NUR104 Contexts Of Practice: The Older Person And Family

Question:

Case1:

Rob Cameron is 81 years of age, retired and lives with his wife Margaret (65 years) in a small coastal town in rural New Zealand. Margaret was a midwife prior to meeting Rob and during their marriage they purchased a yacht, lived on board and eventually sailed around the world together. Previous to their adventure, Rob worked in various occupations, mostly outside and often independently or in his own businesses. Lila, Rob’s former wife, is 75 years old and lives alone in Auckland. They separated after their three children left home. The GP diagnosed Rob with hypertension and prescribed oral antihypertensives. Rob believes that he does not need to take his antihypertensives unless he feels unwell and that he can control his blood pressure by eating garlic and drinking cider vinegar. Of most concern to him is his belief that taking antihypertensives will make him impotent; their sexual relationship is very important to this couple. Rob is very good at building and making things, and loves to be outside in his shed or maintaining the house. He prides himself on his ingenuity and independence; he would never hire a professional or tradesperson to do a job, believing that he can do everything himself. In addition to his passion for sailing and the ocean, Rob loves cars and has owned some beautiful classic cars in the past. Currently he drives what he describes as a ‘boring’ 10-year-old sedan. They love to eat out or meet friends for a coffee at the local café, go for a drive in the country or a weekend away, but they have to budget as they live on the New Zealand universal superannuation pension of $576.20 per week (Work and Income New Zealand, n.d.). Margaret notices that Rob is becoming increasingly forgetful as he misplaces objects. Recently, he left some tools out in the rain and they were damaged, causing him to become very angry and frustrated with himself. As a result, Margaret researched the Alzheimer’s New Zealand website (Alzheimer’s New Zealand, n.d.) and is concerned that he may have mild dementia. Her suggestion to see the GP leads to an argument, with Rob angrily accusing her of thinking that he is ‘a loony’. Margaret has been trying to encourage Rob to remain well by suggesting that they go on walks together for exercise and meet friends for social stimulation; she has also been trying to get him to take his antihypertensive medication more regularly. Recently, matters came to a head when Rob became distracted when driving Margaret to visit a friend. The car went over the curb and hit a brick fence, causing some damage to the car, the fence and to his forehead when the impact of the airbag deploying forced his spectacles against his forehead and caused a small laceration. After taking a careful history of the accident and the events leading up to it, the GP suggested to Rob and Margaret that it would be worthwhile doing a more thorough assessment of Rob’s cognitive function.

  1. Discuss the biophysical processes pertinent to the case.
  2. Discuss the psychosocial processes pertinent to the case.
  3. Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
  4. Discuss 3 priorities of care for this person.
  5. Discuss any equity, rights and access issues relevant to the case.

Case 2: 

Betty is a 72-year-old woman who has had multiple falls in the last 12 months. Her last fall resulted in her badly spraining her right shoulder; this has limited her ability to undertake a lot of her general household duties. When presenting to her local doctor about her shoulder injury, she commented that she often feels very unbalanced and dizzy, especially when getting out of bed, and is worried it might have something do with her new blood pressure medication. Betty also indicates she has been having trouble walking because of the arthritis in her feet. Betty’s last fall has really had a significant impact on her confidence and she tells her doctor that she is frightened that the next fall will do some major damage. As a result of this fear and her injury, she has not been getting out much. She also had to cancel her last optometry appointment because she could not drive herself with her shoulder.

  1. Discuss the biophysical processes pertinent to the case.
  2. Discuss the psychosocial processes pertinent to the case.
  3. Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
  4. Discuss 3 priorities of care for this person.
  5. Discuss any equity, rights and access issues relevant to the case.
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