NUR104 Assessment Task 3: Case Study Analysis

NUR104 Assessment Task 3: Case study 40%
Case study 1.
Read Rob’s story, outlined on page 325-326 of your course textbook (Scoot, Shannon & Davies,
2017, p. 325-326).
Discuss the biophysical and psychosocial processes pertinent to the case.
Rob is experiencing symptoms and signs of Alzheimer’s disease. Alzheimer’s disease is a chronic
disease which causes degeneration of neurones. The disease progresses slowly and it is the cause
of 70% of all cases of dementia worldwide (Khan, Elhassan, and Qureshi 2014, p. 47). Early
symptoms of Alzheimer’s disease are difficulty remembering recent events and memory loss. As
the disease advances, symptoms such as language problems, disorientation, mood swings and
lack of motivation develop. Rob is not able to remember where he left some tools he had used
recently. He also experienced difficulty in driving which led to him causing an accident.
Alzheimer’s disease leads to loss of neurons and synapses in the cerebral cortex. This leads to
atrophy of affected brain regions especially temporal and parietal lobes. Frontal lobe and
cingulate gyrus may also be affected. The disease result due to deposition of insoluble beta
amyloid plaques and neurofibrillary tangles outside and around the neurons. Beta amyloid
plaques are formed when gamma secretase and beta secretase divide the amyloid precursor
protein into smaller fragments through proteolysis. According to hall (2015), amyloid precursor
protein is a transmembrane protein which is important in the growth and repair of neurones after
injury. Therefore, division impairs its function. Neurofibrillary tangles result due to chemical
changes in tau protein. Tau protein is important in stabilizing microtubules. In Alzheimer’s disease
tau protein becomes hyper phosphorylated and pair with other threads creating neurofibrillary
tangles which disintegrate neuron’s transport system (Serrano-Pozo 2015). The disease
mechanism result due to deposition of toxic proteins around the neurons which induces apoptosis
therefore, progressive neuron degeneration. Psychosocial factors such as low educational
achievements, non-mentally stimulating activities and lack of physical exercises have been found
to contribute to Alzheimer’s disease (sachdev et.al 2017 p. 11-23).
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
Appropriate assessment tool for Alzheimer’s disease is the Alzheimer's disease assessment scale-
cognitive subscale ( ADAS-Cog test).This tool mainly measures language and memory. It consists
of 11 parts and takes approximately 30 minutes to administer. It measures two-part scale, the
cognitive function and non-cognitive functions such as behavior and mood. The 11 parts of ADAS
are: word recall task which can be tested by giving the patient a list of ten words and asking the
patient to recall as many words as possible. This helps in testing short term memory. Naming
objects and fingers can be tested by presenting different items to the patient asking him to name
them. Following commands like making a fist, Constructional praxis to test visuospatial abilities,
Ideational praxis, orientation and word recognition task are other items to remember test
directions, spoken language comprehension and finally word finding difficulty (Solomon, Feaster,
and Miller 2016, p. 286).
Discuss 3 priorities of care for this person.
Self-care deficit related to cognitive decline and physical limitation is one of the priority nursing
diagnoses. The patient can be helped to remember as many tasks as possibly by maintaining
regular daily activities and dividing tasks to smaller parts (Ackley, Ladwig and Makic 2016).
Altered thought process related to irreversible neuronal damage can be intervened through
multidisciplinary involvement and also pharmacological intervention (Livingstong et.al 2017,
pp.2673-2734). Risk of injury related to weakness and inability to recognize or identify hazards in

the environment is another priority nursing diagnosis. Individuals can be helped to avoid injuries
by providing a safe environment and removing all unnecessary items in the patient environment.
Discuss any equity, rights and access issues relevant to the case.
Poor care and support can breach the rights of people with Alzheimer’s therefore caregivers
should be advocates to these patients due to their forgetfulness and decline cognition.
Case study 2.
Read Dulcie’s story, outlined on page 370 of your course textbook (Samuelson, Crawford &
Alexander, 2017, p. 370.
Discuss the biophysical and psychosocial processes pertinent to the case.
Eating diet lacking one or more nutrients can lead to a condition called malnutrition. Important
nutrients are carbohydrates, proteins vitamins and minerals. Malnutrition is common in old
people especially those who are 65 years and above. This is due to several factors which can be
either intrinsic or extrinsic. Diseases such as gastroenteritis and chronic illnesses can lead to
malnutrition (Cederholm.et.al 2015 p.335-340). These diseases affect digestion and absorption of
nutrients thus reducing nutrients available for use. They can also increase metabolic demand,
decrease food intake or directly lead to nutritional loss for example in conditions such as
diarrhoea. The digestive system undergoes changes in old people. This results in decreased
nutrients absorption and malnutrition can result. Old people also have decreased appetite and
therefore intake of less food. They also have health problems with a wide range of food therefore
influencing their nutrition. Psychosocial factors such as poverty and food prices have an influence
in individual's nutrition (Bokhari.et.al 2018 p.351). Poor socioeconomic status inhibits purchase of
nutritious foods such s meat and milk. This forces poor people to opt for affordable food even
though they are not of any nutritious benefit. Agricultural productivity is also a contributing factor
to malnutrition. Food shortages can be caused by natural calamities such as famine and floods.
Poverty can also be a cause as farmers cannot afford to buy fertilizers, pesticides or storage
facilities. Loneliness can also contribute to malnutrition. From Dulcie's story, it is clear that she is
not eating a balanced diet now that she is living alone. She takes simple meals which may
contribute largely to her nutritional status deteriorating. Therefore, living with other family
members can help stimulate appetite.
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
The most appropriate tool to assess malnutrition in old people is the MNA tool. It is used to
screen for malnutrition or risk of malnutrition in people with 65 years and above. It consists of six
questions. They include; asking the patient whether there has been a decline in food intake for
the last three months due to loss of appetite or any other digestive problems. Two points are
given if there is no decrease in food intake, 1 point if there is moderate decrease and 0 if there is
severe decrease in food intake. Another question is asking about weight loss within the last three
months. Score of zero is given if there is a loss of more than 3 kg, 1 point if the patient doesn't
know, 2 points if weight loss is between 1 and 3 kgs and 3 points if no weight loss. Mobility is
another part. A score of zero is given if the patient is on bed or chair bound, 1 point if the patient
is able to get out of bed and 2 points if the patient can go out. If the patient has suffered from any
psychological stress or an acute disease, 0 point is given and two points if no history of
psychological stress or an acute disease. If the patient has suffered from neurological problems
such as severe dementia or depression, 0 is given. If the patient has mild dementia 1 point is given
and two points if the patient has no psychological problems. Finally, body mass index is done. If
the patient has a BMI of less than 10 a score of zero is given.1 point is given if the BMI is between

10 and 21, 2 points if BMI is between 21 and 23 and 3 points if the BMI is more than 23. In total,
between 12 and 14 points indicate normal nutrition, between 8 and 10 points indicate risk of
malnutrition and between 0 and 7 points shows malnutrition (Marshall.et.al 2017).
Discuss 3 priorities of care for this person.
Imbalanced nutritional intake less than body requirement related to poor appetite and changes in
the digestive system is one of the priorities of care. This can be intervened by serving food in a
pleasing manner to stimulate appetite.
Activity intolerance related to decreased energy levels is also another priority of care. Old people
can be helped by encouraging them to perform their duties slowly and having rest periods in
between.
Risk of injury related to poor muscle tone and low immunity. Old people have decreased
immunity and malnutrition makes it worse. Therefore, patients should be encouraged to avoid
situations that can predispose them to injuries.
Discuss any equity, rights and access issues relevant to the case.
People have a right not to be malnourished. Old people find it difficult to fight for their rights
therefore, health professionals should be their advocates. They should be encouraged on what to
eat and what not to eat in order to maintain normal nutritional status.
Case study 3.
Read Betty’s story, outlined on page 389 of your course textbook (Robson 2017, p. 389).
Discuss the biophysical and psychosocial processes pertinent to the case.
Falls are a common and serious health problem with consequences especially in elderly. They are
significant in causing mortalities and morbidities and are class of preventable injuries. The cause
of falls is usually multifactorial and therefore requires multidisciplinary approach in the
management. Falls are caused by a number of factors which may be either intrinsic or extrinsic.
Intrinsic factors include; existence of an ailment or disease for example stroke (Pasquetti, Apicella,
and Mangone 2014, p.222). Extrinsic factors include environmental factors such as poor lighting.
Intrinsic factors such as balance and gait can cause falls. This may result from diseases such as
stroke, Parkinsonism, arthritic changes and neuromuscular diseases. Medication side effects given
for other conditions may contribute to falls. Medications such as sedatives, polypharmacy and
cardiovascular medications are of great importance. Visual conditions such as glaucoma, cognitive
problems such as dementia and cardiovascular conditions such as orthostatic hypotension are
also important in causing falls in elderly. Extrinsic factors such as poor lighting and eyesight
deterioration with age can cause falls as old people cannot see clearly especially in dim light and
therefore may not see hazards around them. Stairs with inadequate handrails are also a risk
factor. Old people have reduced balance and therefore require some support especially in
climbing stairs. Doorways without adequate headroom and floors with low friction can also cause
falls. Low friction floors cause poor traction and individual instability. People with joint problems
such as arthritis require additional support when walking. Walking aids such as walking sticks or
walking frames are important to them. Therefore, lack of these walking aids my lead to falls
(Ungar et.al 2016, pp.877-882).
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.