NUR104 Assessment Task 2: Workbook 45% - Musculoskeletal and Psychosocial Changes in Ageing, Social Justice Principles, and Care Planning for Mrs. James

This workbook covers musculoskeletal and psychosocial changes in ageing, social justice principles, and care planning for Mrs. James. It explains the musculoskeletal changes that occur in ageing and the psychosocial challenges associated with fractures. It also discusses the principles of access and participation and provides four actions that the nurse could take to assess and provide care appropriate for Mrs. James’s situation to reduce risk, promote health and ensure safety.

NUR104 Assessment Task 2: Workbook 45%
Student Name:
Student ID:
Rubric Criteria:
Use of evidence to analyse the biophysical, and psycho-social processes associated with
ageing.
Question:
1. Explain the musculoskeletal changes that occur in ageing that could have
predisposed Mrs. James to the fracture.
2. Describe two possible psychosocial challenges associated with Mrs. James
fracture.
Response:
1. Muscles in the elderly lose tone and become rigid with age. The bones are more
susceptible to break because of their brittle nature. The overall height of bones
decreases due to shortening of trunk and spine. Breakdown of joints causes
severe inflammation, stiffness, deformity and pain in older people. Aging of
musculoskeletal system affects the quality of life in elderly. Loss of bone and
narrowing of inter-vertebral discs causes loss of locomotive strength and ability.
The amount of synovial fluid between joints decreases along with thinning of
cartilage. This causes the joints to become stiff and ligaments to shorten. There
is loss of lose mass in the elderly which will lead to brittle bones. Brittle nature of
bones increases the likelihood of occurrence of fractures (Effects of Aging on the
Musculoskeletal System, 2022). There are three major sources of physical pain in
bones that occurs in the elderly, i. e., joint pain, muscle strains and broken
bones. Muscles fibers loose their tensile strength due to inability of the body to
produce proteins required for muscles to grow. This results in small size of
individual muscle cells. Hormonal changes due to age related factors are also
responsible for decreased muscle mass. There is a high chance of fractures and
injuries in old age due to less flexibility of leg muscles. Poor flexibility also causes
excessive stress on joints leading to increased risk of pain in lower back. The
connective tissues in ligaments and tendons tend to become more rigid and
brittle as joints get stiffer with age. According to the case study, Mrs James
suffered a fracture after having a fall which occurred due to weakening of her
joints and ligaments. The patient is 89 years old which is an indication that the
density of bones is very less, as the loss of bones density is higher and rapid in
women. The cartilage joint gets thinner due to which there is a higher possibility
of fracture. Mrs. James has lost muscle strength in her legs due to which that fall
caused increased stress in her joints, ultimately leading to fracture.
2. Psycho-social challenges faced by Mrs. James after fractures include post
traumatic stress disorder, depression and chronic anxiety. Occurrence of
symptoms of depression impact the clinical outcomes of patient. Psychological
distress in elderly leads to chronic anxiety and persistent fear of falling along
with acute stress disorders. The severity of fracture in Mrs. James will impact a
wide of psychological conditions in her mind such as persistent stress and

nightmares from fear of falling again (The physical, psychological and social
impact of long bone fractures on adults: A review, 2019). Orthopedic trauma
from fracture will lead to development of post traumatic stress disorder in Mrs.
James. There are many long and short term mental health problems associated
with onset of an injury. It may take time for a patient to recover from the trauma
of that injury and return to their independent activities of daily lives. Mrs. James
might becomes conscious of her appearance due to fractured limb.
Rubric Criteria:
Appraisal of the principles of social justice
Question:
Consider the social justice principles of access and participation.
1. Explain the principle of access and illustrate your explanation with one example
of a potential barrier that exists for Mrs. James regarding access to healthcare.
2. Explain the principle of participation and illustrate your explanation with one
example of an action that could be taken to ensure that Mrs. James is able to
participate in decisions relating to her healthcare
Response:
1. The principle of access to resources is an important principle of social justice,
which refers to equal access to all the available resources to various
socioeconomic groups. Different levels of injustices in society leads to variations
in accessing public resources. This principle of social justice ensures that patients
from different backgrounds have equal access to healthcare resources. This
policy ensures that patients do not have to face any potential barrier in receiving
healthcare services. Mrs James lives in a housing commission unit and she is
suffering from fracture. There is a possibility that she might be suffering from
lack of financial resources along with her vision problems due to which she has to
wear glasses. Mrs. James has issues related to vision along with a fracture that
she recently suffered from (Pal & et. al., 2019). A potential barrier for her might
include restriction of movement, psychological distress and sedentary lifestyle.
Due to lack of movement, she might not be able to pay a visit to a physician's
clinic and get herself checked. Restriction of activity and a substantially increased
risk of new fractures might prevent her from approaching healthcare institutions.
2. The principle of Participation ensures that involvement of patient and their
family members in decisions related to their health (Pallesen, Honore, Aadal &
Kjeldsen, 2022). The principle of participation is integral in achieving better
health outcomes for Mrs James. Active participation from patient and their
associated family can help individuals have appropriate knowledge about their
health problems. The healthcare workers offer information to patients about
their condition along with their solutions to help them recover. This collaboration
enhances the problem solving skills along with ensuring that needs of both, the
patient and healthcare professional is fulfilled. Possibility of a patient getting
involved in their treatment leads to enhanced care as the patient can discuss

about their personal goals. The nurse can develop a good rapport with Mrs
James and educate her about possible treatment method according to health
status of Mrs James. The treatment decision must be shared to minimize barriers
in delivery of care (Patient participation during primary health-care encounters
among adult patients with multi morbidity: A cross-sectional study, 2021). Mrs
James and the nurse can collaborate in informed decision making with effective
communication. Participation of patient in health related decisions is very helpful
in treatment of chronic conditions. Activation of participation by patient can help
in reducing the possibility of decline in health. Mrs. James' condition can be
improved the nurse gets her involved in treatment and diagnostic choices.
Rubric Criteria:
Interpret and use evidence to plan care to support the health needs of the older
person in diverse health settings
Question:
What are four actions the nurse could take to assess and provide care appropriate for
Mrs. James’s situation to reduce risk, promote health and ensure safety?
Response: (approx. 500 words)
The nurse should implement various reorientation strategies for Mrs James to
reduce the risk of her fall. The patient must be given access to hearing aids and
glasses to help her with her vision. The extrinsic and intrinsic risk must be
identified and eliminated for keeping the patient oriented. Mrs. James' house
must be free from all possible physical hazards and must be equipped with
assistive devices (Shen & et. al., 2019). The patient's bed must be kept in the
lowest position to reduce the risk of fractures. The patient should be
administered with vitamin D supplementation for improve the bone strength
and density. Behavioral therapy aids in ensuring that patient has a better
understanding of their health status.
The nurse can also employ the use of walking and hearing aids to reduce the risk
of fall or hitting a sharp object. Call bells must be attached at every corner of her
house so that she has resources to call for her at any possible situation. Rubber
soled socks and anti-slip shoes should be given to the patient for good support
and traction along with comfort.
Educating Mrs James about the risk factors associated with fractures is also very
important to ensure that the patient themselves is very careful about their
health status (Kua, Mak & Lee, 2019). If the patient falls, the nurse must
consistently check the breathing, pulse and blood pressure of patient along with
checking for severe injuries. In case the patient becomes unconscious,
ambulance must be contacted immediately. A fall risk assessment must be
performed from time to time to identify and eliminate the possibility of falling.
This includes initial screening of previous injuries and analysis of current health
status.
The position of beds must be kept low along with bed ends in proper place. Mrs.
James must be given non slipping footwear with friction to reduce the risk of slip

and trip. The floors must be kept obstacle free for free movement. Intentional
rounds for checking up on the patient must be done frequently to prevent the
possibility of slip and trip. Fitting of good lighting set up is crucial as the patient
suffers from vision problems (Arrieta & et. al., 2019). All forms of sharp objects
must be covered with soft cotton or stuffed toys to prevent severe injury of the
brain or even death. Nurse should introduce balance and posture exercises in
Mrs James' routine to ensure improvement of strength and gait. The entire
environment of her home must be patient oriented. The nurse should familiarize
with the patient and her family members to educate them about the health
status of the patient. Bathrooms, hallways and rooms in Mrs James' house must
possess sturdy handrails.
References:
Online
Effects of Aging on the Musculoskeletal System, 2022 [Online] Available through
<https://www.msdmanuals.com/en-in/home/bone,-joint,-and-muscle-disorders/
biology-of-the-musculoskeletal-system/effects-of-aging-on-the-musculoskeletal-system
>
The physical, psychological and social impact of long bone fractures on adults: A review,
2019 [Online] Available through
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556928/#:~:text=Psychological
%20sequelae%20are%20common%20after,stress%20disorder%2C%20depression
%20and%20anxiety.&text=Depression%20is%20common%20following%20injury%20and
%20may%20adversely%20affect%20clinical%20outcomes. >
Patient participation during primary health-care encounters among adult patients with
multi morbidity: A cross-sectional study, 2021 [Online] Available through <
https://onlinelibrary.wiley.com/doi/full/10.1111/hex.13306 >
Books and Journals
Arrieta, H., Rezola Pardo, C., Gil, S. M., Virgala, J., Iturburu, M., Antón, I., ... &‐
Rodriguez Larrad, A. (2019). Effects of multicomponent exercise on frailty in Long‐ ‐
Term nursing homes: a randomized controlled trial. Journal of the American
Geriatrics Society, 67(6), 1145-1151.
Kua, C. H., Mak, V. S., & Lee, S. W. H. (2019). Health outcomes of deprescribing
interventions among older residents in nursing homes: a systematic review and
meta-analysis. Journal of the American Medical Directors Association, 20(3), 362-
372.
Pal, S., Hitchens, M., Varadharajan, V. & Rabehaja, T., (2019). Policy-based access
control for constrained healthcare resources in the context of the Internet of

Things. Journal of Network and Computer Applications, 139, pp.57-74.
Pallesen, H., Honore, H., Aadal, L. & Kjeldsen, S.S., (2022). Improved active
participation among patients with severe acquired brain injury in early
rehabilitation. Implementation of a professional competence development
intervention. Work, (Preprint), pp.1-16.
Shen, Y., Chen, J., Chen, X., Hou, L., Lin, X., & Yang, M. (2019). Prevalence and
associated factors of sarcopenia in nursing home residents: a systematic review
and meta-analysis. Journal of the American Medical Directors Association, 20(1),
5-13.