Life Stage Consideration: Delirium, Pain, and Strength-Based Care

This report provides a detailed analysis of life stage considerations, focusing on delirium, pain management, and strength-based care within the context of community nursing for elderly patients. The report begins by defining delirium, its types, and the assessment tools utilized for diagnosis, such as the Confusion Assessment Method (CAM). It explores the signs and symptoms of delirium, using a case study of an older adult named Max to illustrate the condition. The report then outlines suitable nursing strategies, including counseling, family-centered care, medication, and the impact of failing to diagnose delirium. The second part of the report addresses pain in older adults, including its implications and assessment methods like the Faces Pain Scale-Revised (FPS-R), the Lowa Pain Thermometer, and the Numeric Rating Scale. It examines Max's pain management through music therapy. The third part focuses on strength-based care, discussing its principles: self-determination, empowerment, collaboration, the importance of the community setting, and community resources. The report emphasizes the importance of these principles in promoting patient well-being, using the case study to exemplify each principle. The conclusion summarizes the key findings, emphasizing the significance of early diagnosis and appropriate interventions for delirium and pain management in elderly care.

Running head: LIFE STAGE CONSIDERATION 1
Life Stage Consideration
Student’s Name
Institution Affiliation

LIFE STAGE CONSIDERATION 2
Life Stage Consideration
Introduction
Life stage consideration is very significant in the healthcare sector. Most importantly, the
aged generation phase diversity of healthcare complications. Such complications come along
with plenty of pain and even loss of personal identity (Inouye, Westendorp, & Saczynski, 2014).
Some of the complications that are prominent in the aged generation include dementia, delirium,
cancer, blindness, asthma, hypertension, coronary heart disease, and chronic bronchitis. Such
conditions call upon different nursing interventions to promote wellbeing among aged people
(Siddiqi et al., 2016). This essay is set to explore different aspects relating to delirium while
utilizing a conversation between a community nurse and Max (an older adult) as a case study.
Part A
Delirium is a health condition experienced among the older generation whereby mental
abilities experience serious disturbances leading to reduced awareness of the environment and
confused thinking. There are three primary types of delirium. These include hyperactive,
hypoactive, and mixed delirium. Hyperactive delirium includes symptoms like hallucinations,
agitation, restlessness, and refusals to cooperate with care. Hypoactive delirium includes
symptoms like reduced motor activity, abnormal drowsiness, and sluggishness. Mixed delirium
entails both hypoactive and hyperactive signs and symptoms.
The first assessment tool in the diagnosis of delirium is to observe the respective signs
and symptoms of the disease. The doctor examines if a patient can move, speak, and think
normally. Confusion Assessment Method (CAM) can also be utilized. The method enables one
to tell if the patient is rambling, has a hard time paying attention while others speak, or personal

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behaviors camouflage throughout the day. Based on the symptoms presented, the practitioner can
proceed to conduct laboratory tests like blood chemistry test, head scan, alcohol, and drug test,
liver test, chest X-ray and thyroid test to identify for imbalances that might have caused delirium.
Following the case study, Max presents plenty of delirium signs and symptoms. For
instance, he feels not relaxed during hospitalization. In fact, he has a negative attitude towards
care and thinks he will ultimately die. Furthermore, he is agitated and thinks everyone is against
him following the fact that no one responds to his request for water. Finally, the fact that Max
becomes depressed and thinks of suicide is an indication of changes in brain chemistry.
Nursing strategies for a patient who is experiencing delirium depends on the ultimate
cause of the condition. For instance, the nursing practitioner may initiate a counseling program
on a patient whose delirium is caused by drug and substance abuse. Counseling can also be used
to anchor the thoughts of patients who feel disoriented like Max, who feels an injection will lead
to death (Barr et al., 2013). Nursing practitioners should also promote family-centered care. Max
believes that the presence of family members would assure him of safety. However, he was left
alone, which made him restless. Nursing practitioners may also help in providing medications to
the patients depending on the cause of their condition. For instance, a nursing practitioner may
help in providing inhalers to patients whose delirium is caused by severe asthma. Additionally,
the practitioner may provide antibiotics in circumstances where delirium is caused by a bacterial
infection (Schuckit, 2014). The nursing practitioners may also provide sedatives to ease
withdrawal from alcohol. In cases whereby the patient is either depressed or agitated, smaller
doses of different drugs may be recommended (Fong et al., 2015). For instance, the nursing
practitioner may help in providing antidepressants to relieve depression, thiamine to prevent
confusion, and dopamine blockers to aid in drug poisoning (Brummel, & Girard, 2013). Failure

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to diagnose delirium in Max would lead to the destruction of the brain. Since the brain controls
all the body functions, primary body functions will stop, thus leading to death (Salluh et al.,
2015).
Part B
Pain presents serious impacts on older adults. Such implications include decreased
socialization, depression, anxiety, sleep disturbance, impaired ambulation, and frequent
healthcare utilization and costs (Ryan et al., 2013). Pain is the primary reason why patients
frequently visit the hospital. Pain should be considered a fundamental problem when it impacts
either the quality of life or physical function.
Pain assessment starts when a physician believes the patient and takes her/his complaints
regarding pain seriously. With respect to pain assessment, several recommendations have been
placed by the Agency for Healthcare Research and Quality. Firstly, healthcare practitioners have
a fundamental role to inquire about pain and believe in the words presented by the patients. The
practitioner should also obtain a thorough pain history, which includes a description of pain
intensity and characteristics from the patient. The pain rating scales can be utilized to assess the
severity of pain. The figure below illustrates a facial example of pain-rating scale.

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Retrieved from: (Hicks et al., 2010).
Also, it is essential to assess the development of new pain. The older adult shall be evaluated to
identify changes in the pain patterns. Presence of changes in the pain pattern calls for ultimate
shifts in the treatment plan. Apart from the Faces Pain Scale-Revised (FPS-R), other tools that
can be used to measure the intensity of pain include the Lowa Pain Thermometer and the
Numeric Rating Scale. The LPT is a modified Verbal Descriptor Scale (VDS) with seven levels
descriptors which identify the level of pain intensity (Rodrigues et al., 2015). On the other hand,
the Numeric Rating Scale (NRS) asks the patient to rate her/his pain experience numerically
within a range of 0-10 where zero is “no pain” and ten is “the highest pain intensity.”
Concerning the case study, Pain has adverse impacts on Max. Firstly, Max is
experiencing depression and anxiety. He keeps talking to himself. Such feelings make him think
of even killing himself. Max does not enjoy himself. The pain has also lead to decreased
socialization. Max has lost his relationship with the family members.
Max manages his pain by listening to music. This is a significant pain reliever. Music
therapy helps patients by reducing the amount of pain they perceive, alleviating stress and

LIFE STAGE CONSIDERATION 6
anxiety, providing their mood with a positive boost and promoting relaxation (Erkkilä et al.,
2011). Research shows that music therapy has helped manage pain among patients with chronic
pain. Music therapy helps people get relief and solace in cancer and pain centers (Maratos, Gold,
Wang, & Crawford, 2008). There are currently more than five thousand music therapists in the
U.S working in pain management centers.
Part C
The first principle of strength-based care is self-determination (Moyle, 2014). In this
case, the community nurse is expected to provide an opportunity for the patient to tell their
capabilities, strengths, and areas they would wish to expand. In the case provided, the
community nurse asks queries which aim at discussing Max's strengths, capabilities, and areas
that require improvement. For instance, the nurse asks Max’s experience with depression. Such a
query is wide enough to narrate personal actions regarding the condition. Such helps the nurse to
identify Max’s strengths and tell the areas that require improvement. Also, the queries help
identify Max as an individual who is determined to promote personal wellbeing.
The second principle of strength-based care is empowerment. In this case, nurses are
required to provide an opportunity for the patients to use their strengths and capabilities in
controlling their situation. In the case presented, Max is asked what he did to help himself. Such
questions enable the patient to acknowledge the fact that he is the controller of his condition. He
is also asked to tell how he manages his depression and stress. Such queries are set to empower
the patient and boost his confidence in personal control.
Thirdly, collaboration is an important principle in strength-based care (Moyle, 2014). A
patient is provided with an opportunity to work collaboratively with other patients, nurses, and

LIFE STAGE CONSIDERATION 7
family members. In this case, Max is asked if the presence of the family members would make
things different. The fact that Max anticipates the presence of family members as an assurance of
personal safety reveals the significance of collaborative approach in promoting his relieve from
adverse conditions.
Also, working with people in a natural setting within the community is the preferred
venue for helping (Walter, 2019). In this case, Max is asked to narrate personal experience in the
hospital setting. However, it is clear that he felt agitated and restless. But now, the interview is
being contacted in a natural setting, where he feels safe and free to tell his story. Thus, the use of
this principle has promoted the acquisition of vital information that leads to the recovery from
Max's conditions. Such data can also be used in fostering reflection-based management for the
staff to identify areas that call for change.
Lastly, the community is viewed as an oasis of resources in problem-solving. Thus, the
resources in the community should be considered first before the actual nursing programs. In this
case, Max narrates his medication side effects. It's obvious that they lead to more depression,
unlike music therapy (Marcantonio, 2017). Thus it's clear that his conditions can be minimized
with community-based resources rather than actual nursing medical interventions (Hshieh et al.,
2015; Maldonado, 2013).
Conclusion
In conclusion, delirium is an adverse condition in elderly adults. It has critical impacts
such as depression, loss of memory, and loss of personal identity. The disease can be diagnosed
by anticipating its signs and symptoms. Diagnosis of delirium also entails laboratory tests to
include its cause. Treatment depends solely on its cause. Treatment of delirium may involve

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counseling, and medications depending on the cause of the disease. Pain associated with older
age can be assessed using tools such as LPT, NRS, and FPS-R. Concerning delirium, pain can be
managed through music therapy. Therefore, it’s vital to diagnose delirium because its long-time
effects may lead to the destruction of the brain and death.

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