Case Study-Pain, Health and Wellness in Aging, Gerontological Nursing

Case Study-Pain
Jeff is a 50-year-old man who works on a loading dock. He is required to do heavy lifting. He was picking up a 55-pound box when he felt immediate pain and what he describes as a “pop” in his back. He has come to the ED for care.

1. What assessment information should the ED nurse gather?

While awaiting results of a CT scan of Jeff’s back, the emergency health care provider orders opioid pain medication to be given.

2. Besides following the “rights” of medication administration, what concerns should the nurse have about Jeff taking opioid pain medication?

The ED physician diagnoses Jeff with a herniated nucleus propulsus (HNP). He has been following up with his primary care provider since he was discharged 6 months ago, and now has chronic back pain. Today, he lifted his 3-year-old nephew and felt an immediate increase in back pain.

3. Could Jeff have acute pain and chronic pain at the same time? Based upon your answer, how is treatment impacted?

4. With which members of the interprofessional health care team would the nurse coordinate at this time?

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Case Study-Health and Wellness in Aging

You meet a 76-year-old widow in the geriatrician’s office. Her daughter brought her to the geriatrician for a comprehensive geriatric assessment. The widow is a retired school teacher who lived with her husband of 58 years in another state until he passed away 6 months ago. She sold her house and moved in order to be closer to her daughter and two sons. She purchased a condominium in a high-rise luxury building within walking distance of one of her son\’s homes and approximately a 15-minute car ride from her daughter’s home.
She has a history of lung cancer, hypertension, hyperlipidemia, osteoarthritis, and osteoporosis. She is 5 feet tall and weighs 85 lb. She reports a 10-lb weight loss over the past year and attributes it to the illness of her husband. She was an avid walker before her move, walking a minimum of 1 to 2 hours per day. She was also very social and had many friends with whom she socialized. She states that she is sad over the loss of her husband, but very happy to be near her children and grandchildren. She states that she is “not going to let the cancer get the best of me.” She also reports that “minor aches and pains will not stop me.”

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1. Rate her self-perception of wellness on the continuum of wellness.

2. How would you rate her level of wellness? Why?

3. List two areas where you would make recommendations on changes in health practices that would maximize the patient’s level of wellness.

4. In light of her medical diagnoses, discuss primary and secondary prevention.

Case Study-Gerontological Nursing
Christian Johnson is a home health nurse who works primarily with the older adult population. He is a case manager of approximately 20 patients who are visited on an intermittent basis. Christian provides skilled nursing treatments, disease and medication teaching, and disease management.
He has been a registered nurse in the home health field for about 2 years. He started his nursing career in a medical-surgical unit of an acute care hospital after obtaining his Associate Degree in Nursing. This unit gave him an excellent foundation for home health. Christian maintains an excellent rapport with his colleagues and is very well liked by his patients and caregivers. Christian would like to continue his home health career and is interested in advancement to a management role. He is considering a BSN program with eventual advanced practice with a gerontology focus.

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1. Which of the following is considered to be the fastest growing sector in the health care field?
A. Eldercare
B. Social work
C. Pharmaceutical sales
D. Custodial care

2. Which of the following initiatives addressed competence in geriatrics among nursing specialty organizations?
A. National Hartford Center
B. Geriatric Nursing Leadership Academy
C. Gerontological Nursing Excellence
D. Nurse Competence in Aging

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3. True or False: Essential educational competencies and academic standards for care of older adults have been developed by national organizations such as the American Association of Colleges of Nursing (AACN) for both basic and advanced nursing education.

4. Which of the following statements are true about gerontological nursing research? Select all that apply.
A. Best practice standards are not available for the care of older adults.
B. Nurses have generated significant research on the care of older adults.
C. Research with older adults receives minimal funding.
D. Palliative care is an area of considerable focus.
E. Nursing research has significantly impacted the quality of life of older adults.

SAMPLE SOLUTION

Case Study: Pain
Back pain usually strikes a person as a result of fracture or strain of the ligaments and muscles, repeated heavy lifting, or as a result of an awkward movement that strains the muscles at the back and the spinal ligaments. The first information that the ED nurse should gather from Jeff is his occupation, which would lead to understanding the origin of the pain. The second source of data falls under the ‘red flags’ of pain, which include the history of trauma, cancer history, fever, unclear weight loss, parental drug abuse, or consistent | GET AN EXPERT FOR YOUR ASSIGNMENT | the nurse follows the “rights” of medication administration by giving the opioid drugs to Jeff, concerns about the side effects should be understood. First, opioid drugs cause drowsiness, constipation, and mental fog, among others. The result is that it may lead to strained breathing, which can also stimulate Jeff to overdose….