Nursing Assessment: Analysis of Mrs. Simpson's Case Study (NSB335)

This nursing assessment analyzes a case study of Mrs. Simpson, focusing on her pre-admission to a clinic, her medical history including hypertension, mild renal failure, and diabetes, and her diagnosis of Alzheimer's disease. The assessment explores the roles of pre-admission clinics, the importance of gathering detailed medical information, and the specific symptoms and behaviors that support the diagnosis of Alzheimer's. It addresses the patient's increased risk of falls, the need for cognitive and validation therapies, and the potential for nosocomial infections due to diabetes. The assessment also examines the medications prescribed, such as Telmisartan, and the use of catheters. Furthermore, it considers the patient's susceptibility to nosocomial infections, the importance of hygiene, and the potential for elder abuse. The assessment concludes with a SMART goal for patient recovery and treatment, emphasizing the need for strict hygiene and blood glucose monitoring to prevent infections and manage diabetes effectively.

School of Nursing
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Question 1
Mrs Simpson was admitted to a pre-admission clinic. The three main significance of the pre
admission facility are as follows:
a) The pre admission facility is responsible for conversing with the patient upon
admission to help understand the health concern of the patient and to assess the
observable symptoms that is being portrayed by the patient. This helps in the
accurate documentation of the medical history of the patient consisting of the
previous surgeries, medical complications, allergies, and medications of the patient
(Singh & Graber, 2015).
b) This increasing the accuracy and efficiency of the medical treatment procedures that
the patient is to avail.
c) This process informs the patients about the procedure they are about to undergo, its
risk, and benefits. This method is often used to build a trust between the patient and
the healthcare professionals.
Question 2
During the nursing assessment process, upon asking Mrs. Simpson about her medical history,
she mentioned that she had hypertension and in the past suffered from mild renal failure. She
further mentioned that she did not indulge in much physical activity and that she had ‘sugar’
for which she had been taking some medications.
The nurses should have asked her to:
a) Specify the medications that she was prescribed and previous blood tests to
understand the degree of her diabetes. They could have further ordered her to take
blood tests in order to understand her blood glucose levels, which would be necessary
to reduce, considering she has diabetes, before the knee surgery.

b) The nurses could also have focused on the different observable symptoms of diabetes
like slow wound healing, fatigue, and frequent urination.
The nurses could also have assessed the major risk factors of diabetes like sleeping
pattern, diet, and other lifestyle factors.
Question 3
According to the video, Ethel seems to have the neurodegenerative diseases called
Alzheimer’s, as she has been seen to portray signs of confusion, uncertainty, time loss, as well
as short-term memory loss.
 Ethel’s granddaughter, during the pre-admission process mentioned that she has been
able to retain the past memories, however has been having difficulty recalling new
memories and recently acquired information.
 She was observed to be oriented during the knee surgery; however, during the post-
operational procedures she showed signs of temporary loss of short term memories as
she enquired from the nurses about where she was.
 In a video, where Ethel is at home with her granddaughter, she is seen to have forgotten
about the procedure as well as the significance of it.
Thus, it can be concluded that she has Alzheimer’s considering the confusion and disoriented
behavior from her end. This shows that she has difficulty in retaining memories and thus
would require constant assistance as well as Validation and Cognitive therapy in order to help
her cope with these symptoms and help her retain her memories (Leyhe et al., 2017).
Question 4
 Given her age and the recent knee replacement procedure that she underwent , she will
is prone to increased fall risk and thus she would require round the clock assistance to
help her with her ADL’s and ensure that she does not fall.

 Considering that she has a neurodegenerative disease which affects the memory
retention of an individual as well as disrupt the cognitive functioning of the patient, the
nurses are to help assist her by incorporating therapies like Validation and Cognitive
therapy sessions. These can help in building up the self-esteem and confidence of the
patient, which usually decreases significantly after the onset of diseases like these, as
this makes them increasingly dependent on others for execution of basic ADL’s.
 She has increased blood glucose, which slows the healing process of the knee surgery
site, providing scope of the contraction of nosocomial infections. Thus, the dressing
needs to be changes regularly, and her knee site requires be disinfecting and cleaning
timely. The nurses are required to maintain proper hand hygiene while tending to the
wound.
Question5
Ethel is suffering from an early stage of Alzheimer’s, showing symptoms like short term
memory loss, making her prone to bullying. She is required to be continuously reminded of
where she is, and what procedures she had undergone. Due to the increased confusion and
delusions faced by Ethel, her behavior towards the nurses can change to aggression and
agitation.
Nurse bullying in cases where the patient is completely dependent on the on the care givers for
the execution of their ADL’s. This can be very tiresome for the nurses and can make them
irritable and agitated. Ethel can be seen to frequently complain about her knee pain after the
surgery, which can also make the nurses develop negative emotions against her and thus, make
her a victim to nurse neglect and ignorance (Moore, 2018).

Question 6
Pre-operation Ethel complained about pain due to:
 Swelling of ankle and legs due to her history of hypertension, this usually is caused due
to the ventricular dysfunction. This can also be due to the edema (Sloane et al., 2017).
 Rheumatoid Arthritis can also lead to inflammation of one or more joints which leads
to the joint stiffness and aching, with the progression of age.
Question 7
a) Considering Ethel’s mental state, she has been showing symptoms of metal confusion
and memory loss, accidental bruising is expected to be highly frequent. Bruises can
be differentiated by closely monitoring their shape and, texture and color. The
common areas of bruising in cases of accidental bruising can be considered to be
knees, forehead and hands. Bleeding assessment and wound assessment processes are
to be conducted in order to understand the degree of the wound better.
b) Other signs of elder abuse might include:
 Psychological abuse- Emotional harassment by verbal abuse and not helping
her where she would require assistance, mainly in executing her ADL’s.
 Sexual abuse – Bruising in genitals, acquiring sexually transmitted diseases,
and swelling and bleeding form vagina and other external reproductive
organs.
c) In cases like these, several measures can be taken to help elders like Ethel from
abuse:
 Provide legal as well as mental support to elders like Ethel (Qld.gov.au,
2019).
 Call the toll free Elder Abuse Helpline in order to get help regarding matters
like these.

Question 8
a) Telmisartan is a medication often prescribed for treating hypertension, as it prevents
the tapering and tightening of the blood vessels resulting in the reduction of the blood
pressure, improving the overall blood flow, due to the decrease in the friction
(Drugbank.ca, 2019).
b) Ethel has a medical history of hypertension for which she has suffered from mild renal
failure. Hence, to help her maintain her blood pressure and keep it in check, she has
been prescribed this angiotensin receptor blocker to help expand the blood vessels to
help reduce the restriction in the blood flow, decreasing her blood pressure
(Drugbank.ca, 2019).
c) This medication is usually prescribed for 2-4 weeks and is usually provided along with
other medications to increase the effectiveness of its functionality (Heart.org, 2019).
d) The two known side effects of this medication are:
 Dizziness, lightheadedness and fainting.
 Rare skeletal muscle breakdown leading to kidney failure (Drugbank.ca,
2019).
 Increased muscle weakness
 Arrhythmia or irregular heart beat
Question 9
a) A catheter can help in her condition, since she is in her old age, with limited mobility
due to a surgery in her knee. If this indwelling urethral catheter is not managed
properly, with appropriate principles of hygiene, then this can give rise to different
risks such as bladder stones, septicemia and even kidney failure. Thus, a nurse should
always be present with Ethel to provide her with treatments, to guarantee that no
infection will occur, which can become fatal for her, as she suffers from diabetes.

b) The Indwelling catheter also known as Foley catheter and even intermittent catheters
(when in post-operative care), can be allowed for short as well as long duration. After
post-surgery Ethel can be provided with intermittent catheters, since her mobility is
limited, and she will require help during bathroom. After few days Ethel can be
provided with an Indwelling catheter, which will provide a better aid to avoid and limit
the risks from fall. Catheters would be assigned to the patient as they will have
problems in urination retention as well as movement, post operation (Feneley, Hopley
& Wells, 2015).
c) 4 things hospitals should be doing with regard to the use of IDCs:
 Maintaining hand hygiene.
 Providing the details to both patients and their family.
 Safe-guarding patient’s information from and leakage and treat patient with
respect and dignity.
 Check the patient’s vital signs before incorporating the catheter.
Question 10
According to the case-study Ethel is having type-2 Diabetes, and she has been susceptible to
the nosocomial infection during her stay in the hospital, after post-surgery. This is because of
different reasons like hyperglycaemic environment that enables immune dysfunction like
depression of the antioxidant system, neutrophil function damage, as well as decrease in the
antibacterial properties of urine (Casqueiro, Casqueiro & Alves, 2012).
There is reduction in production of insulin in pancreatic cells and increased production of the
lipolysis in adipose tissues due to the surgical stress after the post-surgery. Hence, it results in
a rise in the blood glucose level. Usually it is seen that a rise in the blood glucose level in
diabetic patients cause pathophysiological alterations that lead to cell damage and immune
dysfunction. Generally surgery triggers the regulatory balance among the hepatic glucose
production and utilisation in the peripheral tissues. This further enables the discharge of
hormones like cortisol, growth hormones, glucagon, which elevates the manufacture of

cytokines, interleukin-6, interleukin-1β as well as tumour necrosis factor-α which are
accountable for the inflammation (Duggan, Carlson & Umpierrez, 2017). Production of
cortisol causes an increase in the blood glucose levels, and decreases the healing process of the
surgical site.

Question 11
S (Systematic) Considering that Ethel has Diabetes, it is
advised that she recovers fast, in order to not
contract any nosocomial infections. It is also
important to maintain her blood glucose level
post her knee surgery.
M (Modular) The nurses are to impose strict hand hygiene
rules, disinfect and clean mainly the hospital
areas where the patients are kept, post
operation. Depending on the surge observed
in the blood glucose levels, post-surgery, the
patient can be subjected to insulin pump
therapy and would be required to be closely
monitored for any changes in the blood
glucose level (Duggan, Carlson & Umpierrez,
2017).
A (Approach) The goal is achievable, if the hand hygiene
rules are strictly followed as well as the
hospital is efficiently cleaned and disinfected
to avoid exposure to nosocomial infections.
Further, close blood glucose monitoring of the
patients can detect early signs of elevation
and help in the timely administration of
insulin to help the patient.
R (Recovery) The goal is relevant and can be achieved
through efficient and strict management.
These rules can be enforced by the
supervisors or the head nurses. In order to
ensure that the right treatment is being given
and her blood glucose levels are properly
maintained, the nurses can consult a
specialist.
T (Treatment) The hand hygiene and infection control
measures should be applicable to all patients
admitted in a hospital – pre surgery, during
surgery as well as post-surgery. Ethel would
require these interventions during her post
surgery recovery.

Question 12
Nosocomial infections:
 Ethel will be provided with appropriate treatment to assist her in decreasing or
stopping the infections she contracted.
 Hand hygiene should always be followed to help her in decreasing the spread of
infection causing pathogens.
 Her dressings are also needed to be changed in a timely manner to help
decrease the spread of the infection.
a) Blood glucose levels:
 The care of her blood glucose level will help her control the diabetes and thus
indirectly help decrease the infection and wound. Thus, the most important and
best medical method that can help her treat the condition is the insulin pump
therapy (Duggan, Carlson & Umpierrez, 2017).
 It should be maintained by ensuring she has her meals on time, as well as
customising her diet plan to suit her situation.
Question 13
Ethel should be given appropriate medicine in order to limit her infection from spreading any
more, and also should be given with dry dressings to avoid any repetition of strikethrough in
the dressing just like in the handover video. To assess the amount of spread of infection in the
wound, with the provision of treatment to the wounds it is also necessary to follow certain
important steps such as assessing the stage of infection, location, measurement of the spread of
the wound, colour, odour as well as pain assessment. Therefore, through this certain
assessments comprising of the skin and pain assessment, these can assist in defining the kind

of infection and assist in the treatment procedure. Bearing in mind that Ethel is having
diabetes, it is very important for the nurses to monitor her wound healing process.
Question 14
 A swab from Ethel’s wound should be used to test to see whether the infection in the
wound is a bacterial, viral or fungal infection. After the tests of the results only,
treatments such as antifungal therapy, antiviral can be delivered to help with the
infection.
 It must be ensured that Ethel takes her diabetic medicine in a timely manner and also
should manage and customise her diet to help herself in maintaining the glucose level.
 Imposing stricter hygiene rules and thoroughly disinfecting the hospital area where she
is kept.
These will facilitate immediate and effective assessment and prevention of the nosocomial
infections and improve patient outcome.
Question 15
Two challenges faced:
 Since Ethel has been diagnosed with Alzheimer’s disease. Administering treatment to
Ethel can become a tough procedure since patients who suffer from such worse
disorder lose their memory regarding their treatment and usually behave in a violent
manner, when they are treated for disease.
 Situations when the patients becomes violent and don not take the required treatment
generally causes a hindrance in the planning, organizing and delivering the medication,
which disrupts the recovery process of patient.

Thus nurses are needed to help the patient to work in an appropriate manner through their
best physical and psychological manner. Such outcomes can only be obtained when the
patient are explained their treatment procedure and the purpose behind them in calm and
patient composure. Nurses should include the family members and friends in the treatment
process and encourage them to help the patient feel comfortable and at ease. The nurses
should also remember that the treatment procedure are delivered in a respectful and
dignified manner and also focus on their mental state.
Question 16
a) After the operation completes, the nurses check for the vital indications, especially they
observe for the circulation. The monitoring is done to evaluate the blood glucose levels in
regard to her medical history to administer quick healing of the surgical location and also
to decrease the shrinkage of nosocomial contaminations. During this evaluation
procedure, the WBC’s and platelets assist in identifying any shrinkage of nosocomial
infections. By assessing the hemoglobin amount in the blood flow it will help in a
significant way in the well-being of the patient. Thus, this assessment can be done in two
ways - perioperative blood evaluation and blood transfusion (Cook et al., 2014).
b) Since Ethel has been diagnosed with Alzheimer disease therefore, she requires continuous
observation. This diagnosis will help the nurses in understanding the issues which she is
experiencing and will assist her recovering quickly, after the operation. As she has a
medical history of diabetes, thus, she needs to have her blood checked for any change in
the blood glucose level, to make the nurse comprehend whether it is in normal condition
or would require to be comprehended to quicken the healing procedure of the knee
surgery. In this ways the shrinkage of the surgical site will decrease. The hemoglobin
level is also measured in this surveillance, to evaluate of any requirement for the
allogeneic blood transfusion, to prevent any anemia, after the post-operation.