NUR104 Assessment Task 3: Case Study Analysis of Elderly Patients

This assignment, prepared for NUR104, presents a detailed analysis of two case studies involving elderly patients. The first case focuses on Louis, who is suffering from delirium and dehydration, exploring the pertinent biophysical processes of cerebral dysfunction and mental fluctuations, and the psychosocial processes of depression and cognitive impairment. The assignment identifies the Delirium Risk Assessment Tool (DRAT) as an appropriate assessment tool and outlines priorities of care, including person-centered care and managing underlying health issues. It also addresses equity, rights, and access issues related to comprehensive assessment and cognitive impairment. The second case study examines Josie, diagnosed with metastatic pancreatic cancer, discussing the biophysical process of cancer cell metastasis and the psychosocial processes of psychological distress and emotional distress. The palliative and end-of-life care assessment tool is identified as appropriate, and priorities of care, including palliative care, emotional and spiritual support, and symptom management, are discussed. The assignment also addresses equity and access issues related to the denial of care and support. Both case studies adhere to the assignment brief, including word count, and provide a comprehensive evaluation of the cases, including the biophysical and psychosocial aspects, assessment tools, priorities of care, and equity issues.

NUR104 Assessment Task 3: Case study 40% (1500 words)
Case study 1.
Read Louis’s story, outlined on page 276- 278 of your course textbook (Bryan, Montayre and
Bernoth, 2017, p. 276). [750 words]
Discuss the biophysical processes pertinent to the case.
The case is about Luis who is suffering from delirium. The two biophysical processes that
are pertinent to the case are Delirium and dehydration. Delirium is the condition that is
very common to older individuals who become unwell. The clinical manifestations of
delirium include the mental fluctuations, disordered levels of thinking and changes in
consciousness (Bernoth and Winkler, 2016). Louis experience of food poisoning which
made him vomit four times is the main cause of his current dehydration. Vomiting as a
result of food poisoning decreases oxidative metabolism in the brain causing abnormalities
of various neurotransmitter systems thus resulting into cerebral dysfunction. The cerebral
dysfunction makes the mental status of Luis to fluctuate leading to disordered levels of
thinking and changes in his consciousness. This makes him to become confused and when
he is admitted in the hospital he yells at everyone in the hospital including the staff.
Discuss the psychosocial processes pertinent to the case.
The two psychosocial processes that are pertinent to the case include depression and
cognitive impairment. The cognitive impairment of Louis includes memory loss, language,
his perception and orientation to time or place. The cognitive impairment that makes Louis
to be defiant in hospitals and this can lead to inappropriate medication or management.
Another psychosocial processes involved in the case is emotional and psychological
distress. Besides, Louis’ mental state makes him to be agitated by health specialists in the
hospital and becomes difficult to be managed by nurses in the healthcare facility. It is as a
result of his mental health status that makes him become confused in thinking (King, et al.,
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2013).
Furthermore, Louis might be undergoing emotional and psychological distress as a result
of separation of his daughter who has become married. He used to see his daughter daily
but now he can only see her only on few occasions which made him to be emotionally and
psychologically stressed. This can be supported by Betty’s statement that Louis’s current
behaviour occurred suddenly after the wedding of his daughter.
Identify an assessment tool appropriate for use in this case and discuss key elements
of the tool.
The appropriate tool for use in this case is Delirium Risk Assessment Tool (DRAT).The
assessment tool is used to identify the risk factors of delirium. Some of the delirium risk
factors identified by the DRAT include Visual impairment like difficult to read newspaper,
cognitive impairment, dehydration and severe illness such as mental disorders and
depression. If the patient is at risk the next step is to conduct the cognitive screening
assessment referred to as confusion Assessment Method (Beard et al., 2016).
The first feature of confusion assessment tool is the acute onset and fluctuating course
which is commonly obtained from the family member. Besides, the nurse can assess the
feature following positive responses to some questions that are based on the patient’s
health condition. The second feature is inattention which is shown by a positive response to
focusing attention of the patient. The third feature is disorganized thinking which
determines whether the patient is disorganized or incoherent. The fourth feature of
confusion assessment tool is altered level of consciousness which determines whether the
client is alert (Bernoth and Winkler, 2016).
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Discuss 3 priorities of care for this person.
 One of priorities of care to Louis is to apply a person centered care approach. This
will involve gaining more valuable information about Louis and his family which
will play a critical role in care approach. The person centered care approach will
also involve consisted care for Louis and developing a relationship with him
(Butler, 2017).
 Monitoring and controlling his clinical vital signs such as temperature, blood
pressure and heart rate. Controlling such vital signs will help in maintaining his
health to the optimum (Bernoth and Winkler, 2016).
 Provide aid in the treatment of underling health issue of biochemical imbalance
such as electrolyte imbalance and dehydration to manage the client’s pain.
Dehydration involves the loss of water from the body which is mostly accompanied
by an imbalance of electrolytes such as potassium and sodium. Nurses can provide
ensure Louis consumes clear fluids such as water and sports drink. Besides, they
can manage the condition by applying intravenous fluids to rehydrate Louis (Butler,
2017).
Discuss any equity, rights and access issues relevant to the case.
One of the issues of rights, equity and access that is relevant to the case is failure of nurses
to provide comprehensive assessment of Louis’s physical condition, cognitive, social, risk
factors and the existing medications. Louis has the rights to access quality treatment which
should involve comprehensive assessment. Nurses failed to provide comprehensive
assessment such as measuring clinical vital signs such as temperature and his blood
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pressure (Henderson et al., 2018). Besides, nurses did not develop and integrated
prevention management plan for the Louis together with his family.
Another health issue is cognitive impairment and ageism. In regards to the case, Louis has
no capacity to make decision due to his cognitive impairment. Louis should be given an
opportunity to be heard and be treated in a friendly manner. The nurses see misinterpret
Louis’s health issue as defiant or thus a high possibility of mismanaging his condition.
Nurse should consider Louis condition have sympathy on him and manage him in a
friendly manner.
Case study 2.
Read Josie’s story, outlined on page 431-432 of your course textbook (McKenzie, 2017, p.
431-432). [750 words]
Discuss the biophysical processes pertinent to the case.
The case is about Josie who is diagnosed with metastatic pancreatic cancer. The
biophysical processes pertinent to the case involve the hallmark of metastatic cancer cells
which invades the basal membrane and endothelium of the nearby organs and blood
vessels near pancreatic (Arber et al., 2014). The cells in the pancreatic develop mutations
in their DNA. This mutation makes cells in the pancreatic to grow rapidly and in
uncontrollable manner. The accumulation of these cells forms tumour which spreads to
nearby organs and blood vessels. It is a result of the pancreatic cancer that causes jaundice
to Josie. Pancreatic cancer blocks the bile duct in the live which results to jaundice. The
signs include yellow skin and eyes which Josie is experiencing as per the case. Other signs
as per the case include minimal discomfort and fatigue (Bernoth and Winkler, 2016).
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Discuss the psychosocial processes pertinent to the case.
The psychosocial process relevant to the case of Josie is psychological distress,
emotionally and hopelessness. Josie is undergoing psychological and emotional distress as
she was left by her husband who loved her. She lived independently after the death of her
husband which made her to have psychological and emotional distress. Besides, Josie
becomes psychologically distressed when she is told diagnosed with advanced metastatic
pancreatic cancer (Beard et al., 2016). The positive psychosocial processes involved in the
case are enjoyment as Josie enjoys her active life with her close friends and family. Josie
also feels happy when travel arrangements are made to go and meet her beloved sister in
Perth.
Identify an assessment tool appropriate for use in this case and discuss key elements
of the tool.
Palliate and end of life care assessment tool is appropriate tool for use in this case of Josie.
The palliate care assessment tool can be used by nurses to determine various issue within
the palliate care (Beard et al., 2016). Palliate care assessment tool can be used by doctors in
hospital setting to directly assess signs and symptoms of Josie. The tool can also be used as
a quality indicator that enables nurses to quantify the quality of measures of care by
comparing it to evidence based criteria. Furthermore, Palliate care assessment tool may be
utilized in research studies to evaluate nursing interventions that are specific.
Palliate care assessment tool will be appropriate for Josie as it will help the
multidisciplinary team to assess and provide best care measures for her.
The key elements of palliate care assessment tool may include assessment of physical,
psychological, social and spiritual wellbeing. The assessment of physical well-being part
may include pain, fatigue, respiratory and gastrointestinal assessments (Butler, 2017). The
social wellbeing may include the client’s wishes regarding her goals of care and the
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preferred place of care. Furthermore, the psychological wellbeing assessment may involve
assessment of the mood and interests, adjustment to illness and the psychological pain that
the client is going through. After the assessment, the multidisciplinary team can agree and
act by implementing a care plan for Josie that will lengthen her end of life stay (Butler,
2017).
Discuss 3 priorities of care for this person.
 One of the priorities of care for Josie involve palliate care. This involves the care
provided to patient whose illness is impossible to be cured. Josie is diagnosed with
metastatic pancreatic cancer which is in advanced stage thus hard to cure. Josie can
be advised on the way forward with the support of her family by making her
prepare for the physical changes that may occur during her end of life (Wilson,
Moss and Willetts, 2016).
 Emotional and spiritual care- Palliate health care professionals are supposed to
provide emotional and spiritual care support to Josie by dealing with emotions that
may come as a result of cancer diagnosis and treatment. Depression, fear and
anxiety are some of the concerns that nurses should address while caring for Josie.
On spiritual care and support, the nurses can help Josie by exploring her beliefs and
values so that she can find a sense of peace and reach a point of acceptance that is
appropriate for her situation (Arber et al., 2014).
 Another priority of care that Josie requires is management of her conditions so as to
prolong her life stay. Although there is no treatment for jaundice, the management
of its symptoms can be managed. Nurses can provide medication whose aim will be
to prevent the rapid breakdown Josie’s red blood cells which is causing the level of
bilirubin to be high in the blood.
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Discuss any equity, rights and access issues relevant to the case.
There are various issues of equity and access that are pertinent to the case of Josie. One of
the issues is denial of Josie’s rights to access care from health care specialists when in
need. As per the case, Josie makes several visits to doctors for assessment of her health but
the visits ends unsuccessful and she becomes frustrated as none of the doctors attends her
need of care. As a result, Josie develops vague symptoms when deeply jaundiced. In this
scenario, the doctors denial Josie her rights of access to care by failing to attend to her for
several months. If Josie had been attended early enough, the health care specialists could
have managed her condition and this could have prevented the condition from reaching to
the advanced stage (Bernoth and Winkler, 2016). The other issue is the nurse not taking
time to advice the Josie and her family. As per the case, the nurse was very quickly when
meeting Josie and her family and quickly told them that whatever Josie wants she will get
without even introducing himself.
The other issue is the right for care and support as shown in the case. Josie is allowed to
travel all the way to Perth to see her beloved sister instead of allowing her sister to come
and see Josie.
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Reference List
Arber, S., Bowling, A., Creech, A., Duncan, M., Goulding, A., Gyi, D., Hallam, S.,
Haslam, C., Kazi, A., Phillips, A.C. and Twumasi, R., 2014. Maintaining health and well-
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Bristol, pp.113-54.
Beard, J.R., Officer, A., De Carvalho, I.A., Sadana, R., Pot, A.M., Michel, J.P., Lloyd-
Sherlock, P., Epping-Jordan, J.E., Peeters, G.G., Mahanani, W.R. and Thiyagarajan, J.A.,
2016. The World report on ageing and health: a policy framework for healthy ageing. The
Lancet, 387(10033), pp.2145-2154.
Bernoth, M. and Winkler, D., 2016. Healthy ageing and aged care. Oxford University
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Butler, J., 2017. Palliative care in residential aged care: An overview.
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journal on ageing,
36(4), pp.258-261. link
https://researchoutput.csu.edu.au/en/publications/healthy-
ageing-and-aged-care
Henderson, J., Javanparast, S., MacKean, T., Freeman, T., Baum, F. and Ziersch, A., 2018.
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Networks. Health & social care in the community, 26(1), pp.80-89.
King, D., Mavromaras, K., Wei, Z., He, B., Healy, J., Macaitis, K. and Smith, L.,
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link https://www.voced.edu.au/content/ngv:55502
Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.F. and Gunn, J.,
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Wilson, C., Moss, C. and Willetts, G., 2016. Achieving person-centredness with older
people in residential aged care. Australian Nursing and Midwifery Journal, 23(7), p.47.
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