation.

sources, include all in-text citations and references in APA format.