Nursing Case Study: Leonard's Health Risk Factors Analysis

This case study focuses on Leonard, an elderly patient presenting with multiple health issues, including hypertension, cognitive impairment, arthritis, decubitus ulcer, urinary tract infection, and anemia. The assignment requires the identification and discussion of three key health risk factors associated with Leonard's condition. Furthermore, it necessitates a critical evaluation of three best-practice assessment tools that nurses can utilize in this scenario, such as blood pressure measurement, Falls Risk Assessment Tool (FRAT), and the Norton Scale, with references to current peer-reviewed literature. The case study emphasizes the importance of a multidisciplinary approach to care and the selection of appropriate assessment tools to improve patient outcomes and ensure effective management of Leonard's complex health needs. The document showcases the application of nursing knowledge in a practical context, highlighting the challenges and considerations involved in caring for elderly patients with multiple comorbidities.

Running head: NURSING CASE STUDY: LEONARD
NURSING CASE STUDY: LEONARD
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1NURSING CASE STUDY: LEONARD
Introduction
Due to the detrimental physiological conditions associated with ageing, elderly patients
are often inflicted with a number of disruptive physiological and psychological health condition
(Vemuri et al. 2017). As observed from the Australian Institute of Health and Welfare, aged
individuals comprise of a major proportion of the Australian population, with one out of a group
of seven citizens, belonging to the age group of 64 years and beyond (Australian Institute of
Health and Welfare 2019). The following report focuses extensively on the case study of
Leonard, the various risk factors underlying his health and the best practice assessment tool
which nurses can use for this scenario.
Discussion
Health Risk Factors
Leonard’s symptom of hypertension is a key risk factor for his health, since lack of
mitigation of the same can result in his future acquisition of cardiovascular diseases such as
strokes (Turin et al. 2016). Further, an additional health risk factor of his would be his
emergence of symptoms associated with mild cognitive impairment - pre-requisite symptom of
neurodegenerative conditions like Alzheimer’s. Acquisition of Alzheimer’s have been associated
with loss of logical reasoning, memory and decision-making skills, which further hampers an
individual’s performance of activities of daily living (ADL). It has been already observed that
Leonard’s acquisition of cognitive impairment has affected his perception skills resulting in his
wandering, which if not monitored, can increase risk of falls, injuries and fatalities (Hedman et
al. 2016). Leonard’s further health risk factors lie in his symptoms of arthritis, which results in

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disrupted mobility as observed in Leonard’s difficulty to move and engage in self-care tasks.
Lack of osteoarthritis mitigation can increase Leonard’s risk of falls and fracture acquisition,
further leading to negative health outcomes (Quach and Burr 2018). Leonard as also been
observed to suffer from a decubitus ulcer, which is associated with detrimental damages to the
skin caused by friction. Lack of adequate management of this ulcer may increase Leonard’s risk
of pressure ulcer progression resulting in severe skin damages, possible tendon and muscle
exposure and the risk of microbial infections and permanent immobilizations (Parker et al.
2018). Leonard’s diagnosis of urinary tract infection and incontinence are also major health risk
factors since lack of proper treatment of the same results in possibilities of acquiring chronic
kidney diseases, pyelonephritis, urethral strictures and a fatal condition of urosepsis (Grabe et al.
2015). Lastly, inadequate management of Leonard’s anaemia coupled with inabilities to engage
in ADL tasks may lead to impaired self-care and loss of his physiological and psychological
wellbeing (Röhrig 2016). Hence, considering Leonard’s acquisition of a wide range of
debilitating health conditions, the nurse and health professionals must consider the deliverance of
a multidisciplinary approach to care in order to ensure achievement of positive health outcomes
(Mudge et al. 2016).
Assessment Tools
Considering Leonard’s symptoms of hypertension, nursing measurement of the patient’s
blood pressure using appropriate devices such as a sphygmomanometer may be considered as
one of best practice assessment tools for evaluation (Noble et al. 2016). However, in criticism,
considering that hypertension may be a risk factor for cardiovascular diseases, the nurse may
also conduct further assessments in the form of a cardiac examination of blood tests screening
lipid levels, to further assess future possibilities of atherosclerotic symptom acquisition.

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Additionally, the nurse may also conduct an additional assessment of Leonard’s medical history
to detect the presence of any lifestyle or disease factors which may contribute to his condition
(Yu et al. 2017). Additionally, considering Leonard’s symptoms of arthritis, the nurse may work
collaboratively with the orthopaedic or the general practitioner, and perform a physical
examination to observe for swelling, redness and pain along with diagnostic implementations in
the form of X-rays or ultrasound to assess joint health (Glyn-Jones et al. 2015). However,
considering the increased risk of falls associated with arthritis, the nurse can apply a Falls Risk
Assessment Tool (FRAT) which will assess Leonard’s susceptibility by measuring his risk for
falls, conduct a falls checklist and implement a preventive action plan (Cattelani et al. 2015).
Considering Leonard’s acquisition of a decubitis ulcer, the nurse can follow up treatment
effectiveness, by performing a skin integrity assessment to evaluate presence skin redness,
oedema and breakdown. However, for more comprehensive treatments, the nurse can also
engage in usage of the Norton Scale, which assess patient’s physical condition and state of
mobility, mental condition, activity and incontinence in response to the pressure ulcer (Mallah et
al. 2015).
Conclusion
Hence, to conclude, it can be observed that, elderly patients like Leonard are in
possession of high risk of acquiring multiple morbidities which require nursing care
interventions in the form of a multidisciplinary approach. The nurse in Leonard’s case must seek
to consider all possible health risk factors and engage in the administration of best practice
assessment tools to evaluate treatment effectiveness.

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References
Australian Institute of Health and Welfare (2019). Older Australia at a glance, Healthy ageing -
Australian Institute of Health and Welfare. [online] Australian Institute of Health and Welfare.
Available at: https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/
contents/healthy-ageing [Accessed 1 Apr. 2019].
Cattelani, L., Palumbo, P., Palmerini, L., Bandinelli, S., Becker, C., Chesani, F. and Chiari, L.,
2015. FRAT-up, a Web-based fall-risk assessment tool for elderly people living in the
community. Journal of medical Internet research, 17(2).
Glyn-Jones, S., Palmer, A.J.R., Agricola, R., Price, A.J., Vincent, T.L., Weinans, H. and Carr,
A.J., 2015. Osteoarthritis. The Lancet, 386(9991), pp.376-387.
Grabe, M., Bjerklund-Johansen, T.E., Botto, H., Çek, M., Naber, K.G., Tenke, P. and
Wagenlehner, F., 2015. Guidelines on urological infections. European association of
urology, 182.
Hedman, R., Hansebo, G., Ternestedt, B.M., Hellström, I. and Norberg, A., 2016. Expressed
sense of self by people with Alzheimer’s disease in a support group interpreted in terms of
agency and communion. Journal of Applied Gerontology, 35(4), pp.421-443.
Mallah, Z., Nassar, N. and Badr, L.K., 2015. The effectiveness of a pressure ulcer intervention
program on the prevalence of hospital acquired pressure ulcers: controlled before and after
study. Applied Nursing Research, 28(2), pp.106-113.

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Mudge, A., Radnedge, K., Kasper, K., Mullins, R., Adsett, J., Rofail, S., Lloyd, S. and Barras,
M., 2016. Effects of a pilot multidisciplinary clinic for frequent attending elderly patients on
deprescribing. Australian Health Review, 40(1), pp.86-91.
Noble, K., Brown, K., Medina, M., Alvarez, F., Young, J., Leadley, S., Kim, Y. and DiCarlo, L.,
2016. Medication adherence and activity patterns underlying uncontrolled hypertension:
Assessment and recommendations by practicing pharmacists using digital health care. Journal of
the American Pharmacists Association, 56(3), pp.310-315.
Parker, S., Burton, C., Adkins, J., Cunningham, S., Thornberry, K. and Sadler, S., 2018.
Prevention of Decubitus Ulcers in the Clinical Setting.
Quach, L.T. and Burr, J.A., 2018. Arthritis, depression, and falls among community-dwelling
older adults: evidence from the Health and Retirement Study. Journal of applied
gerontology, 37(9), pp.1133-1149.
Röhrig, G., 2016. Anemia in the frail, elderly patient. Clinical interventions in aging, 11, p.319.
Turin, T.C., Okamura, T., Afzal, A.R., Rumana, N., Watanabe, M., Higashiyama, A., Nakao, Y.,
Nakai, M., Takegami, M., Nishimura, K. and Kokubo, Y., 2016. Hypertension and lifetime risk
of stroke. Journal of hypertension, 34(1), pp.116-122.
Vemuri, P., Lesnick, T.G., Przybelski, S.A., Knopman, D.S., Lowe, V.J., Graff‐Radford, J.,
Roberts, R.O., Mielke, M.M., Machulda, M.M., Petersen, R.C. and Jack Jr, C.R., 2017. Age,
vascular health, and Alzheimer disease biomarkers in an elderly sample. Annals of
neurology, 82(5), pp.706-718.

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Yu, E.Y., Wan, E.Y., Wong, C.K., Chan, A.K., Chan, K.H., Ho, S.Y., Kwok, R.L. and Lam,
C.L., 2017. Effects of risk assessment and management programme for hypertension on clinical
outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort
study. Journal of hypertension, 35(3), p.627.