Nursing Care Plan for Elderly Patients

This assignment focuses on developing a comprehensive nursing care plan for elderly patients. It requires applying knowledge from various nursing textbooks to address specific health concerns prevalent in this age group. Key areas include falls prevention strategies, pressure ulcer risk assessment and management, and addressing common mental health challenges like depression. The assignment emphasizes evidence-based practice and utilizes resources such as the Geriatric Depression Scale and NANDA Nursing Diagnoses.

Running Head: FOUNDATION OF CARE IN NURSING
Foundation of care in nursing
Name of the Student
Name of the University
Author Note

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Case study of Ron
Introduction
The assignment deals with the case study of Ron (88, M) experiencing cough, headache,
and fever since 8 days. The purpose of the assignment is to discuss the factors to be considered
for conducting the health assessment for Ron. Further, it covers risk assessments needed for the
patient supporting with rationale. The assignment discusses the implications of hospitalisation on
the patient and his family and intends to high light the ways to overcome them. Based on the
case study, the nursing care plan is developed using NANDA guidelines. These include nursing
diagnosis, goals, and nursing interventions appropriate for Ron.
Part 1 critical reasoning
Factors when considering the health assessment data
There is a need of past medical history and need to know the physiological conditions.
Past medication history is needed as certain medications are risk factors for constipation. For
instance, the use of statins and antimuscarinics are known to be associated with clinical
constipation. Past medical history is required to know the factors that may cause infection, or
probability of other chronic illnesses such as COPD and others. Poor mental health can be the
risk factor for older adults. Smoking, alcohols or drug abuse stress, anxiety and depression can
lead to chronic conditions. Mental health and the cognitive ability (Confusion, and delirium) are
the factors to be considered during the health assessment as they are contributors of may
complicated illnesses (Iqbal, Gupta, & Venkatarao, 2015).

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Social history is the other factors to be considered in the health assessment. Social
isolation in old age leads to poor mental and physical health. Since Ron is restricted to home
with decreased gait and mobility, he may be at risk of decreasing physical and mental health. In
addition, Ron does not have his wife with him and hence he may be lacking the emotional
support needed at this age. Social isolation leads to loneliness and depression at old age. It is
necessary to know the family members support and other important people in the life of Ron.
Further economic factors need to be considered to determine the care plan accordingly. Financial
barrier may hamper the diagnosis and care process (Jarvis, 2015)
Other factor to consider for risk is age. Ron is 88 years old and with aging alteration in
mobility is evident. It is due to the decreasing muscle function, strength and loss of muscle mass
and decrease gait. The decrease in gait is evident in Ron. Age is the risk factor for various
chronic illnesses (Bickley & Szilagyi, 2012). In addition there is need to consider the gender
issues as there is a difference in the health reacted behaviour between men and women. Some
patient may prefer to talk about health issue to same sex person. Knowing the patient’s culture
and ethnicity is important as health belies vireos in different culture and may hamper the health
assessment process. Language may act as barrier to health assessment, therefore it is required to
know the language preferred by Ron and if he needs medical interpreter (Jarvis, 2015)
Risk assessments and Rationale
 Fall risk assessment- Since Ron is needs assistance with activities of daily living as he
has an unsteady gait and walks with the 4-wheelie walker; there is an increased risk of
fall. Fall leads to complicated outcomes such as serious injury such as fracture, decline in
functional status, admission in hospitals, and increased use of medical service, and death

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from injury. Most elderly people develop a fear of falling after a fall. Thus, it is necessary
to assess the risk of fall or near falls in the case of Ron (Aranda-Gallardo, et al., 2013)
 Risk assessment for pressure ulcer- Ron is at high risk of pressure ulcer. Patients who are
bound to bed or wheelchair are at high risk of developing pressure ulcer. These are more
likely to occur at hips, buttocks, and sacrum. The risk of pressure ulcer needs to be
assessed as it is difficult to treat. Pressure ulcers significantly hamper the patients’ quality
of life and thus early identifying the conditions that may lead to this condition will help
prevent (Chou, et al., 2013).
 Mental state assessment includes risk assessment for geriatric depression and cognitive
impairment. The rationale for selecting this assessment is high prevalence of depression
among older adults. Depression decreases the quality of life as it commonly accompanies
complicating medical illnesses. Ron is 88 years old and lives with his daughter. He is
dependent on her physically and may be at risk of depression. His depression can be due
to social isolation for being mostly restricted to house (Conradsson, et al., 2013).
 Pneumonia risk assessment- The symptom commonly presented in pneumonia are fever,
headache, cough, tachypnoea, increased confusion, loss of appetite, breathlessness and
wheezing. These symptoms are also evident in Ron and hence it s necessary to identify if
he is at risk of pneumonia. The vital signs of the patient include pulse 105, BP 125/70,
respiratory rate 28, and temperature 37.8. Ron has not open bowels since four days and
symptoms similar to this are found in pneumonia (Iinuma, et al., 2015).
Implications of hospitalisations
Illness hampers the quality of life and decreases the self-esteem of any patient. In this
situation, the knowledge of body image and self identity can affect care. Ron may feel stressed

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about frailty and decreasing physical strength. Greater attention to body image can hamper the
delivery of care. Many elderly patients after the illness and hospital admission may feel
themselves as less attractive. Hospitalisation and illness are accompanied with dietary changes
and social isolation and loneliness. The psychological implications of the illness and bed rest
are worse. In addition to functional decline, the patients may feel anxious and depressed caused
by feeling of dependency. Ron may experience a sudden change in the mental function. As Ron
is dependent on his daughter for activities of daily living and emotional support, he may feel the
loss of autonomy. He may not be able to participate in clinical decision-making and may have
fear of compromising his preferences and values. The patient may also feel a loss of respect and
dignity. Hospitalisation of the household member leads to psychological distress among other
members in the family due to uncertainty of the health outcomes (Bello, et al., 2014).
The patient may feel homesickness and boredom, as he is mainly restricted to house due
to poor mobility. The illness may affect the education of the other in the house such as
grandchildren. It may influence the household responsibilities of Ron’s daughter and her
husband. Admission to hospital involves financial burden. Depending on the length of the
hospital stay, the financial difficulties may increase. If the socioeconomic status of the family is
low then the illness is an added burden on the family. Ron may also feel like burden on the
family (Berman, et al., 2014).
Nurse can deliver patient centred care where the patient’s values, beliefs and preferences
will be considered. Nurse can reduce the psychological implications in Ron by giving
motivational session and involving him in clinical decision-making. It will reduce the anxiety,
depression and poor self-image. By following the ethical principles of beneficence, non-

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maleficence and social justice, it is possible to overcome the psychological implications on Ron
and his family (Berman, et al., 2014).
Part 2- Nursing process
Nursing
Diagnosis
Goal Intervention Rationale Evaluation
Risk of ineffective
airway clearance
and infection
related to
respiratory tract as
evident from
persistent fever,
and cough since 8
days in the patient
and high
respiratory rate
(North American
To reduce the
infection like
symptoms such as
fever and headache
and promote
airway clearance
in-patient which
will be evidenced
by decreased
cough, tachypnoea
and respiratory
rate.
Conduct lung
assessment for
breath sound and
coarse crackles.
Note cough for
efficacy and
coordinate with
the respiratory
therapist (Ghosh,
OKelly, Roberts,
Barker, & Swift,
2016).
The presence of
coarse crackles
during the late
inspiration is
indicative of fluid
in airway. Airway
obstruction can be
confirmed by
wheezing (Gatford
& Phillips, 2016).
The patient
demonstrates
effective coughing,
decrease in fever.
The patient will
demonstrate
normal vital signs.
No sign of
tachypnea after
the intervention
Time- 48-72 hours

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Nursing Diagnosis
Association.,
2015)
Give medication
as prescribed by
the physician for
fever and cough.
These may include
antibiotics,
bronchodilators,
mucolytic agents
and monitor for
side effects and
effectiveness
(Ghosh, OKelly,
Roberts, Barker, &
Swift, 2016)
A variety of
medications are
available to
that treats the
specific problem.
Most of them may
promote airway
clearance. It may
decrease the
airway resistance
(Bullock &
Manias, 2013).
Educate the patient
on coughing, deep
breathing and
splinting
techniques and
proper use of the
medication and
inhalers. The
breathing
technique that will
be taught to the
patient is to take
It is important for
the patient to know
the proper
technique and
underlying
principle for
keeping airway
clean.
An ineffective
coughing leads to
compromised

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deep breath, and
hold for two
seconds followed
by coughing two
to three times in
succession
(Ghosh, OKelly,
Roberts, Barker, &
Swift, 2016).
airway clearance
Patient education
is necessary as
understanding the
prescription will
promote the safe
and effective
administration of
medication
(Tiziani, 2017).
Impaired
elimination and
exchange due to
risk for
constipation as
evident from the
stool retention for
4 days in Ron
(North American
Nursing Diagnosis
Association.,
2015)
To improve the
bowel movement
of the patient and
relief from
discomfort due to
unopened bowels.
Encourage the
patient to increase
the fluid intake
unless cardiac
limitations
(Ghosh, O'Kelly,
Roberts, Barker, &
Swift, 2016)
Adequate fluid
amount is required
to keep the faecal
mass soft
(Coggrave,
Norton, & Cody,
2014)
The patient has
improved bowel
frequency that is
normal at this age
The patient
demonstrates
relive from
discomfort.
The patient learns
the measure that
treats constipation
The patient
maintain normal
diet.
Time- 48 hours
Suggest balanced
diet to the patient
that consists of
adequate fresh
fruits, fibres,
vegetables and
grains (Ghosh,
O'Kelly, Roberts,
One should not
have around 20
grams of fibres per
day as it adds bulk
to the stool and a
makes the
defecation process
easier (Coggrave,

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Barker, & Swift,
2016)
Norton, & Cody,
2014)
The patient can be
administered with
laxative (Ghosh,
O'Kelly, Roberts,
Barker, & Swift,
2016)
Laxative irritate
the bowel mucosa
and causes rapid
propulsion of the
small intestine
contents (Moini,
2015)
Impaired safety
due to risk of fall
and injury as
evident from
decreased gait and
mobility (North
American Nursing
Diagnosis
Association.,
2015)
Improve patient
safety by
preventing fall, so
the patient will be
free of fall during
his hospitalisation
1.During every
shift the patient
should asses the
fall score of Ron
and the nurse must
screen Ron for
stability and
mobility skills (sit
to stand, supine to
sit, walking and
turning around)
(Zwar, et al.,
2016)
Fall scores helps to
determine the risk
of falling in the
patient. Depending
on the score
preventive
measures can be
taught to the client.
Screening will
help to determine
methods to ensure
safety (Cangany,
Back, Hamilton-
Kelly, Altman, &
Lacey, 2015)
The patient
demonstrates
safety behaviour in
two weeks of time
The patient has the
knowledge of fall
and fall prevention
techniques
Time -24-72 hours
2. Nurse should
keep the patient’s
In case the patient
wakes up at night

9FOUNDATION OF CARE IN NURSING
bed in the lowest
position all the
time and modify
the environment
such as removing
tables and chairs in
the path (Zwar, et
al., 2016).
to drink water or
toilet, lower bed
positioning will
reduce his risk of
fall. It is necessary
to remove
obstacles in the
patient’s path such
as chairs and
tables or any other
object to avoid
accident and fall or
injury. It is evident
from literature that
majority of falls
are related to
toileting.
Therefore it is
necessary that
path to washroom
is clear (Cangany,
Back, Hamilton-
Kelly, Altman, &
Lacey, 2015)
3. Ron should be
given yellow fall
Yellow bracelet
and socks act as

10FOUNDATION OF CARE IN NURSING
risk bracelet and
yellow socks so
that other nurses
and staff will be
aware of his
delicate situation
(Zwar, et al.,
2016)
alert for other
nursing staff. It
will increase their
vigilance and they
will be greatly
obliged to watch
for falls (Cangany,
Back, Hamilton-
Kelly, Altman, &
Lacey, 2015)
Conclusion
The paper comprehensively discusses the factors that are to be considered for the health
assessment of Ron. The risk assessment appropriate for the case study are highlighted and the
implications of hospitalisation on the patient is discussed. Illness hampers the quality of life and
decreases the self-esteem of any patient. It significantly hampers the mental wellbeing of the
family members. The nursing process presented in this paper comprises of diagnosis and goals
that are based on the NANDA principles. Risk of ineffective airway clearance and infection, risk
of fall and injury, and Impaired elimination and exchange are the three priority nursing
diagnosis. The interventions are designed corresponding to diagnosis and goals. NANDA
guidelines are useful and effective in designing appropriate care for the patient.

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