NSG1NMA Nursing Management And Assessment

Question:

Scenario

Mrs. Barbara Green is an 89-year-old woman who migrated to Australia from Germany 40 years ago. Barbara is a retired primary-school teacher and lives alone in a single-storey house. Barbara was married to Henry who was in the Royal Australian Navy; however he died of lung cancer two years ago. Barbara has a son Dominik from a previous marriage. He lives in Germany with his family and visits Barbara regularly. Henry‘s daughter from previous marriage, Tracy and his extended family live throughout Australia but keep in contact and visit regularly.

Barbara retired twenty four years ago, at the same time Henry retired from the Navy. The couple spent their time together traveling around the world and volunteering at the local St Vincent de Paul shop. They participated actively in their local Catholic Church, organising fundraising activities. They were also very active members of the German Association. Barbara is fluent in both written and spoken English and German. She speaks with a strong German accent and sometimes people ask her to repeat herself.

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Barbara’s health has been slowly deteriorating over the last two years, forcing her to limit her level of activities. Last year, Dominik and his family visited Barbara. They wanted her to return to Germany with them so he and his family could be close to her, but Barbara decided not to leave her home. She was grateful to her son and family for the offer though. Henry’s daughter Tracy has kept in touch with Barbara since Henry died and visits every three months with daily phone calls.

Barbara’s medical history is as follows:

  • Dry macular degeneration
  • Hypothyroidism
  • Rheumatoid arthritis
  • Osteoarthritis.

Recently, Barbara has stopped driving due to her diagnosis of macular degeneration. She rarely leaves the house due to altered mobility and has lost physical contact with both friends and members of the German Association. Barbara’s house is unusually unkempt and the cupboards have minimal amounts of food consisting of some tins of soup and baked beans.

Barbara feels very connected to her community and wants to stay in her own home. She realises that in order to do this, she may need help. Barbara feels she is already too much of a burden on Tracy and her family. Barbara’s local doctor is concerned that she is not eating properly, is losing weight and becoming too isolated.

Barbara has been referred by her GP to the local community health centre for assessment and review. The referral letter from her GP states the following symptoms:

  • Joint stiffness.
  • Swollen feet and enlarged joints.
  • Painful joints particularly, her knee, hip, fingers and back.
  • Limited joint movement.
  • Constipation
  • Occasional dizziness
  • Vision deficit
  • Non-significant recent weight loss
  • Patient states adherence to medications but it is suspected she may forget or skip doses when she is in pain

Medications:

  • Slow release Paracetamol 665 mg tab ii 3 times a day
  • Ibuprofen 400 mg three times a day
  • Thyroxine 150 mcg daily
  • Hydroxychloroquine 200mg daily

You work at the local community health centre as a Registered Nurse and are assigned to manage Barbara’s assessment and care in her home.

Intructions:

Introduction:

-General Ideas about aged related disease such as macular degeneration, rheumatoid arthritis and osteoarthritis

-Indicate purpose of the essay

-Describe overall parts of essay

Body:

Barbara is at risk of fall related to her macular degeneration as evidenced by subjective claims of vision deficit and occasional dizziness.

  • What is dry macular degeneration?
  • How does it affect an older people ( relate to Barbara) (google the pathophysiology of macular degeneration and explain how does it affect barbara with her age)
  • what are the risk factors of macular degeneration?
  • some information about macular degeneration but not solutions

Barbara is also at risk of decreased mobility ( means limited movements )related to her rheumatoid arthritis and osteoarthritis as evidenced by joint stiffness, painful joints particularly at her knee, hip, fingers and back and limited joint movements.

  • What is rheumatoid arthritis
  • How does it affect older people like Barbara? ( if you type in google the pathophysiology of rheumatoid arthritis, you will read how does it affect barbara considering her age).
  • what are the risk factors of rheumatoid arthritis? (relate too to barbara’s case)
  • what is osteoarthritis? and how does it affect barbara considering her age.
  • pathophysiology of osteoarthritis

Barbara at risk of imbalanced nutrition less than the body requirements related to her hypothyroidism as evidenced by non-significant recent weight loss.

  • What is hypothyroidism
  • Discuss the signs and symptoms
  • Risk factors of hypothyroidism
  • how does it relate to Barbara’s case?
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