NRS221: Life Stage Considerations - Delirium, Pain, and Assessment

This report analyzes the case of Max, an older adult, focusing on the impact of delirium and pain on his well-being. It explores the different types of delirium, assessment tools like the Confusion Assessment Method, and the symptoms that nurses can identify. The report also discusses nursing strategies for managing delirium, including supportive care and addressing underlying causes. Furthermore, it examines the impact of pain on older adults, the use of pain assessment tools such as PAINAD, FLACC, and Abbey Pain Scale, and various pain management strategies, including medication and therapies like acupuncture and cognitive behavioral therapy. The report emphasizes the importance of strength-based assessment in addressing Max's health concerns, highlighting how nurses can use this approach to evaluate his strengths and limitations, promote patient understanding, and empower him to make informed decisions about his care. The report concludes with a summary of the key findings and emphasizes the importance of effective communication and active engagement between nurses and patients to improve patient outcomes.

Running head: LIFE STAGE CONSIDERATION
LIFE STAGE CONSIDERATION
Name of the student:
Name of the university:
Author note:

1LIFE STAGE CONSIDERATION
Introduction:
Delirium is a mental illness which is commonly observed in the case of older patient
(Trachsel et al., 2016). This assignment primarily focusses on the case study of max, who was
suffering from delirium. This study involves the types of delirium and the assessment tools
which helps in the identification of the mental illness. The signs and symptoms of delirium
which can be used by the nurse to ensure delirium in Max is also discussed in detail. The
different nursing strategies and impact of the illness has been also incorporated. Max, in the case,
has been suffering from pain which possesses negative effect on his mental and physical health.
The impact of pain and strategies to manage such pains are included in the discussion. Along
with that the essay also briefly discusses the strength-based assessment which helps in
maintaining the other health complications of the patient.
Impacts of delirium:
Delirium is considered a severe mental illness which disrupts the normal function of the
brain and can lead to emotional disruption and mental confusion. Delirium is often observed in
case after surgery or any dementia (Noblett et al., 2016). In this case, Max has recently recovered
from his respiratory illness which can be considered as the risk factor of delirium.
There are three primary types of delirium which are, delirium tremens, hyperactive
delirium and hypoactive delirium. Delirium tremens is mainly observed in the case of patient
who is either trying to stop drinking alcohol or is consuming alcohol from longer periods of
time. In the case of hyperactive delirium, the patient becomes highly alert and uncooperative and

2LIFE STAGE CONSIDERATION
in the case of hypoactive delirium, the patient disorganised and inattentive and as a result not
able to complete their task attentively (Lahariya et al., 2016).
For the appropriate and safe treatment of the patient, it is crucial to diagnose the disease
at an early stage. There are several methods such as confusion assessment method, neurological
and physical assessment method and another test (blood test, urine test. In the confusion
assessment method, behavior of the patient is observed (Smith et al., 2016). The daily regime of
the patient is kept to assess the attention awareness and thinking perspective of the patient
through conversation. It provides information regarding the mental state, perception and memory
of the patient. In the physical exams, signs and symptoms of the different health problems are
assessed, and in the neurological assessment method, vision, coordination, balances and reflexes
were evaluated. Apart from these other tests such as blood test or the urine tests are also
performed.
The symptoms of delirium include, disturbed sleeping habits, lethargy, restlessness,
hallucinations, anxiety, depression, personality changes, poor memory, difficulty in writing,
speaking and reading and other symptoms (Marcantonio, 2017). The people suffering from
delirium are not able to stay focused for a longer period time. They also provide little or no
response to the environment. The symptoms of delirium which can be used by the community
nurse to identify delirium in the case of max involve his sleeping difficulty, agitated behavior
and hallucination, as he thinks that the nurse and the other health care staff wants to kill him.
The primary goal of the nursing strategies in case of delirium is to address the underlying
cause of the disease and providing intervention accordingly. In the case of delirium, the patient is
provided with supportive care by the nurses. Supportive care helps in the prevention of any

3LIFE STAGE CONSIDERATION
complications in future. The nurse should promote good sleeping habit in the patient by
delivering calm and quiet environment; communication with the patient is enhanced to increase
orientation and calmness. The medical problem is also often observed in case of patient suffering
from delirium. Hence, the nurse should also provide measure for the management of such
complications by providing regular medication, encouraging the patient to intake plenty of water
and suggested diet and by enhancing the involvement in physical activity. In addition, nurse
should also educate patient and their family about the prevention and treatment strategies
(Middle & Miklancie, 2015).
Treatment of delirium at the appropriate time is vital for the proper recovery of the
patient. If the delirium is ignored in the patient, it can have short term or long term impact on the
patient. It can cause permanent harm to the cognitive ability of the patient and can also give rise
to blood clots, pneumonia and other chronic illness (Neufeld et al., 2016).
Pain management in the older patient:
Pain in the case of more former patient possesses negative impact on the quality of life of
the elderly patient. It limits their movement and action and can lead to various adverse health
outcomes such as depression, social isolation, anxiety, Social isolation, immobility and cognitive
impairments (Lisi et al., 2015).
The tools which can be used to identify pain and to assess its intensity includes different
pain assessment tools such as, PAINAD (pain assessment in advanced dementia scale), FLACC
(faces, legs, arms, crying, Consolability) and Abbey.
The PAINAD scale is used to assess the intensity of pain in patient having dementia. In
this method, the behavior of the patient is assessed and based on that score is allotted. If the total

4LIFE STAGE CONSIDERATION
score is above 7, the patient is considered in severe pain and if its below 3, the patient is
suffering from mild pain.
The FLACC tool is based on the observation of the five areas; faces, legs, arms, crying,
Consolability. It is mainly used in the patients who are not able to communicate properly. By
observing the five areas, score is assigned and the overall represents the intensity of pain.
Abbey Pain Scale is commonly used in the case of patients who are not able to express
themselves such as patient with dementia or cognition difficulties. In this case also the behavior
of the patient is observed with the help of questionnaire and score is assigned. .
Max, in the conversation, discusses his pain and its impact on his quality of life. Max
stated that due to pain, he is having sleeping difficulties. It also prevents or restricts him from
involving in any physical activities.
For the management of the pain, max stated that he used to take different medication like
pain killers. According to the Vahedi and Thomas (2019), administration of painkillers such as
aspirin, NSAIDS and other drugs works best to get an instant relieve from the pain. However it
should not be taken without consulting the practitioners. Max stated several pain killers he used
to consume when in pain, but if too much of such medication is administered it can lead to
chronic kidney and liver infection and stomach bleeding.
Analgesics in the older patient works best for treatment of moderate pain. Apart from
that, NSAIDS, opioids, is proved to be effective in the proper maintenance of the pain in older
patients.

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Apart from the medication, different therapy such as acupuncture, cold laser therapy,
cognitive behaviour therapy can also be used for managing pain in older patients. In the
acupuncture a needle is inserted into different parts of the body and relieves pain. Cognitive
behaviour therapy is also commonly applied, in which the patient is educated about how to
minimise the effects of pain (Shepler & Chambe, 2019) Max was only relying upon medication
for managing his pain, but excess consumption of it can damage the physical as well as mental
health.
Strength-based assessment:
Strength-based assessment is the method used in the health sector by the nurses to
evaluate the strength and limitations of the patient. It intends to focus on the area which enthuses,
motivate or excite the patient (Rashid, 2015). In this case, max is suffering from multiple
illnesses such as depression, osteoarthritis and hence have to take different medication which
reduces his standard of life. Therefore it is the responsibility of the community nurse to use the
principal of the strength-based assessment to address his health concern. n the case, while talking
about the experience about his recent hospitalisation, he stated that during the treatment he was
not aware of the effectiveness of the intervention as no one explains anything to him which make
him agitated and as a result he does not follow their care plan
Hence, according to the principles of the strength-based approach, in this case the nurse
should evaluate the strength of the patient so that he can take care of himself and can make
positive changes in his life. In the case of max, as he was suffering from multiple illnesses,
strength-based approach can help him in managing his health condition. For this the nurse should
educate the patient about the disease, they are going through and should also increase their

6LIFE STAGE CONSIDERATION
understanding regarding the prevention and management strategies of the illness. By the aid of
Strength based approach, nurses will enhance patient understanding which will help them to take
a treatment-related decision in their own (Rashid, 2015). It will help max to apply problem
solving approach for his illness. By the aid of the strength-based assessment, knowledge
regarding the management is increased, and hence with the help of that knowledge, he can
manage his health complications on his own.
Conclusion:
From the above essay, it is concluded that delirium in older individuals possesses
negative impacts on both the mental and physical health of the patient. Hence, in order to avoid
that, the community nurse should identify and diagnose the illness and based on that should
provide nursing strategies to prevent any future complications. Max in the case study has also
been suffering from pain for which he is taking different medication. The impacts and
management of pain on max are described in the assignment in the details. From the essay, it is
evident that the strength-based assessment is one of the most effective methods to address
different health concern of the patient, which can be done with the help active engagement
between the community nurse and the patient.

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