NUR341: A Detailed Case Study on Managing Alan's Healthcare Needs

This case study focuses on the health assessment of Alan, a 75-year-old man, addressing key issues such as maintaining a safe environment to prevent falls, managing visual impairments, and addressing potential weight loss due to limited access to nutritious food. The assessment includes questions to evaluate Alan's ability to perform daily grooming activities, mobility, and meal preparation. The study highlights the importance of creating a safe home environment, providing assistance with activities of daily living, and ensuring adequate nutrition. Priority issues identified are Alan's susceptibility to falls and injuries, and his risk of weight loss, leading to recommendations for a case officer examination and an ACAS assessment. The case study also discusses the challenges of transferring elderly patients to acute care environments and emphasizes the need for a multidisciplinary team approach involving physiotherapists, OT technicians, and dieticians. The goal is to improve Alan's overall well-being and independence through targeted interventions and support systems.

NUR341 Case Study: Alan
a. Questions for Alan b. Rationale
1. Do you find it difficult to maintain personal hygiene while performing activities
such as trimming your nails and combing your hair?
This question would help in accessing the level to which the patient is capable of
performing his daily grooming activities alone such as trimming his nails and
combing his hair. It would help in designing an adequate nursing plan to assist the
patient with interventions that would help him with activities of daily living.
2. Do you find it difficult to move from one place to another or climb up stairs?
This question would help in determining the extent to which the patient is capable
of moving from one place to another without hurting himself. It would further help
in evaluating whether or not the patient needs assistance with movement and
walking
3. Do you find it difficult to cook your meals and feed yourself independently?
This question would help in evaluating the extent to which the patient is able to
cook his own meals and at the diet that is being followed by him. It would help in
chalking out a care plan that would essentially highlight the fact that whether or not
there is a need to assist the patient with cooking and pay attention to his nutritional
needs.
c. Major issues d. Significance for Alan
Maintenance of a safe environment
Studies reveal that maintenance of a safe environment is extremely important to prevent fall and injury in the elderly people
(Ambrose,Paul & Hausdorff,2013,p.58). According to the RLT theory, it has been stated that proper care should be taken in
order to ensure ample lighting within the environment (Bibas,Levi,Bendyan,Mullie,Forman & Afilafo, 2014,p.140). Further, care
should also be taken so as to keep items of daily use within the reach of the patient, so that there is no possibility of tripping
over. Sharp objects must be kept out of reach and the floor should be kept dry at every moment. Care should also be taken not
to keep rugs or doormats in front of the door as there can be a high risk of tripping over and most of the incidences of falls
have been reported on account of the same (Prestmo et al., 2015,p. 1630). The case study reveals that Alan had encountered a
fall recently, hence it is extremely important to create a safe environment for Alan so that further incidences of fall can be
prevented.
Visual issues
Although, impaired vision at the age of 75 is common. This is on account of the degenerating tissues. Further, with the
degenerating muscles, the physical fitness is highly comprised and mobilisation is also restricted (Dunlop et al., 2015,p.98). The
case study reveals Alan to have problems with impaired vision. This indicates that he is at a high risk of encountering minor
accidents and falls. This also indicates that Alan could be exposed to several other injuries and hence external assistance could
be provided to him so as to make sure that he does not face issues with his activities of daily living.
Weight Loss It As per the RLT theoretical framework of accessing elderly patients, it must be stated here that with the advancement of age,
people find it extremely difficult to sustain independently (McKenna & Pajnkihar,2014,p.211). A major issue in close association
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to the consumption of food and feeding independently is seen. External assistance to help in the process of eating and drinking
has been reported to be of great help in the senior patients (Jekel et al., 2015,p.17).As has already been mentioned in the case
study, Alan goes out only when the need is primary. This suggests that he has limited access to nutritious food. Therefore, it
can be mentioned here that Alan would lose weight considerably which would affect his physical health well-being.
Nutrition
It should be mentioned that on account of the restricted access to nutritious food, in association to the case study, it can be
stated that the patient might be malnourishes and might be facing issues related to fatigue and weakness (Kim,Kim &
kim,2014,p. 418). Therefore, it can be said that the client must be addressed with adequate diet counselling so as to ensure
that he does not develop any issues related to excessive weight loss.
elimination
It has been reported in research studies that at the age of 65-80 years, elderly patients generally find it extremely difficult to
eliminate toxic wastes from the body on account of slower metabolism rate that leads to constipation (Gokalp & Clarke,
2013,p.914). Further, it should also be noted here that other physical health issues such as frequent need to urinate and
bladder atrophy are common in this age (Fillenbaum, 2013,p.95). In this case study, it has been stated that Alan is a man that
makes him susceptible to issues regarding prostrate problems. Hence proper care should be administered to Allan that would
make use of the bowel routines in order to adequately assist Alan in being able to eliminate wastes from the body without any
difficulty.
ADLs
As is evident from the case study scenario, Alan encountered a fall recently in the bathroom and hence it can be said that he
might have problems with bathing, feeding, dressing and other activities of daily living. So the nursing professional taking care
of him must focus on his taste and accordingly assist him with these activities so that he feels positive and looked after.
mobilization
The case study mentions that Alan only goes out once in two months to visit his GP and at an interval of 2-3 days to fetch items
of grocery. This clearly states that Alan has issues with mobilisation and must be assisted by a professional so as to help him
perform his daily chores with ease.
Social issues
Between the age of 60-80, it has been reported that elderly patients develop feelings of depression (Kim,Kim &
Kim,2014,p.417). This has been reported on account of feeling secluded from the society. The case study mentions that Alan
stays alone and is not visited by any friends or neighbours. This might lead to harbouring feelings of emotional turmoil which
might subsequently impair his social ability to interact with a group of people.
e. Priority issue one
Alan is susceptible to fall and injuries
Rational: Alan is susceptible to fall and injuries on account of his past fall incident which has been mentioned in the case study. Along with the same, it has also been
stated that he has poor vision that might heavily affect his ability to chop vegetables with a knife while cooking. This might lead to a cut and minor accidental injuries. It
has also been mentioned in the case study that he lives alone. Therefore, impaired visual ability would impede with the mobilising ability of the patient.
Justification: In order to ensure that Alan is safe and secure it is important to place him under the care of a home-based nursing professional who would take ensure that
the home-environment is safe for Alan and would further make sure that any accidents caused due to fall or injury is avoided to the maximum.
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f. Priority issue two
Alan is susceptible to weight loss
Rational: It has been mentioned in the case study that Alan retired 4 years ago and lives alone in a two storey building. This clearly states that he has no family members
to take care of him. As old age has been defined as a sensitive age and has been compared to the second childhood extreme care should be taken to ensure that the
elderly patient is mentally motivated and faces no issues with eating or sleeping disorders (Mckeena et al., 2014). Further, in this context, it should also be stated that
Alan walks to the petrol station to fetch food items once in a while. Hence, it can be said that Alan does not have proper access to nutritious food and this might lead to
malnourishment. It is extremely important to consume a healthy nutritious diet so as to stay physically fit and avoid issues related to physical health wellbeing at an
advanced age(Jekel et al., 2015,p.17).
g. Referral one
Examination by case officer: It is recommended that Alan must be thoroughly evaluated by the case officer. The case officer would assess the medical health condition of
the client and finalise the decision if the client is in need of home based support. Support system would include providing community professionals to assist Alan with
house-hold services such as cooking and cleaning, twice a week Myagedcare.gov.au (2018). In addition to this the professional could also help in fetching grocery
items and feeding so that the client is physically fit and at the same time mentally motivated to lead a physically active life Myagedcare.gov.au (2018).
h. Referral two
ACAS assessment: The ACAS assessment thoroughly conducts an assessment of the elderly patients and decides if the patient is eligible to be placed under special care. At
the same time, care is also taken to ensure that eligible patients have adequate access to government funded program Agedcare101.com.au. (2018). On the basis of
the assessment the elderly patients are placed at centres where they are looked after by professionals who are trained to look after old age patients.
i. Transferring issues to the acute environment
In accordance to the evidences furnished by the research studies, it has been noted that it is extremely difficult to transfer the elderly patients to acute care on account of
several health complications. In order to transfer Allan to an acute environment, a thorough coordination would be maintained with the multidisciplinary team. The
multidisciplinary team would comprise of a physiotherapist, OT technician and a dietician. The physiotherapist would assist the client in mobilising and make sure that the
client has proper access to mobility aids. The OT technician would make sure that the client has access to additional rails and shower chair so that the client can be
comfortable while washing. In addition to this, the dietician would scrutinise whether or not the client requires any health supplements. Further, the dietician would also
educate the client about the need to take a balanced meal at frequent intervals so as to avoid chances of being malnourished.
References:
Agedcare101.com.au. (2018). Aged Care Assessment (ACAT assessment). Retrieved from https://www.agedcare101.com.au/aged-care-
overview/aged-care-assessment-acat-assessment
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Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), 51-61.DOI:
https://doi.org/10.1016/j.maturitas.2013.02.009
Bibas, L., Levi, M., Bendayan, M., Mullie, L., Forman, D. E., & Afilalo, J. (2014). Therapeutic interventions for frail elderly patients: part I. Published
randomized trials. Progress in cardiovascular diseases, 57(2), 134-143.DOI: https://doi.org/10.1016/j.pcad.2014.07.004
Dunlop, D. D., Song, J., Arntson, E. K., Semanik, P. A., Lee, J., Chang, R. W., & Hootman, J. M. (2015). Sedentary time in US
older adults associated with disability in activities of daily living independent of physical activity. Journal of Physical
Activity and Health, 12(1), 93-101. DOI:https://doi.org/10.1123/jpah.2013-0311
Fillenbaum, G. G. (2013). Multidimensional functional assessment of older adults: The Duke Older Americans Resources and
Services procedures. Psychology Press,pp.66-69
Gokalp, H., & Clarke, M. (2013). Monitoring activities of daily living of the elderly and the potential for its use in telecare and
telehealth: a review. TELEMEDICINE and e-HEALTH, 19(12), 910-923. DOI: https://doi.org/10.1089/tmj.2013.0109
Jekel, K., Damian, M., Wattmo, C., Hausner, L., Bullock, R., Connelly, P. J., ... & Kramberger, M. G. (2015). Mild cognitive
impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimer's research &
therapy, 7(1), 17. Retrieved from: https://alzres.biomedcentral.com/articles/10.1186/s13195-015-0099-0
Kim, K., Kim, Y. M., & Kim, E. K. (2014). Correlation between the activities of daily living of stroke patients in a community
setting and their quality of life. Journal of physical therapy science, 26(3), 417-419.doi: https://doi.org/10.1589/jpts.26.417
McKenna, H., Pajnkihar, M., & Murphy, F. (2014). Fundamentals of Nursing Models, Theories and Practice, with Wiley E-Text.
John Wiley & Sons,pp.65-90
Myagedcare.gov.au (2018). Access aged care information and services | My Aged Care. [online] Myagedcare.gov.au. Available at:
https://www.myagedcare.gov.au/ [Accessed 1 Oct. 2018].
Prestmo, A., Hagen, G., Sletvold, O., Helbostad, J. L., Thingstad, P., Taraldsen, K., ... & Johnsen, L. G. (2015). Comprehensive geriatric care for patients with
hip fractures: a prospective, randomised, controlled trial. The Lancet, 385(9978), 1623-1633.DOI: https://doi.org/10.1016/S0140-6736(14)62409-0
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Rashidi, P., & Mihailidis, A. (2013). A survey on ambient-assisted living tools for older adults. IEEE journal of biomedical and
health informatics, 17(3), 579-590. Retrieved from:
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