NRS3805 Health & Illness in Older Person: Case Study Report

This health assignment presents a case study of a 65-year-old Aboriginal male, Mr. K, diagnosed with Type II Diabetes, abdominal pain and a urinary tract infection. The paper discusses his physical health condition, including comorbidities like poor vision and social isolation, and how they impact his functional status. The assignment identifies and justifies three care priorities: stabilizing abdominal pain, managing the urinary tract infection, and managing blood glucose levels. It outlines evidence-based nursing interventions for each objective, including abdominal assessments, medication, and dietary referrals. The evaluation criteria for assessing the effectiveness of the care plan are also described, including monitoring pain levels, vital signs, urine output, blood glucose levels, and body weight. The assignment is designed to apply theoretical knowledge from modules 1 and 2 of a Bachelor of Nursing course to a real-world clinical scenario, emphasizing the importance of evidence-based practice in caring for older adults.

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

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Part 1:
Introduction:
The service quality of healthcare organizations across the territory of Australia
has improved significantly. However, the care status for the elderly through the years
has been neglected and compromised pertaining to the social parameters of old age
discrimination and poor access of the elderly to care services. This paper intends to
present a case study of a 65 year old, Aboriginal male, Mr.K who was diagnosed
with a chronic health condition. The paper would critically discuss the physical health
condition of the patient and make use of the evidence base to devise an appropriate
care plan.
Case Presentment:
Mr. K was presented to the Emergency Department by Mr.A who was his
neighbour. The patient complained of intense abdominal pain and experiencing a
burning sensation while urinating. As informed by Mr.A, Mr.K lived alone in a 1BHK
and had a son who was settled in U.S. He had been married to Mrs.J who expired a
year ago. The previous medical history of the patient suggested he was diagnosed
with Type II Diabetes. Mr. K relied heavily upon take away meals as he felt fatigued
and complained of a blurred vision. He could perform his ADLs independently but
complained of fatigue and exhaustion.
Discussion of two comorbidities that impact the functional status of patient:
Upon assessing the case study, it can be said that the two comorbidities that
significantly impacted the patient’s functional status included his chronic illness
condition of ‘Diabetes’ and his ‘Poor vision’. Poor vision or blurred vision could make

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the patient susceptible to fall and accidents. At the same time, his chronic illness
condition of Diabetes has also impacted his lifestyle significantly.
Evaluation of an environmental change that impacts health:
On closely analysing the case scenario, it can be said that social isolation
greatly impacts the physical health status of the patient. The death of the patient’s
wife and distance from his son has led to a diminished family and social life of the
patient. Diminished family life has led to self-negligence and this has further
triggered the feelings of being unhappy, lonely and grumpy.
Discussion on how old age stereotypes impact the physical health status of
the elderly:
It is crucial to take into consideration the racial origin of the patient. The
patient belongs from the cultural background of Aboriginal and Torres Islander
community. As per research reports, the Aboriginal and Torres Islander community is
extensively associated with social stigma and racial discrimination (Gracey, 2014).
Further, on account of social insecurity and stigma, the patient might have potentially
avoided seeking social support and availing healthcare facilities which might have
subsequently deteriorated the physical health condition of the patient. Further, lack
of knowledge about old age healthcare aid and culturally safe healthcare delivery
might have restricted the patient from availing care facilities. In addition to this, it
should also be stated that lack of a culturally safe care plan and a negative care
attitude of the care professionals can lead to confused and grumpy senior adults.
This directly impacts the quality of mental health wellness and generates poor health
outcome.

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Part 2:
Select Identify and Justify the top threecare priorities/objectives for nursing care.
In priority order, what is care priority 1? What is care priority 2 and what is care
priority 3? What recommended text/primary research references support my choice
of each care priority and why are they important?
While caring for the patient, it is important to devise the care priorities, so that
appropriate care interventions can be planned. The three care priorities for the
patient would comprise of the following:
Care Priority one: Stabilising the abdominal pain of the patient
Care Priority two: Managing urinary infection
Care Priority three: Managing the blood glucose level
The rationale for the selection of the three care priorities can be mentioned as
the increased impact of the care priorities on the present physical health wellness of
the patient. On presentment, the primary complains of the patient comprise of
increased abdominal pain and experiencing burning sensation while urinating. As
stated by Foxman (2014), physical health issues that should be prioritized must
include the physical health problems of the patient that affect their comfort level
during the time of admission. It is integral to stabilise the symptoms that cause
increased discomfort so that that the comfort of the patient can be restored and
additional interventions can be undertaken so as to promote holistic wellness of the
patient (Mellitus, 2013). The burning sensation experienced while urinating indicated
a urinary tract infection, therefore the second care priority was to manage the urinary
tract infection. The third care priority that was chosen for the patient included,
managing the blood glucose level of the patient. The rationale for the same can be

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attributed to the previous medical history of the patient that reveals the diagnosis of
Type II Diabetes (Ahern, 2013). Research studies mention that Diabetes type II is a
chronic health condition which requires appropriate lifestyle management and weight
management so that the blood glucose level can be kept under control (de
Mettelinge et al., 2013; Paddon-Jones & Leidy, 2014). It is extremely important to
manage the symptoms of diabetes so as to ensure normal metabolic and
physiological bodily functions. This would help to enhance the quality of life of the
patient. In addition to this, research studies also state that Diabetes is closely linked
to symptoms such as blurred vision which might significantly interfere with the
activities of daily living of the patient (American Diabetes Association, 2016; de
Mettelinge et al., 2013). Therefore, body weight management would help in the
maintenance of blood glucose level and this in turn would ensure positive health
outcome of the patient (American Diabetes Association, 2016).
Discuss evidenced-based nursing interventions to achieve each objective.Ask
yourself: What are the significant health care needs for my older patient related to
each identified care priority? What nursing interventions will address the nursing
care priorities I have identified? How can I support my selection of care priorities
using text and primary research sources?
Care Priority one: The first care priority that has been chosen for the patient
includes, stabilising the abdominal pain of the patient. The patient presentment
complain included abdominal pain which added to the discomfort of the patient. The
first nursing intervention for the management of the care priority would comprise of
conducting an abdominal assessment. The abdominal assessment of the patient
would be followed by documenting the observation and arranging a consultation with
the physician. The rationale for conducting the abdominal assessment can be

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explained as documenting the abnormality which might have contributed to the pain.
The further step would include arranging a consultation with the physician. A set of
nursing intervention would be applied for ensuring pain relief. This would include
repositioning of the patient and administering muscle relaxants and analgesics after
consulting with the physician so as to alleviate the patient’s pain. The evidence base
suggests that abdominal assessment must be conducted to examine the root cause
of abdominal pain for the patient (Rowe &Juthani-Mehta, 2013). It is integral to pay
attention to the changes in the abdominal size and take note of distention as
abdominal distention has been linked to a number of disease processes (Schwenger
et al., 2015). Further, the evidence base also reveals that repositioning of the patient
and use of muscle relaxants can help in alleviating the sensation of pain and
ensuring the patient is comfortable (Grabe et al., 2015).
Care Priority two: The second care priority that was chosen included managing the
urinary tract infection of the patient. On presentment, the patient complained of
experiencing a burning sensation while urinating which is indicative of a urinary
infection. This too had added to the discomfort and inconvenience of the patient.
Therefore, to control the infection, a set of three nursing interventions would be
undertaken. The first nursing intervention would comprise of assessing or palpating
the bladder after every four hours. This would include palpation of the bladder in
order to detect the presence of a possible urinary infection. The evidence base
suggests that burning sensation while urinating is associated with the presence of
urinary tract infections and palpation of the bladder after a modest interval of 4 hours
can help in determining whether or not there is urinary retention (Foxmon, 2014).
This would help to assess the degree to which an infection has traversed. The
second nursing intervention would include administration of pharmacological

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intervention for the treatment of infection and pain. As stated by Grabe et al. (2015),
urinary tract infections can be conveniently treated with the help of antibiotics such
as cephalexin and nitrofurantoin. The selection of the appropriate antibiotic is
increasingly based on the urine test culture and the sensitivity test results (Meddings
et al., 2014). In addition to this, administration of phenazopyridine would help to
relive the numbness of pain within the urinary tract. The third intervention would
comprise of assessing the hydration status and encouraging the uptake of fluids.
Research studies suggest that increased fluid uptake helps to flush toxic waste from
the kidney and improves blood flow (Schwenger et al., 2015; Flores-Mireles et al.,
2015). This would help in the prevention of dehydration which could complicate and
increase the impact of the urinary tract infection.
Care Priority three: The third care priority would comprise of managing the blood
glucose level of the patient. The intervention for the same would comprise of making
appropriate referral to a nutritionist as the evidence base suggests that altered blood
glucose level is tightly linked with improper body weight management (Holmer et al.,
2013; American Diabetes Association, 2016). The nutritionist would critically assess
the dietary needs of the patient and devise a diet routine that would help the patient
regulate his body weight. Proper regulation of body weight would help in ensuring
better management of blood glucose level and this would help in improved symptom
management and promote holistic recovery (Holmer et al., 2013; American Diabetes
Association, 2016; de Mettelinge et al., 2013).
Describe the evaluation criteria that you will use to judge whether your care plan has
addressed the identified care priorities. Ask yourself: How did I evaluate each

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nursing intervention? What measures did I use? What time line was chosen and
why? Was the plan of care successful?
Care Priority 1:In order to evaluate the effectiveness of the first care intervention,
subsequent abdominal assessment of the patient would be conducted. This would
help to evaluate the recovery progress. Further, pain assessment would also be
conducted and the pain score would help to understand the current pain status of the
patient (Foxman, 2014). This would help in modifying the applied intervention
strategies if required so as to promote positive recovery.
Care Priority 2: In order to evaluate the effectiveness of the second care
intervention, the vital assessment of the patient would be conducted. This would help
to evaluate the normal physiological state of the patient. This would specifically
include assessing tachycardia, elevated blood pressure and fever and chills which
are the primary symptoms of urinary tract infections (Rowe &Juthani-Mehta, 2015).
The evaluation of the symptoms would help to track the effectiveness of the applied
interventions and on detecting any abnormality the applied intervention strategy
would be revised. In addition to this, the urine output of the patient would also be
evaluated which is expected to be equivalent to 800-2000 millilitres per day within 24
hour duration (Grabe et al., 2015). Urine output within the normal range would be
considered as a positive sign of recovery and would reveal no signs of infection.
Care Priority 3: In order to evaluate the effectiveness of the third care intervention,
the patient’s blood glucose level would be monitored every month along with the
body weight that would be monitored over 6 months. An optimal body weight
between the ranges of 50 kg to 70kg would be considered normal and would

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facilitate improved management of blood glucose level (American Diabetes
Association, 2018; Brown &Kuk, 2015). Also, blood glucose level within the range of
less than 100mg/dL at fasting and less than 180mg/dL post meal would be
considered optimal for the patient (American Diabetes Association, 2015)

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References:
Ahrén, B. (2013). Avoiding hypoglycemia: a key to success for glucose-lowering
therapy in type 2 diabetes. Vascular health and risk management, 9, 155.
American Diabetes Association. (2016). Standards of medical care in diabetes—
2016: summary of revisions. Diabetes care, 39(Supplement 1), S4-S5.
American Diabetes Association. (2018). 8. Pharmacologic approaches to glycemic
treatment: Standards of Medical Care in Diabetes-2018. Diabetes
care, 41(Suppl 1), S73.
American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes
Mellitus. (2013). Guidelines abstracted from the American Geriatrics Society
guidelines for improving the care of older adults with diabetes mellitus: 2013
update. Journal of the American Geriatrics Society, 61(11), 2020-2026.
Brown, R. E., &Kuk, J. L. (2015). Consequences of obesity and weight loss: a devil's
advocate position. obesity reviews, 16(1), 77-87.
deMettelinge, T. R., Cambier, D., Calders, P., Van Den Noortgate, N., &Delbaere, K.
(2013). Understanding the relationship between type 2 diabetes mellitus and
falls in older adults: a prospective cohort study. PloS one, 8(6), e67055.
Flores-Mireles, A. L., Walker, J. N., Caparon, M., &Hultgren, S. J. (2015). Urinary
tract infections: epidemiology, mechanisms of infection and treatment
options. Nature reviews microbiology, 13(5), 269.
Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence,
bacteriology, risk factors, and disease burden. Infectious disease clinics of
North America, 28(1), 1-13.

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Grabe, M., Bjerklund-Johansen, T. E., Botto, H., Çek, M., Naber, K. G., Tenke, P.,
&Wagenlehner, F. (2015). Guidelines on urological infections. European
association of urology, 182.
Gracey, M., 2014. Why closing the Aboriginal health gap is so elusive. Internal
medicine journal, 44(11), pp.1141-1143.
Holmer, H. K., Ogden, L. A., Burda, B. U., & Norris, S. L. (2013). Quality of clinical
practice guidelines for glycemic control in type 2 diabetes mellitus. PloS
one, 8(4), e58625.
McCoy, R. G., Lipska, K. J., Yao, X., Ross, J. S., Montori, V. M., & Shah, N. D.
(2016). Intensive treatment and severe hypoglycemia among adults with type
2 diabetes. JAMA internal medicine, 176(7), 969-978.
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S.
(2014). Reducing unnecessary urinary catheter use and other strategies to
prevent catheter-associated urinary tract infection: an integrative review. BMJ
QualSaf, 23(4), 277-289.
Nguyen, H. D., Chitturi, S., & Maple‐Brown, L. J. (2016). Management of diabetes in
Indigenous communities: lessons from the Australian Aboriginal
population. Internal medicine journal, 46(11), 1252-1259.
Paddon-Jones, D., & Leidy, H. (2014). Dietary protein and muscle in older
persons. Current opinion in clinical nutrition and metabolic care, 17(1), 5.
Rowe, T. A., &Juthani-Mehta, M. (2013). Urinary tract infection in older adults. Aging
health, 9(5), 519-528.

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Schwenger, E. M., Tejani, A. M., &Loewen, P. S. (2015). Probiotics for preventing
urinary tract infections in adults and children. Cochrane Database of
Systematic Reviews, (12).