Chronic Disease Management and Healthy Ageing Program

Assignment Task

Aim

The purpose for this case study essay is to enable students to produce a nurse-led case discussion of an older adult, using evidence-based information relevant to nurses and up-to-date Australian statistics, for improving the health and quality of life for elderly persons who have multiple comorbidities and care needs. Content should include discussion on the questions provided in the case study using a holistic approach.

Case study

Carolina Bruno is an 86-year-old lady with a rich Italian background. She migrated to Australia when she was 47 years old and has lived and worked in Australia ever since. She is a widow who lives alone in her unit and has been independent with her activities of daily living. She has two daughters Bella and Gia who live nearby and are actively involved with the care of Carolina. Mrs. Bruno presented to ED via ambulance following a fall in her home. She had fractured her right NOF and has been to the operating theatre (O) for a total nip replacement (THR). Mrs. Bruno is now day 4 post-operatively.

Mrs. Bruno has a medical history of osteoarthritis and had a major stroke 6 years ago but managed to recover well after months of rehabilitation. She has moderate congestive heart failure, a mild cognitive impairment, NIDDM for 20 yrs., and pain associated to neuropathy. She has had two recent transient ischaemic attacks (iTA's) at home and recovered well after few days of bed rest. Since her husband Bruno, passed away 3 years ago, she has frequent periods of depression if she forgets to take her antidepressants. She wears glasses for her vision impairment related to glaucoma, cataracts, and diabetic retinopathies. She also wears bilateral hearing aids.

During her stay in the acute care ward, the nurses documented in her progress notes that Mrs. Bruno was:

• Underweight with a BMI of 12.
• Very frail with multiple skin tears on her lower limbs and stage 1 pressure injury to her sacrum.
• Old scars to lower legs with possible history of healed venous/arterial ulcers.
• May have been on the ground for over 8 hours before a neighbour found her.
• Denies pain but noticed to be grimacing and wincing during transfers and repositioning.
• No recollection or memory of her having used her bowels 5 days before she presented in the emergency department.
• Developed delirium post-surgery which resolved after treatment and hydration.

After ten days in the acute care ward and four weeks in the rehabilitation ward, Mrs. Bruno was not able to return home and care for herself. After a long discussion with the Multi-disciplinary Team (MDT), her daughters Bella and Gia reluctantly agreed to transfer Mrs. Bruno to an aged care facility where she would receive 24hrs care. Health education during discharge included: medication compliance, promoting hydration and nutrition, bowel management, skin care, prevention of skin tears as well as future advice on palliative care and end-of-life care.

Questions

1. Using information from your weekly readings and wider research, discuss the impact of the ageing population on the health care system in Australia.

2. Discuss multicultural ageing in Australia, and in your discussion consider the case study inhuiscip of Mrs. Bruno and explain why nurses need to be culturally competent to care for older grouch adults in Australia.

3. Consider Mrs. Bruno's chronic pain. What assessments would the nurse undertake, and gare outline what actions could be implemented to reduce/eliminate the pain? 

4, The occurrence of dementia, delirium and depression are common in older adults as seen in the case study of Mrs. Bruno. Explain in detail why the nurse needs to be able to distinguish between the three conditions.

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