nurs 6540 week (1-11) Discussion Essay.

nurs 6540 week (1-11) Discussion Essay.

Week 1: Initial post

Changes in sites of care

A 68-year-old female, ME, was admitted to the cardiovascular care unit for a chief complaint of chest pain. She lives alone in the upper peninsula of Michigan and was transported by EMS from a smaller facility. Four days prior to her admit, she was discharged from a different facility after a 22 day stay. At that time, she was being treated with exacerbation of CHF as well as pneumonia. Upon her admission, it was found the she had an eight-pound weight gain since her discharge, she had negative cardiac markers, and both her chest x-ray and chest CT were negative for any acute processes. The goal for this patient is to determine why she is having chest pain as well as how are we going to ensure that she will be able to successfully transition home and care for herself on discharge without readmission to the hospital. nurs 6540 week (1-11) Discussion Essay.

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Heart disease continues to be the leading cause of death and one of the most prevalent chronic diseases of adulthood has increased 16% in 1998 (Rafii, F., Shahpoorian, F., Azarbaad, M., 2008). As more patients survive their initial cardiac event, these numbers are going to increase. Heart failure is considered the common final pathway of all cardiac disorders. Many of the leading causes of CHF exacerbations can be prevented by nursing interventions. Learning to manage a chronic condition is the cornerstone of self-care (Rafii et al., 2008).  Self-care as a deliberate action to maintain optimal health and well-being and is the predominant form of health care for persons with CHF. However, many patients with heart failure are lacking adequate self-care behavior because most of their health care is provided away from the supervision of health care providers. Patient education standards are being challenged currently by a shorter hospital length of stay. During hospitalization, patients often lack the physical and mental capacity to concentrate on learning.

A limited number of studies have explored how nurses in particular communicate information about the nutritional status of elderly patients between health care settings. Research has, however, shown that there are barriers related to inadequate information transfer between health care settings.Halvorsenl K., Kjøllesdal, H., Sortland, K., &Almendingen, K., 2016).  Barriers that have been highlighted include short hospital stay, resource demands, and discrepancies in nutritional knowledge and skills among health professionalsHalcorsen et al., 2016).

Education and communication are two ways in which we as health care professionals can help decrease the number of patients who are readmitted to the hospital (Watkin, L., Hall, C., &Kring, D., 2012). At the facility that I work for we participate in the hospital to home program. Phone calls are made with in 24 hours after discharge to ensure the patient understands any lifestyle changes or have any questions regarding medications or other education that the patient may have received prior to discharge. In the case of ME she was going to be transported to a rehabilitation unit prior to going home to help her regain strength from her two admits within the last several weeks.nurs 6540 week (1-11) Discussion Essay.

ME, currently does not have any legal paperwork discussing how to manage situations in the event she cannot make decisions on her own. Information as well as education was provided to the patient. The patient does have a living daughter that would be a good choice to make medical decisions in the event the patient could not.

Halvorsenl, K., Kjøllesdal, H., Sortland, K., &Almendingen, K. (2016). Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes. BMC Nursing, 1-10.

Rafii, F., Shahpoorian, F., Azarbaad, M. (2008). The Reality of Learning Self-Care Needs during Hospitalization: Patients’ and Nurses’ Perceptions. Self-Care, Dependent-Care & Nursing, 16 (2), 34-39.

Watkins, L., Hall, C., &Kring, D. (2012). Hospital to home: A transition program for frail older adults. Professional Case Management, 17(3), 117–125.

Retrieved from the Walden Library databases.

NURS 6540: Advanced Practice Care of Frail Elders | Week 2

As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010). As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, health care providers use a variety of assessments. These assessments are key tools in the care of geriatric patients.

This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction. Then, you explore implications of normal and abnormal age-related changes and consider how functional assessments are used to distinguish between these changes.

Learning Objectives

By the end of this week, students will:

• Evaluate assessment tools used to assess geriatric patients
• Design an evaluation plan for patient with immobility, sensory deprivation, or cognitive dysfunction
• Analyze implications of age-related changes in geriatric patients*
• Analyze the use of functional assessments to distinguish between normal and abnormal implications of aging*

*These Learning Objectives support assignments that are assigned this week, but due in Week 4.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.nurs 6540 week (1-11) Discussion Essay.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

 

• • Chapter 5, “Assessment” (pp. 36-41)

This chapter reviews essential components of the comprehensive geriatric assessment, including physical, cognitive, psychologic, and social assessment. It also emphasizes other areas of importance, such as assessing quality of life and driving concerns.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

 

• • Chapter 1, “Function and Frailty: The Cornerstones of Geriatric Assessment” (pp. 1–12)

This chapter describes frailty and provides guidelines for assessing frailty in older adults. It also examines functional impairment in older adults and identifies functional assessment tools for treating and preventing functional decline in frail older adults.

Rosen, S., & Reuben, D. (2011). Geriatric assessment tools. The Mount Sinai Journal of Medicine, New York, 78(4), 489–497.

This article identifies common conditions that impact elderly patients. It also presents assessment tools that screen for geriatric syndromes, such as hearing impairment, vision impairment, functional decline, falls, urinary incontinence, cognitive impairment, depression, and malnutrition.

Optional Resources

Note: The following resource is highly recommended for addition to your professional library. You are encouraged to utilize this “pocket” text during your on-site practicum experiences.

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2012). Geriatrics at your fingertips (14th ed.). New York, NY: American Geriatrics Society.

Discussion: Assessment Tools

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as the advanced practice nurse, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of geriatric patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability.

For this Discussion, consider which assessment tools would be appropriate for the patients in the following three case studies:nurs 6540 week (1-11) Discussion Essay.

Case Study 1

Mr. Smith, age 77, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

Case Study 2

Mr. Jones, a 68-year-old man, was referred to your office for a hearing evaluation. He continues to work in a printing company, although he works only part-time. He has worked at the printing company for the past 35 years. He complains that he cannot hear much of the dialogue on the television. He is accompanied by his wife, who states that her husband cannot hear her at home. He has no history of dizziness, tinnitus, or vertigo. He has had cerumen impactions removed from both ears in the past. Overall, his medical history is quite benign. His only medications are aspirin 81 mg daily, a multivitamin daily, and occasional ibuprofen for back pain.

Case Study 3

Mrs. Roberts, an 83-year-old widow, is brought to the office by her daughter. The daughter claims that her mother seems to be depressed. There is a history of depression approximately five years ago, shortly after Mrs. Roberts’ husband died. At that time, she was successfully treated with antidepressants. Currently, the daughter states that her mother’s memory for appointments and events has declined severely, and she can no longer drive because she does not remember the route to the store or other familiar places. The daughter also noted that her mother’s house seemed very disorganized and dirty, there was a limited amount of food in the kitchen, and the checkbook had not been balanced for several months. Mrs. Roberts appears slightly disheveled, she has a flat affect, and she does not maintain eye contact during your interview.

To prepare:

• Review the Rosen and Reuben article in this week’s Learning Resources. Consider how assessment tools are used to evaluate patients.
• Select one of the three case studies. Based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
• Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.

By Day 3

Post an explanation of your evaluation plan for the patient in the case study you selected and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
• Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

NURS 6540 Week 3 Discussion

Models of Interdisciplinary Geriatric Care Teams is a NURS 6540 Week 3 Discussion. Here, we have three cases: Case Study 1: Mrs. Martinez is an 83-year-old Mexican American widow…; Case Study 2: Mr. Williams, a 79-year-old African American widower…; and Case Study 3: Mrs. Randall is a 77-year-old female who resides in a long-term care facility…ORDER NOW to get them done for you by our erudute writers!!

Models of Interdisciplinary Geriatric Care Teams

With the growing population of frail elders, there is an increase of geriatric patients requiring ongoing care for multiple medical conditions. This creates the need for interdisciplinary geriatric care teams. Often, the dynamics and culture of these teams differ across various sites of care, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities. As an advanced practice nurse, it is important to understand your role in the care team as well as your potential impact on patient care. In this Discussion, you explore models of interdisciplinary geriatric care teams for different sites of care and the varying roles of the advanced practice nurse. Consider the following three case studies:nurs 6540 week (1-11) Discussion Essay.

Models of Interdisciplinary Geriatric Care Teams Case Study 1:

Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”

Models of Interdisciplinary Geriatric Care Teams Case Study 2:

Mr. Williams, a 79-year-old African American widower, resides in a foster care home. He has lived there for 4 years since his wife died. He is a former minister. His medical history includes long-term diabetes, high blood pressure, and benign prostatic hypertrophy. The home care provider has requested a home visit to evaluate Mr. Williams’s ability to remain in the home. The provider states that because Mr. Williams’s vision is seriously compromised (he is nearly blind), and because he has been unable to get to the toilet as quickly as necessary (he is very unsteady on his feet), his care is becoming burdensome. According to the home care provider, for safety reasons, Mr. Williams may not fit the criteria for remaining in the foster care home.

Models of Interdisciplinary Geriatric Care Teams Case Study 3:

Mrs. Randall is a 77-year-old female who resides in a long-term care facility. She has a history of frequent falls and is severely cognitively impaired. The nursing staff at the long-term care facility called the nurse practitioner at the medical home office to report the recent development of productive cough and high fever. There have been cases of flu in the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner in the office requests a chest x-ray in the long-term care facility. The nurse on duty in the facility states that there is no portable chest x-ray equipment available. She further requests that Mrs. Randall be transferred to the emergency room of the local hospital. Mrs. Randall’s daughter has durable power of attorney for health care decisions for her mother. The long-term care facility has notified the daughter of the change in her mother’s condition. The daughter says whatever the nursing home wants is fine with her.nurs 6540 week (1-11) Discussion Essay.

To prepare for Models of Interdisciplinary Geriatric Care Teams:

Review this week’s media presentation, as well as the American Geriatrics Society and Arbaje et al. articles in the Learning Resources.

Research models of interdisciplinary geriatric care teams that are used at various sites, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities.

Consider the model used for the interdisciplinary geriatric care teams at your current practicum site. Compare this model to models used at other sites.

Reflect on how the role of the advanced practice nurse differs according to the site of care.

Select one of the three case studies. Consider how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric care teams at your practicum site.

Post on or before Day 3 a comparison of the model used for the interdisciplinary geriatric teams at your current practicum site to models used at other sites. Then, explain how the role of the advanced practice nurse differs according to the site of care. Finally, explain how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric teams at your practicum site.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.

Offer and support an alternative perspective based on your own experience and additional literature search.

Validate an idea with your own experience and additional literature search.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

WEEK4 Discussion:Over-the-counter (OTC) drugs

OTC drugs enable people to relieve many annoying symptoms and to cure some diseases simply and without the cost of seeing a doctor. However, safe use of these drugs requires knowledge, common sense, and responsibility.

In addition to the substances such as aspirin and acetaminophen that people typically think of as OTC drugs, many other commonly available products are considered OTC drugs by the Food and Drug Administration (FDA). Some toothpastes, some mouthwashes, some types of eye drops, wart removers, first aid creams and ointments that contain antibiotics, and even dandruff shampoos are considered OTC drugs. Each country establishes which drugs are available OTC in that country.

Some OTC drugs were originally available only by prescription. After many years of use under prescription regulation, drugs with excellent safety records may be approved by the FDA for over-the-counter sale. The analgesic ibuprofen and the indigestion remedy ranitidine are examples of such drugs. Often, the OTC version has a substantially lower amount of active ingredient in each tablet, capsule, or caplet than does the prescription drug. When establishing appropriate doses of OTC drugs, manufacturers and the FDA try to balance safety and effectiveness.

OTC drugs are not always better tolerated than similar prescription drugs. For example, the OTC sleep aid diphenhydramine can cause just as serious adverse effects as many prescription sleep aids, especially in older people.

Historical Background

At one time, most drugs were available without a prescription. Before the Food and Drug Administration (FDA) existed, just about anything could be put in a bottle and sold as a sure-fire cure. Alcohol, cocaine, marijuana, and opium were included in some over-the-counter (OTC) products without notification to users. The Food, Drug, and Cosmetic (FD&C) Act, enacted in 1938, gave the FDA some authority to issue regulations, but the act did not provide clear guidelines as to which drugs could be sold by prescription only and which could be sold over the counter.

An amendment to the FD&C Act in 1951 attempted to clarify the difference between OTC and prescription drugs and to deal with issues of drug safety. Prescription drugs were defined as compounds that could be habit forming, toxic, or unsafe for use except under a doctor’s supervision. Anything else could be sold over the counter.nurs 6540 week (1-11) Discussion Essay.

As noted by an amendment to the FD&C Act of 1962, OTC drugs were required to be both effective and safe. However, determining effectiveness and safety can be difficult. What is effective for one person may not be for another, and any drug may cause unwanted side effects (also called adverse effects, adverse events, or adverse drug reactions). There was no organized system in the United States for reporting the adverse effects of OTC drugs until 2007, when a new law became effective that required companies to report serious adverse events associated with OTC drugs (see OTC Products and Dietary Supplements).

Safety Considerations

Safety is a major concern when the Food and Drug Administration (FDA) considers reclassifying a prescription drug as OTC (over-the-counter). Most OTC drugs—unlike health foods, dietary supplements (including medicinal herbs) and complementary therapies—have been studied scientifically and extensively. However, all drugs have benefits and risks, and some degree of risk has to be tolerated if people are to receive a drug’s benefits. Defining an acceptable degree of risk is a judgment call.

Reclassifying drugs as over-the-counter drugs

The following questions can help determine whether a drug is safe enough to be made available over the counter:

• Has the drug been used for a long enough time so that any harmful effects are fully understood?

• What harmful effects (including those from misuse) may the drug cause?

• Is the drug habit forming?

• Do the benefits of over-the-counter status outweigh the risks?

Other questions help determine the ease with which a disease can be diagnosed and then treated outside of a health care setting:

• Can the average person self-diagnose the condition that calls for the drug?

• Can the average person treat the condition without the help of a doctor or other health care practitioner?

Finally, people need to understand how to use the drug, so labeling on the outside and inside of the package are important considerations:

• Can adequate directions for use be written?

• Can warnings against unsafe use be written?

• Can the average person understand the information on the label?

Choosing and using over-the-counter drugs

Safety depends on using a drug properly. For OTC drugs, proper use often relies on consumer self-diagnosis, which leaves room for error. For example, most headaches are not dangerous, but in rare cases, a headache is an early warning of a brain tumor or hemorrhage. Similarly, what seems like severe heartburn may signal an impending heart attack. Ultimately, people must use common sense in determining when a symptom or ailment is minor and when it requires medical attention and consult a doctor or pharmacist if they are unsure.nurs 6540 week (1-11) Discussion Essay.

The guidelines for choosing and using OTC drugs are as follows:

• Make sure that the self-diagnosis is as accurate as possible. Do not assume the problem is “something that is going around.”

• Choose a product because the ingredients are appropriate for the condition, not because the product has a familiar brand name.

• Choose a product with the fewest appropriate ingredients. Products that attempt to relieve every possible symptom are likely to expose people to unnecessary drugs, pose additional risks, and cost more.

• Read the label carefully to determine the correct dose and precautions, including what conditions would make the drug a poor choice.

• When in doubt, ask a pharmacist or doctor what the most appropriate ingredient or product is.

• Ask a pharmacist to check for potential interactions with other drugs being used.

• Ask a pharmacist to identify possible side effects.

• Do not take more than the recommended dose.

• Do not take an over-the-counter drug longer than the maximum time suggested on the label. Stop taking the drug if symptoms worsen.

• Keep all drugs, including over-the-counter drugs, out of the reach of children.

Reading the labels of over-the-counter drugs

People who purchase OTC drugs should read and follow the instructions carefully. Because different formulations—such as immediate-release and controlled-release (slow-release) formulations—may have the same brand name, the label should be checked each time a product is purchased, and the dosage should be noted. Assuming that the dosage is the same is not safe. Also, different formulations with the same brand name may have different ingredients, so checking the ingredients on the label is important. For example, there are several dozen different Tylenol® formulations with a vast array of ingredients and doses. Some Maalox® products contain aluminum and magnesium hydroxide, while others contain calcium carbonate. When selecting a product, people should read the label carefully to determine which product is most appropriate for their particular problem. Labels on OTC drugs, which are required by the FDA, can help people understand a drug’s benefits and risks as well as how to use the drug correctly. People should ask a pharmacist if they have any questions about an OTC product.

Often, the labels of OTC drugs do not list the full range of possible side effects. As a result, many people assume that these drugs have few, if any, side effects. For example, the package insert for one analgesic cautions people not to take the drug for more than 10 days for pain. However, the possible serious side effects that can occur with long-term use (such as life-threatening bleeding from the digestive tract) are not mentioned—not on the box, bottle, or package insert. Consequently, people with chronic pain or inflammation may take the drug for a long time without realizing that such use could lead to serious problems.nurs 6540 week (1-11) Discussion Essay.

Reading a Drug Label

Nonprescription drugs in the United States are required to have labels that explain what a drug’s benefits and risks are and how to use the drug correctly. The label is entitled “Drug Facts.” Active ingredients are listed at the top, followed by uses, warnings, directions, other information, and inactive ingredients. Active ingredient: The drug itself is the active ingredient. Combination products have more than one active ingredient. The drug’s generic name is listed with the amount of drug in each tablet, capsule, or dose unit. The same generic drug may be sold under several different trade (brand) names. Uses: Symptoms or disorders for which the drug product is recommended are listed. Warnings: When the drug should not be used, when a doctor or pharmacist should be consulted (and after how long), and which factors can alter the expected response to the drug are listed, usually in four sections. “Ask a doctor before use if you have” lists conditions that can make taking the drug more problematic or unsafe. This section refers to drug-disease interactions. “Ask a doctor or a pharmacist before use if you are taking” lists other drugs that can interfere with the drug’s effectiveness or safety. This section refers to drug-drug interactions. “When using this product” includes common side effects, foods that may interfere with the drug’s effectiveness or safety (drug-food interactions), and special precautions to take (for example, not driving while taking the drug). The last section lists special warnings for women who are pregnant or breastfeeding and for children, with instructions about what to do in case of an overdose. Directions: How much of the drug and how often to take the drug are given for different age groups, because size and age, among other factors, affect how a person responds to a drug. Other information: Special instructions, such as how to store the drug so that it does not deteriorate, are listed. Inactive ingredients: In addition to the drug, drug products—the tablets, capsules, or other formulations that consumers buy—contain substances added to facilitate the administration of the drug, such as ingredients that provide bulk or a pleasant taste and color. Products with the same active ingredient may contain different inactive ingredients. Inactive ingredients are usually harmless, but some of them cause an allergic reaction in a few people, who should look for products made without those ingredients.

NURS 6540 Week 5 Discussion

Fall-Risk Assessment Discussion is part of NURS 6540 Week 5 Discussion. In this discussion, we will use Fracture Risk Assessment Tool (FRAX) in addition to another one from the following list to assess a geriatric patient: Tinetti Performance Oriented Mobility Assessment (POMA), Systems Approach, Berg Balance Scale, Elderly Mobility ScaleTimed Unsupported Stead Stand (TUSS), Six-Minute Walk Test (6MWT), and Hendrich II Fall Risk Model. All you need to do is ORDER NOW and we will follow the instructions below to the letter. nurs 6540 week (1-11) Discussion Essay.

Fall-Risk Assessment Discussion Instructions:

Fall risks are very high for the geriatric population. According to the Centers for Disease Control and Prevention (2013), one out of every three adults aged 65 years and older falls each year. This can be attributed to factors such as changes in aging, other health issues, environment, and effects of prescribed drugs. When caring for geriatric patients, it is important to screen them for risks and perform fall-risk assessments. These assessment tools help to determine the level of risk for patients so that preventive measures can be taken. The implications of falls are very serious and range from fractures to mental health disorders and even death. In this Discussion, you explore risk assessment tools for use with patients at your practicum site.

To prepare for Fall-Risk Assessment Discussion:

Review the Kanis article in this week’s Learning Resources.

Consider a geriatric patient at your practicum site who is at risk for falls. Coordinate an opportunity to assess this patient with your Preceptor. Note: When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

In addition to the Fracture Risk Assessment Tool (FRAX), select one of the following tools to assess this patient for falls:

• Tinetti Performance Oriented Mobility Assessment (POMA)
• Systems Approach
• Berg Balance Scale
• Elderly Mobility Scale
• Timed Unsupported Stead Stand (TUSS)
• Six-Minute Walk Test (6MWT)
• Hendrich II Fall Risk Model

Consider why you selected the assessment tool for this particular patient when completing the Fall-Risk Assessment Discussion.

Assess the patient using the tool you selected under Preceptor guidance. Reflect on the assessment, including any issues with the patient and/or the effectiveness of the tool.

Think about strategies and interventions to reduce the risk of falls for frail elders.

Post on or before Day 3 a case study description of a geriatric patient from your practicum site who is at risk for falls. Describe this patient’s FRAX assessment. Then, describe the other assessment tool you used in the fall-risk assessment and explain why you selected the tool for this particular patient. Explain the patient assessment, including any issues with the patient and/or the effectiveness of the tool. Finally, explain strategies to reduce the risk of falls for your patient.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different assessment tool than you did.

Suggest alternative tools for assessing your colleagues’ patients.

Recommend additional strategies to reduce the risk of falls for your colleagues’ patients.

Share insights based on your own experience and additional literature search.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.nurs 6540 week (1-11) Discussion Essay.

NURS 6540: Advanced Practice Care of Frail Elders | Week 6

In so many countries, to be old is shameful; to be mentally ill as well as old is doubly shameful. In so many countries, people with elderly relatives who are also mentally ill are ashamed and try to hide what they see as a disgrace on the family.

—Dr. Nori Graham, Psychiatrist and Honorary Vice President of Alzheimer’s Disease International

In this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia, delirium, or depression. Lynda Hogg, an Alzheimer’s patient, shares her feelings that “some people don’t want to be associated with someone with an illness affecting the brain” (Alzheimer’s Disease International, 2012). As an advanced practice nurse providing care to patients presenting with dementia, delirium, and depression, it is critically important to consider the impact of these disorders on patients, caregivers, and their families. A thorough understanding of the health implications of these disorders, as well as each patient’s personal concerns, will aid you in making effective treatment and management decisions.

This week you explore geriatric patient presentations of dementia, delirium, and depression. You also examine assessment tools and treatments for these disorders. Then, you develop a question related to dementia, delirium, or depression to complete a PICO analysis. Finally, you examine literature that relates to evidence-based practices for the disorders.

Learning Objectives

By the end of this week, students will:

• Assess patients presenting with symptoms of dementia, delirium, or depression
• Develop a question related to dementia, delirium, or depression
• Analyze literature that relates to evidence-based practices for dementia, delirium, or depression
• Evaluate the impact of dementia, delirium, or depression on frail elders*
• Evaluate geriatric patient care plans for dementia, delirium, or depression*

*These Learning Objectives support assignments that are assigned this week, but due in Week 8.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

• • Chapter 36, “Dementia” (pp. 280-291)

This chapter examines the epidemiology and societal impact of dementia. It also presents guidelines for assessing, diagnosing, treating, and managing dementia in addition to providing pharmacologic and nonpharmacologic treatment options.

• • Chapter 37, “Behavioral Problems in Dementia” (pp. 292-300)

This chapter explores clinical features of behavioral and psychologic symptoms related to dementia, as well as guidelines for assessment, differential diagnosis, and treatment. It also examines treatment for mood disturbances, manic-like behaviors, delusions and hallucinations, disturbances of sleep, hypersexuality, and intermittent aggression or agitation.

• • • Chapter 38, “Delirium” (pp. 301-310)

This chapter explores the spectrum of delirium, including the incidence and prognosis, risk factors, and diagnostic criteria for delirium. It also presents guidelines for diagnosing, treating, and managing patients with delirium, including pharmacologic therapy and drugs to reduce or eliminate as part of delirium management.

• • Chapter 40, “Depression and Other Mood Disorders” (pp. 322-329)

This chapter explores treatment strategies for depression and other mood disorders affecting older adults. It examines types of pharmacotherapy, antidepressants, as well as other treatment options, such as electroconvulsive therapy and psychosocial interventions.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

• • Chapter 6, “Clarifying Confusion: Preventing and Managing Delirium” (pp. 65–72)

This chapter examines strategies for screening, prevention, and management of delirium among older adults in hospital settings.

• • Chapter 7, “Preserving the Memories: Managing Dementia” (pp. 73–93)

This chapter examines dementia risk factors and screening tools for dementia. It also presents strategies for managing patients with dementia, focusing on pharmacological and nonpharmacological treatments.

• • Chapter 8, “Enjoying the Golden Years: Diagnosing and Treating Depression” (pp. 94–104)

This chapter defines depression and identifies causes and risk factors that make older adults more susceptible to depression. It also examines treatment options for managing older adults with depression.

Document: Literature Review Matrix (Word document)

Required Media

Alzheimer’s Association. (n.d.). Brain tour [Multimedia file]. Retrieved August 1, 2014, from http://www.alz.org/braintour/3_main_parts.asp

 

This website provides an overview of the structure and function of the brain and explores how Alzheimer’s disease changes the brain.

Discussion: Patient Presentation of Dementia, Delirium, and Depression

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?

Case Study 1

HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.nurs 6540 week (1-11) Discussion Essay.

Review of Symptoms (ROS): Unable to obtain at this time.

Objective Data:

PE:

VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.

General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.

Her physical exam is unremarkable except –

Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.

Psych: A & O x 1 to person only. She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.

Case Study 2

CC: “irritable and forgetful”

HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.

On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.

Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.

Objective data: Her physical examination is within normal limits.

Case Study 3

HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”

PMH: He has been in good health with the exception of hypertension, which is well controlled.

Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.

Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect.

To prepare:

• Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
• Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
• Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.nurs 6540 week (1-11) Discussion Essay.

By Day 3

Post an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different case study than you did.

• Suggest additional tools for assessing the patients in the case studies your colleagues’ selected.
• Offer and support an alternative perspective based on your own experience and additional research.
• Validate an idea with your own experience and additional literature search.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

NURS 6540 Advance Practice Care of Frail Elders Week 7 Discussion

Nutrition and Hydration

Geriatric patients have many nutritional and hydration concerns that impact their health and ability to acquire sufficient nutrients. Advanced practice nurses evaluating these patients must be able to account for all barriers that prevent elders from obtaining adequate nutrition, including medical conditions, transportation, finances, physiologic changes, and functional abilities. When evaluating patients, it is important to consider how they eat, what their diet consists of, and whether they have any special dietary needs that are not being met. Assessment tools, such as the Lawton Instrumental Activities of Daily Living (IADL) Scale, are an integral part of this evaluation process as they help providers identify potential obstacles for patients. In this Discussion, you assess a patient at your current practicum site and consider strategies for improving any nutrition or hydration issues.

To prepare:

Review this week’s media presentation, as well as Chapters 28 and 29 of the Flaherty and Resnick text.

Assess a patient using tools for inpatient and long-term patient care, such as the Lawton IADL Scale. Note: You should coordinate this opportunity with the Preceptor at your practicum site.

Consider whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Reflect on whether the patient is able to go out and get food to eat, cook meals, safely use the stove, etc.

Consider the patient’s diet and whether they have any special dietary needs due to medical conditions, such as congestive heart failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect on whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.nurs 6540 week (1-11) Discussion Essay.

Based on your patient assessment, think about strategies for improving any nutrition issues that might have presented (e.g., nutritional supplements, community resources such as Meals on Wheels, referral to a nutritionist or dietician, etc.).

Post on or before Day 3 a description of the patient assessment you performed using a tool for inpatient and long-term patient care, such as the Lawton IADL Scale. Explain whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Then, describe the patient’s diet and whether he or she has any special dietary needs due to medical conditions. Address whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet. Finally, explain strategies for improving any nutrition issues that might present during the patient assessment.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the following ways:

Suggest additional strategies for improving nutrition issues for your colleagues’ patients.

Offer and support an alternative perspective based on your own experience and additional literature search.

Validate an idea with your own experience and additional literature search.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

NURS 6540 week 7 Quiz

1 Which of the following nutritional parameters is an indicator for functional decline among older adults? a. Fasting blood glucose of 100 mg b. A body mass index greater than or equal to 35 c. Total serum cholesterol of 175 mg d. A planned weight loss of 1 pound per week as a result of healthy dietary changes Question 2 Which two laboratory test results provide evidence of malnutrition in hospitalized older adults? a. Low albumin and cholesterol b. Elevated hemoglobin and hematocrit c. Low sodium and potassium d. Elevated liver enzymes and CRP Question 3 Strict adherence to therapeutic diets in hospitalized frail older adults is a. Essential to control disease states until the end of life b. Essential to conform to nursing home regulations c. Not essential if the patient is at risk for malnutrition or diet results in poor quality of life d. Not essential because old people don’t eat that much anyway Question 4 In what way does functional disability contribute to malnutrition? a. The functionally disabled stomach does not absorb nutrients adequately from the food b. Dietary restrictions of functionally disabled individuals cause low caloric intake c. The person with functional disability has little money to buy food d. Declining functional ability interferes with shopping, preparing meals, or feeding Question 5 For patients in whom protein energy supplements are indicated, when should these supplements be provided? a. At bedtime b. With breakfast and lunch c. Between meals as tolerated d. Before breakfast Question 6 Which of the following is the first step in managing chronic constipation? a. Order saline enemas twice per week b. Order 8 ounces of warm milk at bedtime c. Stop constipating medicines when possible d. Order opioid antagonists daily Question 7 The average older adult requires the following fluid intake to maintain health a. 1 gallon of water per day b. As much fluid as required to diminish thirst c. 30 mL per kilogram of body weight per day d. None of the above Question 8 Which class of laxatives is NOT useful in managing opiod-induced constipation? a. Osmotic laxatives b. Bulk-forming laxatives c. Saline laxatives d. Stimulant laxatives Question 9 For undernourished, frail older adults, effective medications to promote weight gain include a. Dronabinol b. Megestrol acetate c. Ensure Plus d. No medications are FDA-approved to promote weight gain in older adults Question 10 Which of the following medications is constipating? a. Erythromycin b. Morphine c. Lipitor d. Synthroid

NURS 6540 Advance Practice Care of Frail Elders Week 8 Discussion

Nursing Homes in Your Community and Neighboring Communities

Nursing homes have become a viable option for geriatric patients who require routine care and need help performing basic activities of daily living, with about 3.3 million patients residing in nursing homes in the United States (Centers for Medicare & Medicaid Services, 2013). While nursing homes provide care and services to patients, problems can arise resulting in reduced quality of care and, in some cases, illness and morbidity. The severe implications of pressure ulcers make them a major concern for elders residing in nursing homes. The Centers for Medicare & Medicaid Services (2013) estimate that 7.5% of nursing home residents have pressure ulcers and about 82,000 patients develop them each year. In your role as the advanced practice nurse, you must understand factors that contribute to the incidence of pressure ulcers in order to improve patient outcomes. For this Discussion, you examine the prevalence of pressure ulcers in nursing homes and develop strategies for increasing awareness and reducing incidence.

To prepare:

Review Chapter 38 of the Flaherty and Resnick text and Chapter 12 of the Holroyd-Leduc and Reddy text.

Select four nursing homes in your community and/or neighboring communities. Research and locate reports on these nursing homes through organizations such as Centers for Medicare & Medicaid Services.

Compare the four nursing homes you selected based on reported cases of the development of new pressure ulcers.

Think about factors in the nursing home setting that contribute to pressure ulcer issues, such as patient activity, nutrition, or the number of staff available to care for patients.nurs 6540 week (1-11) Discussion Essay.

Research guidelines for the prevention of pressure ulcers. Think about how you might increase awareness among nursing home staff about the incidence and consequences of pressure ulcers in patients.

Post on or before Day 3 a brief description of the four nursing homes you selected from your community and/or neighboring communities. Compare these four nursing homes based on the reported cases of new pressure ulcers. Then, explain factors in the nursing home setting that might contribute to incidence of pressure ulcer issues. Finally, based on guidelines for the prevention of pressure ulcers, explain how you might increase awareness among nursing home staff about the incidence and consequences of pressure ulcers in patients.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different nursing homes than you did.

Offer and support an alternative perspective based on your own experience and additional literature search.

Validate an idea with your own experience and additional literature search.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

NURS 6540 Advance Practice Care of Frail Elders Week 9 Discussion

Treating Patients in Specialized Areas of Care

When treating frail elder patients in specialized areas of care, there are various dynamics that might impact patient care plans. From questions about potential outcomes, benefits of treatment, and quality of life to factors such as personal values, families, culture, and religion, decision making can be difficult for patients and their families. As the advanced practice nurse, you must support them through this process. For this Discussion, you examine the following case studies and consider how you might address the needs of the patients and their families.

Case Study 1:

Mr. Wiggins is a 78-year-old African American male with chronic kidney disease, which requires dialysis. The etiology of his renal disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy. He has been on hemodialysis for the past 10 years and has done relatively well. Four weeks ago, he had a major CVA and is minimally responsive. His condition is not expected to change, and the family is having a difficult time with his recent health changes. Advanced directives were discussed with them, and his wife is a durable power of attorney for his health care. The wife hates to see her husband this way and understands this is not how he would want to go on, but their children and many of the family members (his brothers and sisters) think the patient will return to himself. They want everything done in terms of life support measures—full code status. His family wanted a feeding tube placed, and he is now receiving 24-hour tube feedings. You are the NP caring for Mr. Wiggins. You have known and cared for him and his wife for several years. The wife pulls you aside, shares her dilemma, and asks you to make the decision regarding continuing medical care/support for her husband. How will you respond?

Case Study 2:

Mrs. Adams is a 96-year-old Caucasian female who has recently been diagnosed with colon cancer. She was admitted to the hospitalist service through the ED with dehydration and rectal bleeding. The bleeding resolved, and she received 2 units of PRBs and fluid/electrolyte replacement. She is stable and ready to be discharged home.

Mrs. Adams is in remarkably good health, and other than arthritis and mild HTN, she has no significant medical or surgical history. She is able to carry out all of her essential daily living activities. She pays her own bills, is competent, and has good functional abilities. She was driving up until last year. Now, she has neighbor’s assist with weekly shopping and transportation to church. Her sensory, functional, and cogitative abilities were evaluated this admission and remain intact. She has been offered palliative surgical intervention, but deferred all treatment. Her only son is in agreement with his mother’s decision. Her parents and husband are deceased. You have been asked to obtain advanced directives. What will your discharge treatment plan be for Mrs. Adams?

Case Study 3:

Mr. Pierce is an 82-year-old East Indian male, recently widowed 6 months ago. He fractured his left hip 2 months ago attempting to climb his backyard fence to get his cat out of a tree. His children live internationally and have been taking turns caring for him. His eldest son brought him in through the ED last night because Mr. Pierce started having shortness of breath and his lips turned blue. In addition, his son noticed his left leg was very swollen compared to the right. The ED nurse practitioner ordered a thin cut cat scan (CT) with pulmonary embolism (PE) protocol and deep vein thrombosis (DVT) scan. Mr. Pierce has a large DVT that is obstructing circulation and multiple pulmonary emboli. His condition is life threatening and he is only expected to live a few weeks. He has a living will and advanced directives and has requested to be able to die in the comfort of his home. “I hate hospitals.” You have been consulted at the patient and family’s request because you are Mr. Pierce’s primary care provider. What additional services can be offered to ensure his care/comfort at home and to give him peace of mind regarding his estate?

To prepare:

Select one of the three case studies. Reflect on the provided patient information.

Think about potential outcomes for the patient in the case study you selected.

Consider how care, treatment, and/or support might be facilitated for the patient. Reflect on how you might also address the needs of the family.

Post on or before Day 3 an explanation of potential outcomes of the patient in the case study you selected. Then, explain how care, treatment, and/or support may be facilitated for the patient. Include how you might address the needs of the patient’s family as well.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different case study than you did.

Offer alternative outcomes based on the case study and provided patient information.

Share additional suggestions for the care, treatment, and/or support for the patients in the case studies your colleagues’ selected.

Validate an idea with your own experience and additional literature search.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

NURS 6540 Advance Practice Care of Frail Elders Week 10 Discussion

Community Advocacy Agencies

Having received a diagnosis of Alzheimer’s and encountering the associated stigmas, Michael Ellenbogen encourages increased advocacy efforts for the geriatric population struggling with this disease. He says, “We did nothing wrong to get this disease, and we need to speak up to let our voice be heard…There are no excuses for not wanting to help. The human cost factor is too high, and we are all accountable to do something” (Ellenbogen, 2012). As an advanced practice nurse caring for the geriatric population, it is important for you to join in advocacy efforts within your community whether it is in support of Alzheimer’s or another prevalent need such as abuse. You should be aware of community agencies that advocate for the well-being and care of your local geriatric population, as these agencies often provide resources and assistance to the elderly in need. In your role of care, you are able to identify prevalent needs and work with patients, their families, and agencies to promote change and impact lives.nurs 6540 week (1-11) Discussion Essay.

To prepare:

Review this week’s media presentation, as well as the American Geriatric Society’s Public Policy and Advocacy website in the Learning Resources.

Locate and research two agencies that advocate for the elderly in your community. Consider their current advocacy actions and/or campaigns.

Reflect on your experiences and observations at your practicum site. Consider new advocacy actions you might suggest to the agencies you selected. Based on these advocacy actions, think about new policies that might improve the care of the population at your current practicum site.

Post on or before Day 3 a description of two agencies that advocate for the elderly in your community, including their current advocacy actions and/or campaigns. Then, explain new advocacy actions you might suggest to these agencies based on your experiences and observations at your practicum site. With these advocacy actions in mind, suggest at least one new policy that might improve the care of the population at your current practicum site.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who are in different practicum settings than you. Explain issues within your own community that might impact the advocacy actions and policies suggested by your colleagues.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

NURS 6540 Advance Practice Care of Frail Elders Week 11 Discussion

Discussing End-of-Life Care

There is a human tendency to postpone uncomfortable or unpleasant tasks.

—Nancy Kummer, geriatric patient

This human tendency to avoid the unpleasant makes end-of-life care and hospice decisions difficult for many patients to discuss with their families. Kummer is a former social worker who used to counsel patients with terminal illnesses, yet she avoided discussing her own end-of-life wishes with her children. While many Americans, like Kummer, agree that these discussions need to take place, few have actually had these conversations with their families (Lazar, 2012). Although initiating conversations about end-of-life care and hospice might be difficult for patients, as an advanced practice nurse, facilitating these conversations is an integral part of your geriatric nursing practice. For this Discussion, consider how you would facilitate care conversations with the patients and families in the following case studies:nurs 6540 week (1-11) Discussion Essay.

Case Study 1:

Mrs. Sloan, a 69-year-old widow, is about to enter the hospital for an elective cholecystectomy; she is being medically cleared by her primary care provider. During the discussion, she requests to be placed on a no code status during her hospitalization. Mrs. Sloan claims that besides her gallbladder problem, her general health status is good. She wishes to have the surgery to avoid any further attacks, which have been very painful. She states, however, that if during surgery or her postoperative period, she undergoes a cardiac arrest, she would prefer not to be resuscitated. She has read about the chances of successful resuscitation, and has determined that the risk of brain damage is too high. For this reason, she is requesting a no code status.

Case Study 2:

Ms. Stearns is an 83-year-old nursing home resident with hypertension, coronary artery disease, arthritis, renal insufficiency, hearing impairment, and a previous history of stroke. She also has a foot deformity from childhood polio. She is disoriented at times. She has lived in the nursing home for 10 years and rarely leaves the chair beside her bed. She has recently developed urinary incontinence, but has refused a bladder catheterization to determine postvoid residual urine or possible bladder infection. She does not have a diagnosis of dementia; however, current testing reveals that she performs poorly on a standardized mental status examination. She can, however, identify all the staff in the nursing home, and she can describe each patient who has been in the bed next to hers over the past 10 years. When asked to explain why she does not want bladder catheterization, she gives several reasons. She states that the incontinence does not bother her, and that she has always been a very private person. She particularly dislikes and objects to any examination of her pelvic organs; in fact, she has never had a pelvic examination nor has she ever had sexual intercourse. She realizes that she has a number of medical problems and that any one of them could worsen at any time. She states she is not willing to undergo any treatment for any of her current problems should they become worse.

Case Study 3:

Mr. Marley, age 91, is admitted to the intensive care unit following a stroke. The stroke progressed from mild hemiparesis and difficulty speaking to complete unresponsiveness and an inability to swallow. His daughter feels certain, based on prior explicit conversations with her father, that he would not want to have any treatment that would prolong his life and leave him in a severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s assessment of their father. The son claims that their father still has a strong desire to live, and that he has been very active in his church until this stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is asked about insertion of a feeding tube. It is explained to the family that without food and fluids, their father will die fairly quickly. There are no existing advance directives or a designated health care decision maker noted for Mr. Marley.nurs 6540 week (1-11) Discussion Essay.

To prepare:

Review Chapter 14 of the Holroyd-Leduc and Reddy text.

Reflect on the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families.

Think about how you, as an advanced practice nurse, would approach a family who wants “everything” done for a patient with only a limited time to live.

Consider when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services.

Select one of the three provided case studies related to the end-of-life care of the frail elderly. Reflect on potential patient outcomes and how you would facilitate the discussion of care with this patient’s family.

Post on or before Day 3 an explanation of the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families. Explain how you would approach a family who wants “everything” done for a patient with only a limited time to live. Then, explain when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services. Finally, explain potential outcomes of the patient in the case study you selected and how you would facilitate the discussion of end-of-life care with this patient’s family.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected different case studies than you. Based on the site of care, suggest strategies for establishing the role of advanced practice nurses in end-of-life discussions with patients.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

nurs 6540 week (1-11) Discussion Essay.

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