Nursing Case Study Report Analysis

Running head: NURSING CASE STUDY
Nursing
Student Name
University Name
Author Note

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ANSWER TO QUESTION 1:
For geriatric population, falls are a common phenomenon. It is observed that falls are a
leading cause of serious injury in the older population having devastating and long-lasting
consequences (Cameron et al., 2018). The reason why older people are experiencing frequent
falls could be associated with their increasing imbalance and unnatural gait postures. In the
case of Olive, she has suffered a fracture on the neck of femur which had resulted in constant
pain and immobility. It has also been reported that people in the older generation have been
experiencing decreased muscle strength which does not give them the ability to conduct the
daily activities and be depending on other individual (Kihara et al., 2019). It is crucial for the
nursing professionals to question the patient about the history of falls and then administer the
nursing interventions for the effective reduction of falls. As per the Australian and New
Zealand Society for Geriatric Medicine, it is crucial to conduct yearly assessment programs
on elderly population above the age of 65 in the nation such that the risk of falls is reduced
and every citizen is shared about the prevention measures that needs to be undertaken by
them to reduce them (Peeters et al., 2019).
From the case of Olive, it can be observed that she is been prescribed Rivaroxaban for her
thromboprophylactic condition (Weitz et al., 2017). This medication is generally
administered to individuals who have been diagnosed with blood clots and vein thrombosis.
However, there is a reported muscle weakness and muscle spasms which may result in the
individual sustaining a critical fall (Christopoulou, Filippatos & Elisaf, 2017). Hence, a part
of the nursing interventions, it could be natural to plan appropriate exercises for the
individual such that muscle strength is significantly regained and enrolling them for
physiotherapy. According to the review conducted by Guirguis-Blake et al., (2018), it could
be observed that researchers who had conducted weekly exercise programs for the elderly
population in the community resulted in better management of gait and balance within the

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individual. There was a significant difference observed in individuals who have been
undertaking exercises for their health improvement. However, the exercises which were
conducted in groups showed higher levels of activity and increased resistant to falling. In the
case of Olive, her muscles have lost the strength due to her femur breakage and she will be
undergoing a surgery. Hence, this kind of an intervention may help her regaining the lost
strength in the muscles such that she can go ahead with her work at her place.
Another intervention that could be planned and administered to the patient is to introduce
the patient to a walker or a wheelie walker which will help the patient in walking (Finch et
al., 2018). This will help the patient is maintaining a possible balance and greatly reducing
the chances of the patient sustaining a fall. A well trained nursing professional is a suitable
candidate to help Olive in learning the possible and appropriate way in which the wheelie
walker should be used such that maximum benefit is achieved. After the wound is bandaged,
she could be taken for a walk with the help of the wheelie to regain the strength of the
muscles.
ANSWER TO QUESTION 2:
The medication that had been administered to Olive prior to her femur fracture was
Warfarin. This is a medication which is generally used as an anti-coagulant. However, after
she sustained a fall and broke her femur bone, a surgery was ordered and her medication
changed from Warfarin to Rivaroxaban. Both of the medications that were ingested by Olive
were given to her because of her atrial fibrillation. There have been studies conducted which
showed that Rivaroxaban was a better medication that needs to be administered to the patient
rather than Warfarin because of its decreased possibility of bleeding (Lip et al., 2016). In the
case of Olive, it could be seen that she had also sustained a skin laceration which could be
deep and release a significant amount of blood she would have still be on Warfarin. Hence,

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after discussion with physicians, her medication was changed such that her bleeding could be
managed efficiently. The food that is being ingested by the patient may influence the
pharmacology of the medication. In case of Warfarin, it reacts chemically with certain
vitamins like vitamin K and Vitamin E. As per the complications of bleeding is concerned,
Rivaroxaban is a better option to be administered to surgical patients rather than Warfarin. In
the study conducted by Norby et al., (2017), the effectiveness and the risks which are
associated with the administration of Rivaroxaban was determined in comparison with other
anti-coagulants such as Warfarin and Dabigatran used all over the world. These all
medications fall under the category of anti-coagulants which manages the bleeding of the
individual in an emergency case and to non-valvular atrial fibrillation. In the case of Olive,
she has been administered to control her bleeding from the skin laceration that she had
sustained after the fall and fracturing her femur bone. However, in their study, it was also
observed that individuals who have been switched to Rivaroxaban from Warfarin
experienced higher gastro-intestinal bleeding than individuals who have been using Warfarin
only. Hence, it could be deduced that it may be a complicated decision by the physicians
which could prove to be detrimental for the health of the patient in the long run recovery
period. In addition, it could also be possible for the individual to experience intracranial
bleeding or myocardium infarction.
Rivaroxaban has developed as a potential option in contrast to warfarin for the avoidance
of thromboembolism in patients with atrial fibrillation (AF). Be that as it may, there has been
worry for the danger of significant dying, particularly in Asian patients (Lee et al., 2019). Be
that as it may, it cannot be promptly comprehended whether Olive is an Asian. Thus, it
cannot be conceded that she will have comparable likeliness of dying.