Healthcare Assessment Report: Leonie's Case Study Evaluation

This report presents a detailed analysis of Leonie's case study, a 73-year-old retired teacher presenting with hypertension, agitation, and confusion. The report identifies key behavioral health risk factors including decreased physical activity, poor nutrition, and social isolation, supported by relevant literature. It then evaluates the Cumulative Index Rating Scale (CIRS), Mini Nutritional Assessment Tool, and Mini Mental State Examination as appropriate assessment tools. The report further outlines nursing interventions, specifically focusing on pressure ulcer management through compression stockings and weight management through dietary modifications, while emphasizing the importance of person-centered care, collaboration with allied healthcare professionals, and patient education. The conclusion summarizes the identified risk factors, assessment tools, nursing interventions, and the obligations of nursing professionals in providing comprehensive care.

Running head: HEALTHCARE
HealthCare
Name of the Student
Name of the University
Author Note

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Introduction
The report is based on the case study of Leonie a retired school teacher who is 73
years old. He is widowed and lives alone. She arrived at the emergency unit with symptoms
include hypertension, agitated and confused. The report will highlight behavioural health risk
factors of Leonie followed by highlighting the health assessment tools that will be used for
conduction of health assessment. At the end, the report will highlight the nursing
interventions and other nursing obligations in order to manage the health priorities.
Behavioural health risk factors
Decrease in the level of physical activity
According to the case study, Leonie used to walk for half an hour in the morning three
days a week but from the past 6 months she is refraining herself from executing the same.
She was a keen gardener but for the past 12 months, her garden is unkept. These examples
show decrease in the level of physical activity. According to Biesek et al. (2019), decrease in
the level of physical activity among the older adults increase the risk of accidental falls. The
chances of accidental falls are higher for Leonie as she experiences difficulty from standing
from the sitting position and past medical history indicates arthritis in the knees. Biesek et al.
(2019) states that women post menopause suffer from poor bone health and arthritis and
encountering accidental fall increase severity of fatal bone injury and damage of the skeletal
muscles.
Poor level of nutrition
As per the reporting of Leonie’s older sisters, Leonie has been feeding on micro-wave
meals for the past 6-months and this has promoted 6 to10 kilograms of weight gain. Initially
she used to cook her meals own by using vegetables from her own garden. Sudden weight

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gain and lack of vegetables in her meals is indicating poor level of nutrition in her diet. Poor
level of nutrition in the diet of the older adults decreases the level of immunity and thus
increasing the chances of infectious disease. Poor level of nutrition is also increasing her
body mass index (BMI). At present Leonie is obese as she is 160 cm in height and weighs
nearly 105 kilograms (ideal weight should be: 52 to 65 kilograms). High level of weight gain
increasing the overall body pressure over the knees and thus hampering the bone health
further (Verlaan et al. 2017).
Social isolation
Leonie is suffering from isolation. According to the case study, for the past 6 months,
Leonie is spending more time indoors rather than outdoors. She used to go for movies with
her friends but has lost interest in the same. She also ceased executing her painting and
gardening activities. Newall and Menec (2019) stated that social isolation for the older adults
can increase the level of depression and thus hampering the overall mental health condition.
Hamper in the mental health condition will impact the physiological health of the person
further. Leonie is vulnerable to develop depression as she has lost her husband from cancer 8
years back, has no children and lives all alone.
Assessment tools
Cumulative Index Rating Scale (CIRS)
It is a comprehensive medical assessment tool that is used for assessing the level of
physical impairment and the severity of the illness. Thus the use of the comprehensive
medical assessment tool will help in assessing the level of physical fitness of Leonie. The
assessment of this tool mainly relies in the clinical judgement of the physicians and the
subjective symptoms reported by the patients. Martínez-Velilla, Cambra-Contin and Ibáñez-
Beroiz (2014) stated that relying on the clinical judgement of the physician can be regarded

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as one of the prime advantage of this health assessment tool as physicians are the best person
for assessing the health priority and other physical health anomalies. Martínez-Velilla,
Cambra-Contin and Ibáñez-Beroiz (2014) further stated that CIRS is a reliable yet valid
instrument under the primary care setup for the measurement of the physical health needs and
physical fitness of the people. One of the disadvantage of the CIRS include, it depends on the
subjective data reported by the patients and this at times might be false positive as patient
might tend to over-express the level of pain.
Mini Nutritional Assessment Tool
This tool is used for the assessment of the nutritional level of Leonie. This nutritional
assessment tool, used to screen the presence of the nutritional deficiency among the older
adults (above 65 years of age). The nutritional deficiency is highlighted as malnourishment.
Few of the advantages of this assessment tool is, it can be used under any healthcare settings
and can be administered within few minutes. The implementation of this tool does not
demand any special nursing skills (Donini et al. 2016). The tool mainly use 6-question based
on food intake, weight-loss, psychological stress and body mass index (BMI). The tool need
no laboratory data and this can further be considered as one of the advantage of this tool. A
72-hour food dairy recording of the patient is important for the conduction of the assessment.
Since Leonie lives alone it might become difficult to obtain the 72-hour food diary. This can
be considered as one the disadvantage of this assessment tool (Donini et al. 2016).
Mini mental state examination tool
Mini mental state examination can be used for ascertaining the mental health Leonie,
resulting from social isolation. Mini mental state examination tool can be used for assessing
the level of cognitive functioning and language orientation and memory function of the older
adults and this can be regarded as some of the advantages of this tool. Some of the

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disadvantages of this tool include difficulty in identification of the mild cognitive impairment
and difficulty in recording chances of developing severe dementia (Mitchell, 2017).
Two Nursing interventions (Criteria 3)
Management of pressure ulcer
Leonie has decubitus ulcer on the shin of her left leg. It is a kind of pressure ulcers
and it is due to this ulcers, Leonie is experiencing problem in mobility. Healing of wound at
the area of the left leg (decubitus) will help Leonie to mobilize easily and thus helping to
conduct her activities of daily living and live independently at her home. The nursing
intervention for the effective management of the pressure ulcer at the left leg of Leonie will
include use of the compression stockings. The systematic review and the meta-analysis
conducted by Hobson et al. (2017). highlighted that the use of the compression stockings is
helpful in the reduction of the leg pressure ulcers. Compression stockings mainly prevent or
stop the progression of venous disorders (Hobson et al. 2017).
Management of diet
Another barrier towards the independent execution of the activities of daily living and
independent living is unmanaged weight issues of Leonie. Leonie is obese and is she is
double to that of her ideal weight as estimated from the age, gender and height. Leonie is 160
cm tall and weighs 105 kilograms. The reason behind her unmanaged weight is sedentary
lifestyle for the past 6 months and consumption of microwave-able food. Thus, the nursing
interventions must be triggered towards reduction of weight. Reduction of weight will help to
ease her mobility and will reduce her difficulty experienced while standing up from sitting
position. Effective management of weight in case of Leonie will include proper management
of diet and complete cessation of microwave-able food. Conduction of physical activity for

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the weight management might not be suitable for Leonie as he is suffering from pressure
ulcer in her left leg and has knee arthritis (Kim 2016).
Nursing intervention
Nursing intervention
According to the professional code of conduct of the registered nurses, nursing and
Midwifery Board of Australia (NMBA) it is the obligation of the nursing professional to
provide person-centred care plan for the patient. For Leonie, the person-centred care plan will
be to help her move back to her house. She has also expressed her unwillingness to take
home-help thus Leonie must be physically fit enough to conduct her activities to daily living.
Thus nursing interventions will be directed towards the speedy recovery along with
promotion of physical fitness. NMBA professional code of conduct for nurses, also promotes
practicing in active collaboration with the other allied health-care professionals. In case of
Leonie, the allied healthcare professionals include occupational therapists. The duty of the
occupational therapists will include selection of proper compression stockings for the
effective management of pressure. Second allied healthcare professionals will include
nutritionist or dietician. The role of the nutritionists will include proper planning of the
nutritional assessment of Leonie depending on her nutritional requirement, age, weight and
gender. This will be followed by obligation of nursing professional to educate Leonie in the
domain of importance of social activity, re-initiation of gardening and feeding over healthy
diet.
Conclusion
Thus from the above discussion, it can be concluded that the main behavioural risk
factors for Leonie include lack of conduction of physical activity, social isolation and poor

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level of nutrition. The health assessment tools that will be used for the proper assessment of
these behavioural risk factors are CIRS, mini mental state examination tool and mini
nutritional assessment tool respectively. The main nursing intervention will include effective
management of the pressure ulcer in the left leg by the use of compression stockings and
reduction of weight by the use of proper diet patterns. The obligation of nursing professionals
will also include working in active collaboration with the allied healthcare professionals,
designing of person centred care plan and educating the patient for the generation of health-
related awareness.

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References
Biesek, S., Pereira, B., Vianna, A.M., Molina, G.C., Bendhack, L., Michalouski, R.F., Rabito,
E. and Gomes, A.R.S., 2019. Prevalence of Sarcopenia and Fall Risk Factors Among
Outpatient Older Women. Journal of Professional Exercise Physiology, 16(3).
Donini, L.M., Poggiogalle, E., Molfino, A., Rosano, A., Lenzi, A., Fanelli, F.R. and
Muscaritoli, M., 2016. Mini-nutritional assessment, malnutrition universal screening tool, and
nutrition risk screening tool for the nutritional evaluation of older nursing home
residents. Journal of the American Medical Directors Association, 17(10), pp.959-e11.
Hobson, D.B., Chang, T.Y., Aboagye, J.K., Lau, B.D., Shihab, H.M., Fisher, B., Young, S.,
Sujeta, N., Shaffer, D.L., Popoola, V.O. and Kraus, P.S., 2017. Prevalence of graduated
compression stocking–associated pressure injuries in surgical intensive care units. Journal of
critical care, 40, pp.1-6.
Kim, C.O., 2016. Food choice patterns among frail older adults: The associations between
social network, food choice values, and diet quality. Appetite, 96, pp.116-121.
Martínez-Velilla, N., Cambra-Contin, K. and Ibáñez-Beroiz, B., 2014. Comorbidity and
prognostic indices do not improve the 5-year mortality prediction of components of
comprehensive geriatric assessment in hospitalized older patients. BMC geriatrics, 14(1),
p.64.
Mitchell, A.J., 2017. The Mini-Mental State Examination (MMSE): update on its diagnostic
accuracy and clinical utility for cognitive disorders. In Cognitive screening instruments (pp.
37-48). Springer, Cham.

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Newall, N.E. and Menec, V.H., 2019. Loneliness and social isolation of older adults: Why it
is important to examine these social aspects together. Journal of Social and Personal
Relationships, 36(3), pp.925-939.
Nursing and Midwifery Board of Australia. (NMBA). (2016). Registered Nurse Standard for
Practice. Access Date: 26th March 2020. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/enrolled-nurse-standards-for-practice.aspx
Verlaan, S., Aspray, T.J., Bauer, J.M., Cederholm, T., Hemsworth, J., Hill, T.R., McPhee,
J.S., Piasecki, M., Seal, C., Sieber, C.C. and Ter Borg, S., 2017. Nutritional status, body
composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older
adults: A case-control study. Clinical nutrition, 36(1), pp.267-274.