NUR104 Assessment Task 3: Case study 40% (1500 words)

NUR104 Assessment Task 3: Case study 40% (1500 words)
Case study 1.
Read Louis’s story, outlined on page 276- 278 of your course textbook (Bryan,
Montayre and Bernoth, 2017, p. 276). [750 words]
Discuss the biophysical processes pertinent to the case.
The case is about Luis who is suffering from delirium. The two biophysical processes that
are pertinent to the case are Delirium and dehydration. Delirium is the condition that is
very common to older individuals who become unwell. The clinical manifestations of
delirium include the mental fluctuations, disordered levels of thinking and changes in
consciousness (Bernoth and Winkler, 2016). Louis experience of food poisoning which
made him vomit four times is the main cause of his current dehydration. Vomiting as a
result of food poisoning decreases oxidative metabolism in the brain causing abnormalities
of various neurotransmitter systems thus resulting into cerebral dysfunction. The cerebral
dysfunction makes the mental status of Luis to fluctuate leading to disordered levels of
thinking and changes in his consciousness. This makes him to become confused and when
he is admitted in the hospital he yells at everyone in the hospital including the staff.
Discuss the psychosocial processes pertinent to the case.
The two psychosocial processes that are pertinent to the case include depression and
cognitive impairment. The cognitive impairment of Louis includes memory loss, language,
his perception and orientation to time or place. The cognitive impairment that makes Louis
to be defiant in hospitals and this can lead to inappropriate medication or management.
Another psychosocial processes involved in the case is emotional and psychological
distress. Besides, Louis’ mental state makes him to be agitated by health specialists in the
hospital and becomes difficult to be managed by nurses in the healthcare facility. It is as a
result of his mental health status that makes him become confused in thinking (King, et al.,
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2013).
Furthermore, Louis might be undergoing emotional and psychological distress as a result
of separation of his daughter who has become married. He used to see his daughter daily
but now he can only see her only on few occasions which made him to be emotionally and
psychologically stressed. This can be supported by Betty’s statement that Louis’s current
behaviour occurred suddenly after the wedding of his daughter.
Identify an assessment tool appropriate for use in this case and discuss key elements
of the tool.
The appropriate tool for use in this case is Delirium Risk Assessment Tool (DRAT).The
assessment tool is used to identify the risk factors of delirium. Some of the delirium risk
factors identified by the DRAT include Visual impairment like difficult to read newspaper,
cognitive impairment, dehydration and severe illness such as mental disorders and
depression. If the patient is at risk the next step is to conduct the cognitive screening
assessment referred to as confusion Assessment Method (Beard et al., 2016).
The first feature of confusion assessment tool is the acute onset and fluctuating course
which is commonly obtained from the family member. Besides, the nurse can assess the
feature following positive responses to some questions that are based on the patient’s
health condition. The second feature is inattention which is shown by a positive response to
focusing attention of the patient. The third feature is disorganized thinking which
determines whether the patient is disorganized or incoherent. The fourth feature of
confusion assessment tool is altered level of consciousness which determines whether the
client is alert (Bernoth and Winkler, 2016).
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Discuss 3 priorities of care for this person.
 One of priorities of care to Louis is to apply a person centered care approach. This
will involve gaining more valuable information about Louis and his family which
will play a critical role in care approach. The person centered care approach will
also involve consisted care for Louis and developing a relationship with him
(Butler, 2017).
 Monitoring and controlling his clinical vital signs such as temperature, blood
pressure and heart rate. Controlling such vital signs will help in maintaining his
health to the optimum (Bernoth and Winkler, 2016).
 Provide aid in the treatment of underling health issue of biochemical imbalance
such as electrolyte imbalance and dehydration to manage the client’s pain.
Dehydration involves the loss of water from the body which is mostly accompanied
by an imbalance of electrolytes such as potassium and sodium. Nurses can provide
ensure Louis consumes clear fluids such as water and sports drink. Besides, they
can manage the condition by applying intravenous fluids to rehydrate Louis (Butler,
2017).
Discuss any equity, rights and access issues relevant to the case.
One of the issues of rights, equity and access that is relevant to the case is failure of nurses
to provide comprehensive assessment of Louis’s physical condition, cognitive, social, risk
factors and the existing medications. Louis has the rights to access quality treatment which
should involve comprehensive assessment. Nurses failed to provide comprehensive
assessment such as measuring clinical vital signs such as temperature and his blood
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