NSB335: Integrated Nursing Practice - Ethel Case Study - Nursing Assingment Help

Assignment Task :

Case Summary

This case study is based on Mrs. Ethel Simpson who is 64 years old. She attends the pre-admission clinic with her grand-daughter to discuss her up-coming left knee arthroplasty. Later, she undergoes the surgery and is then three days post-operative, in the orthopaedic ward.

Social History

Ethel is 64 years old and lives in a granny flat attached to her daughter’s home. She has good support from this daughter and grand-daughter, and her other two children who visit at least weekly. She was previously a registered nurse.  She has six steps in her house that she needs to negotiate to go outside of her home.  Her worsening arthritis, particularly the arthritis in her left knee, has made it extremely difficult for her to leave the house in the last two months. Ethel complains of poor appetite, difficulty sleeping and not wanting to leave the house.

Ethel was diagnosed with Alzheimer’s dementia a year ago and has been partially independent in all her basic activities of daily living.  She is continent but needs assistance with bathing and household activities such as cleaning.  She can cook basic meals and feed herself. Cognitively she is oriented to person, place and year.  She can recall 3 out of 3 words immediately, but 0 out of 3 words at 5 minutes.  Her attention is intact.

Ethel and her family sought advice from her GP because of the worsening pain of her arthritis, particularly in her knee and the impact this was having on her mobility. After being referred to an orthopaedic surgeon for review, the decision was made for a knee arthroplasty to be done.

Question 1: 

What type of arthritis do you think that Ethel has? Provide a rationale for your answer linking to pathophysiology.                                                                             

Question 2: 

Nurses need to understand the indications for and actions of medications they administer and make clinical decisions to ensure safe medication administration.

a) Donepezil is a commonly used medication to treat mild to moderate dementia caused by Alzheimer’s disease.  Briefly describe the mode of action (pharmacodynamics) of Donepezil.                                                                                                                                                     .                                                             

b) Discuss the nursing considerations for patients taking Donepezil and the education you would provide to the patient/family.                                                       

c) Name one (1) side effect of Donepezil and state how you would assess Ethel for this?   

d)  Ethel takes non-steroidal anti-inflammatory drugs (NSAIDs). What is the risk for her with also taking Telmisartan? What advice can you give to reduce this risk and what monitoring should occur?                                                                                                                                                                             

Question 3: 

Review knowledge on types of dementia as it is important to understand the type of dementia that Ethel has.

Ethel has been diagnosed with Alzheimer’s dementia. 

1. Outline briefly the basic pathophysiology of Alzheimer’s’ dementia.       

When the family first became concerned about Mrs Simpson’s cognitive status, they visited her GP. You will do a further examination of mental status.  There are many cognitive tools available that you might use to assess mental status.  

2. Name and justify one (1) cognitive test that would be applicable to use for Ethel.                    

3. Name three (3) other tests (not cognitive) a doctor might order to determine a diagnosis of Alzheimer’s dementia and explain briefly why.                                                       

Question 4: 

After reviewing NSQHS standard five, answer the following questions related to safety and comprehensive care

1. Ethel is at increased risk of injury while in hospital. Name three (3) reasons why.       

2. Discuss two (2) interventions that you would implement to help Ethel avoid injury while she is in hospital. Justify your answer using evidence beyond the NSQHS standard.      

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