University Nursing Report: Leonard's Case Study and Best Practices

This nursing assignment presents a case study of Leonard, a 73-year-old patient with multiple health issues including social isolation, hypertension, and cognitive impairment. The report identifies and discusses three primary health risk factors: social isolation, difficulty with activities of daily living, and weight gain. It then evaluates three best-practice assessment tools: the MSE evaluation, the Dementia Rating Scale, and a head-to-toe and vital assessment, justifying their use based on the identified risks. The assignment emphasizes the importance of holistic care, including assistance with daily living, psychological and emotional wellness, and blood pressure regulation, while also advocating for a safe environment to prevent falls and injuries. The conclusion highlights the need for evidence-based assessment tools to develop effective care plans.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
The patient, Leonardis 73 year old stays alone at home. He has reported reduced level
of social participation over the past six months. Upon presentment the patient is assessed to
be febrile and hypertensive. The patient also suffers from a urinary tract infection. The
medical history of the patient includes cognitive impairment, a decubitus ulcer on the left leg,
arthritis, anaemia, industrial deafness, hypertension and urine urgency. This paper intends to
identify the primary risk factors related to the holistic wellness of Leonard. The paper would
also discuss about the 3 best practice assessment tools that are used by nurses to provide
effective care to the concerned patient.
Discussion:
Identification of health-risk factors:
The first risk factor that can be identified in this case would include social isolation
and increased loneliness. In close relation to the case study, it has been mentioned that
Leonard stays alone and his wife had died of cancer, 3 years ago. Further, it has also been
mentioned that he has no children and has two sisters who visit him once a week. Further, it
has also been reported that Leonard has a history of industrial deafness and cognitive
impairment and has lost interest in activities that interested him. This suggests that he is at an
increased risk of developing depression due to social isolation (Courtin and Knapp 2017).
The second risk factor can be identified as his difficulty in mobilizing and in
effectively carrying out activities of daily living. Studies suggest that advancing age leads to
the deterioration of muscles and bone strength which increases the risk of falls (Ambrose et
al. 2013). Therefore, Leonard is susceptible to falls and accidental injuries due to his
advancing age and reduced ability to perform activities of daily living.

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The third risk factor can be identified as his weight gain during the previous six
months. The case study reports that the patient has gained 5 to 8 kilograms and also has a
history of hypertension. Research studies that weight gain and uncontrolled hypertension
increases the risk of cardiac arrest and other cardiovascular disorders (Hall et al. 2015;
Vaneckova et al. 2014). This suggests that due to increase in body weight, Leonard is at an
increased risk of suffering from a cardiac arrest or other cardiovascular disorders.
Choice of best practice assessment tool:
In order to select the best practice assessment tool, the nurse would make use of the
evidence base to select an assessment method that would help in evaluating the identified risk
assessment. The MSE evaluation would help in assessing the level of cognitive impairment
and accordingly help in planning interventions to support the cognitive needs of the patient
(Bisi and Stagni, 2016). The Dementia Rating scale would help in evaluating the level of
ADL impairment of the patient. It should be mentioned in this case that a total score which is
less than 121 or equivalent to 121 suggests the onset of difficulties in managing basic
activities of daily living for the patient. The rationale for the choice of the Dementia Rating
Scale as the assessment criteria can be directly linked with the symptoms of confusion that
the patient has been reported to experience (Pirogovsky et al. 2014). Upon assessment of the
level of ADL decline, appropriate intervention strategies can be undertaken to assist the
patient while conducting activities of daily living. The third assessment that would be
appropriate to assess the third health risk factor of the patient would comprise of conducting a
head-to-toe assessment and a vital assessment. It should be mentioned here that the head to
toe assessment would help in investigating the level of physical wellness of the patient and at
the same time would help in identifying the important patient needs or problems (Anderson et
al. 2014). On the other hand, the vital assessment would help in documenting the current
status of the temperature, respiratory rate, blood pressure and the heart rate. Upon

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documenting the vital signs, it would help in planning the appropriate nursing care
interventions.
Conclusion:
Therefore, to conclude, it can be mentioned that the primary care goals for the patient
must include, assistance with daily living, psychological and emotional wellness and
regulation of his increased blood pressure within the normal range. In addition to this, it is
also important to foster a safe environment which would ensure that the patient is free from
falls and accidental injuries. In addition this, the nursing professional could make appropriate
use of the evidence based scholarly literatures to choose appropriate assessment tools which
could help in clearly assessing the identified risk factors. The assessment results could then
be analysed and appropriate care process could be planned.

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References:
Ambrose, A. F., Paul, G., and Hausdorff, J. M. 2013. Risk factors for falls among older
adults: a review of the literature. Maturitas, 75(1), 51-61.
Anderson, B., Nix, E., Norman, B., and McPike, H. D. 2014. An evidence based approach to
undergraduate physical assessment practicum course development. Nurse education in
practice, 14(3), 242-246.
Bisi, M. C. And Stagni, R. 2016. Complexity of human gait pattern at different ages assessed
using multiscale entropy: from development to decline. Gait & posture, 47, 37-42.
Courtin, E., and Knapp, M. 2017. Social isolation, loneliness and health in old age: a scoping
review. Health & social care in the community, 25(3), 799-812.
Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z., and Hall, M. E. 2015. Obesity-
induced hypertension: interaction of neurohumoral and renal mechanisms. Circulation
research, 116(6), 991-1006.
Pirogovsky, E., Schiehser, D. M., Litvan, I., Obtera, K. M., Burke, M. M., Lessig, S.
L., ...and Filoteo, J. V. 2014. The utility of the Mattis Dementia Rating Scale in Parkinson's
disease mild cognitive impairment. Parkinsonism & related disorders, 20(6), 627-631.
Vanecková, I., Maletinska, L., Behuliak, M., Nagelová, V., Zicha, J., and Kunes, J. 2014.
Obesity-related hypertension: possible pathophysiological mechanisms. J endocrinol, 223(3),
R63-78.