NUR202 Geriatric Nursing: Management Concepts for Elder Care

NUR202 Geriatric Nursing: Management Concepts for Elder Care. Mrs. H, a 65-year-old woman with a history of hypertension, presents to the clinician with a continued complaint of a cough. She has been to the office 3 times over the last 6 months with the same troublesome cough. She has had 2 chest infections, 1 of which resulted in an admission to the hospital. She reports that she has been feeling increasingly fatigued and breathless on exertion over the past few weeks. She had a hysterectomy 20 years ago and an appendectomy when she was a child. She lives on her own in a rural area. Her husband died when she was in her 40s. She has 4 children, 2 living nearby and 2 in the UK. She has an occasional social drink, does not currently smoke, but has a smoking history of 15–20 cigarettes per day for 45 years. She stopped smoking 4 years ago. Her income comes primarily from social security and a small widow’s pension. She is very involved with her family and attends Catholic services weekly. Recently she feels that her health is declining, and she finds that she is able to do less and less. In particular, she finds housework almost impossible; and she has just moved her bedroom to the ground floor as she finds it very difficult to climb stairs. She is having some problems with bathing and dressing, and she finds these to be increasing struggles. She visits her clinician every month for repeat prescriptions and, when needed, follow-up of her hypertension. Her children are healthy. Both of her parents are deceased. Her father died in his sixties of chronic bronchitis. Her mother died of cancer at 66. On review it is evident that she is experiencing increasing shortness of breath (SOB), dyspnea on exertion (DOE), difficulty in undertaking household tasks, and disturbed sleep due to coughing. She is also experiencing fatigue and is worried about her capacity to manage her home tasks. Her medications include Spiriva, 500 mcg once daily; Seretide, 200 mcg twice daily; Ventolin, 200 mcg as needed; and Exforge, 100 mg once daily. She has no known allergies (NKA). OBJECTIVE: Mrs. H is awake, alert, and oriented. She appears breathless on exertion. Her oxygen saturation levels are 93%, dropping to 90% following exertion. She appears clean and well kept. Her clothes are appropriate. She is 5 ft 2 inches and weighs 180 lb. Her vital signs are BP: 164/92; P: 110; respirations: 25 per minute. She is afebrile with a temperature of 97.8. There is hyperinflation of the chest, some use of accessory muscles of respiration, crackles, and an occasional audible wheeze. Cardiac exam reveals a regular heart rate, S1, S2, and no abnormal sounds. Her abdomen is soft and nontender, and her bowel sounds are present in all 4 quadrants. She has a small scar as a result of an appendectomy as a child. Her skin is dry and intact, and there is some dehydration evident. She has slight pedal edema and positive pedal pulses. Her eyes reveal clear normal sclerae with PERRLA. Her ears reveal heavy wax buildup and normal tympanic membranes bilaterally. Her mouth is dry; oral mucosa is spotted with possible thrush present. Neurological exam reveals 2+ deep tendon reflexes bilaterally and equal strength. Her gait is normal, and she has full range of motion of all extremities. DIAGNOSTICS: Spirometry performed and a post-bronchodilator measurement using spirometry. The test results reveal pre-bronchodilator: FVC 1.64, FEV1 .98, FEV1% predicted 47%, FEV1/FVC ratio 60%. Post-bronchodilator: FEV1 .96, FEV1% predicted 55%, FVC 1.62, FEV1/FVC 59%. Email: lOMoARcPSD| Case Study #2 – Cardiac Mrs. S, a 78-year-old female, presents to the clinic complaining of difficulty catching her breath and persistent indigestion. She is a well-established patient at the clinic. With the exception of today’s visit, she describes her overall health as good. Her medical history includes hypertension, dyslipidemia (both well controlled with medications and lifestyle management), and osteoarthritis. Her surgical history consists of a Cesarean section 40 years ago and a total right knee replacement 5 years ago without complications. She is recently widowed and lives alone within a retirement community complex. She has 2 daughters and 5 grandchildren who live in different states. She is a nonsmoker and drinks 2–3 glasses of wine per month. Her physical activity is limited secondary to osteoarthritis of her knees and hips; but she participates in aquatic aerobics every Monday and Wednesday morning although, since her husband’s death 6 months ago, she has not been going regularly. She is actively involved in the retirement community, where she serves as a board member and is one of the social chairs for the clubhouse. Her mother, a lifelong smoker, died at age 65 from lung cancer; her father had a history of hypertension and died at age 80 from pneumonia. Her sister is a breast cancer survivor. There is no other significant family history. Upon review of systems, she reports fatigue, general weakness, and indigestion discomfort on and off for 2 weeks. Her indigestion typically lasts for 5–20 minutes. She has had bouts of heartburn that typically resolve with over-the-counter (OTC) antacids, but these have not helped lately. Within the past few days, she’s noticed shortness of breath (SOB), activity intolerance related to dyspnea on exertion (DOE), nausea, a nonproductive cough, and an epigastric/reflux burning sensation. Her chief complaints today are shortness of breath (SOB) and indigestion pain that does not radiate. She denies palpitations, headache, fever, chills, vomiting, and diarrhea. Her medications include losartan, 50 mg daily; lovastatin, 10 mg daily; naproxen, 250 mg twice daily as needed for pain. She is allergic to penicillin. OBJECTIVE: Mrs. S is ambulatory, awake, alert and oriented x4. She is noticeably short of breath and appears anxious. Weight: 150 lb; height: 5 ft 4 inches; BP: 80/60; P: 106; T: 98.6; RR: 24. Chest/lungs: Diminished at bases although difficult to assess related to patient’s inability to take a deep breath due to discomfort. No chest tenderness on palpation. Cardiac: Rate irregular, tachycardic; S1, S2, and S4 sounds noted. Skin: Diaphoretic, cool. DIAGNOSTICS: EKG reveals some ST depression in leads V1 and V2 suggestive of posterior heart ischemia. Cardiac enzymes and CXR should be deferred to emergency department. We offer online tutoring, help with assignments and essay writing for all Majors with a guaranteed pass. For assistance Email Tutor Lucas: