Elder Case Studies Situation- Mrs.

Elder Case Studies

Situation-

Mrs. Elli Baker is a 73-year-old female who was transferred to the Emergency Room after collapsing in her backyard.

Just prior to the collapse, she was on the phone with a friend, who reported her to be confused and anxious.

Upon arrival to the ER, Mrs. Baker complained of dyspnea, and had an increase in both respiratory and pulse rates.

Previous medical history includes both diabetes and hypertension.

Medications -- Mrs. Baker uses metformin and hydrochlorothiazide, and recently added a new BP medication, lisinopril.

The ER nurse was able to ask Mrs. Baker a few questions, but after a brief time she became unresponsive and had more difficulty in breathing.

Part a -- Mrs. Baker is clearly in distress. The first step is to alleviate her anxiety, calm her down, so that further assessments can be made. Because of her respiratory difficulties, she should be given Oxygen which should also alleviate some of her tension and presumed pain. Depending on her response rate, it might also be advisable to give her a low-dose sedative, perhaps one of the benzodiazepines (National Institute of Mental Health, 2011). Once Mrs. Baker is able to breath and is less anxious and less likely to hyperventilate, we can reassess her condition and symptoms that caused her collapse. Until the patient is coherent and/or we receive previous medical records, we must proceed based on current information.

Assessment

1. Blood pressure is elevated, and background notes present confusion and anxiety prior to collapse. All immunizations are up-to-date, and no complications reported from recent procedures. Recent medication, lisinopril, Lisinopril presents possible side effects of dizziness, headache and/or difficulty breathing, but these are relatively uncommon (PubMed Health, 2012).

Skin, Hair, Nails

No recent abnormalities with exception of client complaint

Head, Neck, related lymphatics

Unremarkable

Eyes

No abnormalities

Ears, Nose, Mouth and Throat

Unremarkable

Respiratory Function

Difficulty in breathing, airway seems distended

Breasts

Unremarkable

Cardiovascular

Slight pain, unsure whether anxiety issue

Peripheral vascular

High pulse rate, anxious

Abdomen

Unremarkable -- no constipation and positive bowel sounds

Urinary

Unremarkable

Musculoskeletal

Some evidence of osteoarthritis in joints of legs, arms and hands.

Neurologic

Confusion, anxiety

Part B- Medical and Technological Tools

Stethoscope, sphygmomanometer, thermometer, scale -- basic indications of stats -- heart, lungs (clarity), blood pressure, temperature, height and weight

Radiographs to determine if there are osteo-injuries -- findings include osteo issues in hip area, but no breaks, hairline fractures, or joint tears. . There is some discoloration around the upper thigh area, but this bruising seems to be rather localized and not terribly serious in this instance. Patient appears to have sustained a hip pointer based on the swelling, bruising, and tenderness in the area (Brown, 2009).

Syringe, rubber tube, gauze, etc. -- Ordered basic blood tests, CBC for infection, basic toxicity screen, Coagulation tests (PT, PIT, INR), Blood Chemistry (glucose to check diabetes or stoke), Blood Lipid panel (risk factors); may order cardiac enzyme tests and coagulation factors.

Oxygen tank and mask -- designed to increase O2 for patient

CPSS test -- for stroke, no technology needed (Peck, 2003).

Part C -- Prioritizing of data collection was done based on stabilizing patient and then working to ensure patient's comfort. In addition, to glean more information from the patient, we needed the breathing stabilized to assess pain levels and potential for stroke. We also needed patient to be responsive so we could inquire about diet to see if her reaction was something based on diabetes or a hypertension trigger. At all times the working priorities were to stabilize vital signs and then work backwards for more information.

Part D/E - Pain is subjective in all of us, and sometimes more so with an elderly patient with other symptoms. Sometimes, studies show that elderly patients are perceived not to be in pain because they do not complain about pain, or that the perceive it differently than younger people. In both receptive and non-receptive patients, one can observe facial tics and/or grimaces, blood pressure (elevated blood pressure sometimes indicates more pain), body temperature, and even mobility.

For the functional patient, assessment can be done by observation of body movement, gait, grimacing, and asking the patient to rate pain on a scale and describe the characteristics (burning, stabbing, aching, frequency, duration, etc.). If the patient is cognitively impaired, simple questions can be asked -- "do you feel a burning sensation, etc." If the patient is non-responsive or cannot understand, one can observe changes in behavior, agitation, facial expressions, or vocalizations. Note, too, that cognitively impaired patients can sometimes be overstimulated by their environment, so take that into account. Finally, involve family or caregivers and ask questions. Additionally, particularly for the elderly, pain assessment must be regular since many think that pain is a normal part of aging or are reluctant to report symptoms (Victor, 2001).

1. Assuming we are given the order to administer 500mg acetaminophen orally or .05 mg/kg IV or .1mg/kg IM of morphine to the patient. To properly assess whether any of the pain medications were successful would depend on the patient's condition, the medication given, and the timing. The oral dose of acetaminophen would likely not react for 30-60 minutes, the morphine far quicker. I would regularly monitor the patient's heart rate, blood pressure, and respiratory rate. I would compare these, likely at the 15, 30 and 60 minute interval after injection with pre-medication and actively look for signs showing decreasing heart rate, BP, and anxiety levels. After administration of the morphine, patient should be calmer, show fewer signs of distress, and potentially be asleep.