You are working in a general practice (GP) clinic as a registered nurse. Your next patient is…

Length:2000 words +/- 10% (excluding references) Markers will stop reading at the maximum allowable word count

Referencing: At least seven (7) high quality, current resources (published within the last 5 years), integrated in CDU APA 6th style (APA 7th accepted)

Relevance:High quality aged care is dependent on a holistic and integrative approach to patient assessment and care planning. Assessment three is designed to meet the learning outcomes: 1,2,3,4,5,6

Instructions

  • For assessment three read the following case study and supplementary documentation and respond to the following questions:

You are working in a general practice (GP) clinic as a registered nurse. Your next patient is Mr Alexander Kumar and his Wife Sarah. Alexander is 85 years of age and is the main carer for his wife who has dementia. Alex has not attended the clinic for himself in over 3 years, but normally attends with his wife for regular check-ups.

When Alex and Sarah arrive, you notice that Alex is limping and both Alex and Sarah look underweight. You also notice that both their clothes look a little dirty, which is unusual for them. When you read their medical file, you note that they have no services in place and their children all live interstate. When you ask Alex, what has brought him in, he tells you he has a wound on his leg which he has been dressing at home for three months, but it is not getting better. Alex tells you he hasn’t seen a doctor about his leg earlier as he can no longer drive and finds it difficult to catch public transport with his wife, who sometimes becomes agitated and upset.

1. Aged care services and interdisciplinary care

  1. Identify and discuss aged care services and interdisciplinary referrals that you would make as a registered nurse to promote Alex and Sarah independence. Provide a rationale for the services you have selected and link this to the case study.

2. Age related changes and Patient assessments

  1. Identify five body systems you would like to assess with specific linkage to the case study. Provide a description of the assessment and possible age-related changes (specific to the body system) that the patient may be experiencing and how this is impacting on the patient’s quality of life.
  2. Identify five different assessments (not body systems) you would perform on Alex and link these assessment to the case study. With each assessment provide a rationale as to why you would perform this assessment.

3. Medication management

Examining the patient’s medication history answer the following questions:

  1. Identify and describe the age-related changes that impact on pharmacokinetics (Absorption, Distribution, Metabolism & Excretion)
  2. The older person is vulnerable to adverse drug events. Identify and describe what factors in the case study increase the risk of an adverse drug event.
  3. For each medication describe what the medication is used for and any potential complications that Alex may experience while taking this medication.

4. Reflection

  1. Reflecting on the case study evaluate the impact of your own personal experiences and beliefs on how you would feel in this situation.

History

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Assessment data

Patient profile

Alexander Kumar, 85-year-old man

Chief complaint

Ulcer to left lower leg

History of complaint

Small wound appeared over 3months ago, unsure what caused it.
Applying pawpaw ointment and dry dressing every few days.

Phx

Hypertension, GORD, Myocardial Infarction 10 years ago, angina, arthritis (knees)

Allergies

Nil known allergies.

Medications

  • Aspirin 100mg mane

  • Perindopril 2mg mane

  • GTN 400mcg spray S/L prn

  • Omeprazole 20mg mane

  • Panadol Osteo 2 tablets twice a day (recommended

    by pharmacist)

  • Ibuprofen 400mg prn

Alcohol use

Social–1 to 2 glasses of white or red wine with dinner each night. May have a glass of port once or twice a week

Tobacco use

Smokes 10-15 cigarettes daily. Rolls his own from a tobacco pouch, no filters.

Drug use

Nil.

Home environment

Lives with wife Sarah.
Sarah has dementia, Alexander is her fulltime carer. Sarah always needs supervision, she likes to walk off and becomes disorientated easily. Sarah needs prompting to eat and drink. She needs assistance to wash and dress.

Work environment

Retired school teacher

Stress

States he is managing just fine, there are people worse off them him.

Education

Post graduate studies

Economic status

Self-funded retiree

Sexual practice

Married–high school sweet hearts. Has four sons all living interstate.

ADLs

Independent. Assists wife with all hers cares.

IADLs

Does not drive states the traffic is too fast for him now. Needs reading glasses and uses a walking stick due to arthritis pain in knees.

Cognitive function

Nil identified.

Diet

Doesn’t have much of anappetite. Wife is very fussy with food.

Sleep

5-6 hours a night, broken sleep. Gets up several time to toilet or assist wife with toileting. Falls asleep in the chair whilst watching TV most evenings

Health check ups

Has not been to the GP for self in 3 years. Regularly attends for wife

Vital signs

Temp 35.9, Pulse 62, Respiration 15, SpO2 96% RA, BP 135/65, BGL 4.3mmols/L, Pain 6 out of 10

NUR341 Assessment 3–Case study supportive document

1

2.

a. Identify and discuss aged care services and interdisciplinary referrals that you would make as a registered nurse to promote Alex and Sarah independence. Provide a rationale for the services you have selected and link this to the case study.

Age related changes and Patient assessments

  1. Identify five body systems you would like to assess with specific linkage to the case study. Provide a description of the assessment and possible age-related changes (specific to the body system) that the patient may be experiencing and how this is impacting on the patient’s quality of life.

  2. Identify five different assessments (not body systems) you would perform on Alex and link these assessments to the case study. With each assessment provide a rationale as to why you would perform this assessment.

Medication management

Examining the patient’s medication history answer the following questions:

  1. Identify and describe the age-related changes that impact on pharmacokinetics (Absorption, Distribution, Metabolism & Excretion)

  2. The older person is vulnerable to adverse drug events. Identify and describe what factors in the case study increase the risk of an adverse drug event.

  3. For each medication describe what the medication is used for and any potential complications that Alex may experience while taking this medication.

3.

1. Aged care services and interdisciplinary care

4. Reflection

a. Reflecting on the case study evaluate the impact of your own personal experiences and beliefs on how you would feel in this situation.

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