ASSESSMENT INFORMATION Assessment Title ...

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ASSESSMENT INFORMATION
Assessment Title	Written assessment
Purpose	The purpose of this written task is to engage students with the application of theory into practice and how this needs to be flexible to meet the needs of the person requiring health care assistance.
Weighting	40%
Length	1500 words +/- 10% (includes in-text citations, excludes reference list)
Assessment Rubric	Refer to Extended Unit Outline Appendix 2
LOs Assessed	LO1, LO3, LO5
Task	Students will assess, prioritise and plan the care of the guided case study patient using a clinical reasoning framework in hospital and community setting. Introduction and conclusion not needed. Case study Mr. Johnson is a 75-year-old man, was brought to the emergency department (ED) by his daughter with concerns about his increasing levels of pain, intermittent periods of acute confusion and deteriorating overall general health. Initial Assessment Mr. Johnson is alert but disorientated to time and place. He appears dishevelled and malnourished, with a strong odour of urine. He was brought in a wheelchair and was guarding his L knee. Daughter stated Mr. Johnson took two (2) Ibuprofen (neurofen) tablets couple of hours ago with minimal effect. BP - 140/93 HR XXXXXXXXXXbpm and regular Peripheral pulses - Present RR - 18 rpm Temp - 37.0C (tympanic) Sa02 - 98% RA BGL – 9 mmol/L Height -170 cm Weight - 74 kg (weighed 80 kgs six months ago) ECG - NAD

MMSE
–
23/30

L
Knee
Xray-

NAD

Urinalysis
-
dark
concentrated
yellow,
clear
urine,
SG
1.010,
pH
7,
Leukocytes
and nitrite- positive.

Medical

history

Mr. Johnson has a history of multiple chronic medical conditions, including osteoarthritis,
osteoporosis,
hypertension,
and
diabetes.
He
is
on
several
medications
and has regular visits with his primary care physician.

Medications

Ibuprofen
Panadol
osteo

Alendronate
(Fosamax)
Norvasc

Cholecalciferol
Calcium supplements

Metformin
Hydrochloride
Gliclazide Hydrochlorothiazide

Patient history

Mr. Johnson lives independently in his own home and usually cooks his own meals at home.
His
daughter
visits
him
couple
of
times
each
week.
Mr.
Johnson
walks
for
an
hour daily
and
catches
up
with
his
friends
at
the
nearby
park
once
a
week.
He enjoys
spending time with his grandchildren. He never smoked and drinks a bottle of beer after dinner while watching TV. He wears glasses for long distance and bilateral hearing aids.

Recently
the
daughter
noticed
Mr.
Johnson
increasingly
neglecting
his
personal
hygiene, nutrition, and household upkeep. Mr. Johnson has been socially isolated.
and had multiple falls at home recently.

Admitting
diagnosis:

Early
signs
of

dementia.

You
are
the
registered
nurse
looking
after
Mr.
Johnson,
and
you
are
required
to
plan
her care
guided
by
a
clinical
reasoning
framework
and
the
provided
case
study
information. Sections you need to respond to include:

1.

Patient
assessment
(500

words)

·

Provide
an
initial
impression
by

identifying
relevant
and
significant
features
from Mr. Johnson’s current ED presentation.

·

Discuss
the
possible
causes
for
Mr.
Johnson’s
intermittent
cognitive
impairment.

	Do you agree or disagree with Mr. Johnson’s diagnosis of an early onset of dementia. Justify your opinion and support your discussion with evidence from the case study. · Evaluate the impact a misdiagnosis may have on the care provided for Mr. Johnson. Mr. Johnson’s intermittent confusion resolved after 3 days. He was assessed by the Aged Care Assessment Team (ACAT) and was eligible for a community care package. Mr. Johnson was discharged home with regular codeine for his chronic pain. 2. Physiological changes of ageing and identify patient issues (500 words) · Discuss how the normal physiological changes of ageing may increase Mr. Johnson’s risk of falls. Identify three (3) evidence-based nursing interventions with rationales that should be implemented for Mr. Johnson to reduce the risk of falls. (Do not include referrals in your answer). · Evaluate how Mr. Johnson’s chronic pain would impact on his capacity to complete two of his activities of daily living (ADL’s) ensuring you have justified your choice of ADL’s. 3. Pharmacological management and nursing considerations (500 words) · Discuss why Mr. Johnson, as an older adult, is more vulnerable to adverse drug effects. Ensure you include factors related to the anatomical, physiological and behavioural considerations associated with ageing. · Identify with rationale two (2) nursing interventions you would consider when caring for Mr. Johnson who takes multiple medications (polypharmacy). (Do not include referrals in your answer.)
Submission	The assessment must be in word document format and is to be submitted to the relevant campus Turnitin assessment drop box located on NRSG266 LEO Assessment Tile
FORMATTING
File format	Please submit as a .doc or .docx (not .pdf files)
Margins	2.54cm, all sides
Font and size	Use 11-point Calibri, Arial or Times New Roman
Spacing	Double spacing
Paragraph	Aligned to left margin, indent first line of each paragraph 1.27cm

Title page/images	No cover pages, bullet points, numbering, tables, or diagrams are to be used.
Introduction/Conclusion	Introduction or concluding paragraphs are not required.
Additional Info	This is an academic piece and as such, third person writing is required. Headings must be used, such as Question One and Question Two and so on.
Structure
Direct quotes	Always require a page number. No more than 10% of the word count should be direct quotes.
Footer	Name _ Student Number_ Assessment _ Unit _ Year (9-point Calibri or Arial)
REFERENCING
Referencing Style	APA 7th Edition.
Minimum References	There is no set number of references that must be used as a minimum for this task, but as a rough guide only, if you have utilized less than 12 unique quality peer-reviewed sources then you have not read widely enough. All arguments must be supported using a variety of high-quality primary evidence. Avoid using any one source repetitively.
Age of References	Most references for this task should be published within the last 5 years, however the appropriate use of older evidence sources (e.g. seminal theoretical ethical work) is acceptable.
List Heading	“References” is centered, bold, on a new page (14 point Calibri or Arial).
Alphabetical Order	References are arranged alphabetically by author family name
Hanging Indent	Second and subsequent lines of a reference have a hanging indent
DOI or URL	Presented as functional hyperlink
Spacing	Double spacing the entire reference list, both within and between entries

ageing-at2-oz40eq2g-rgn3zcxg.docx

Dipali · Accepted Answer

WRITTEN ASSIGNMENT		2
WRITTEN ASSIGNMENT
Table of contents
Patient Assessment	3
Physiological Changes of Aging and Patient Issues	5
Increased Risk of Falls	5
Impact on Activities of Daily Living (ADLs)	6
Pharmacological Management and Nursing Considerations	7
Vulnerability to Adverse Drug Effects	7
Nursing Interventions for Mr. Johnson's Polypharmacy	8
Medication Reconciliation	8
Rationale	8
Implementation	8
Medication Adherence Support	9
Rationale	9
Implementation	9
References	10
Patient Assessment 
Mr. Johnson, a 75-year-old man, arrived at the emergency room (ED) with a number of alarming symptoms that necessitate a thorough evaluation to direct his care. This initial evaluation tries to pinpoint pertinent and important elements from Mr. Johnson's presentation, talk about plausible reasons for his sporadic cognitive impairment, and examine the precision of his early onset dementia diagnosis. First off, Mr. Johnson's daughter took him to the ED because of his poor general health, rising discomfort, and periodic severe disorientation. During the evaluation, some important conclusions were made:
· Mental Status: Mr. Johnson appeared awake but out of place and time. Concerns regarding cognitive damage arise because of this disorientation.
· Physical Appearance: He smelled strongly of urine and looked dishevelled and undernourished. These data imply that diet and personal cleanliness have been neglected.
· Pain and Mobility: Mr. Johnson showed signs of localised discomfort by protecting his left knee. He had taken Ibuprofen, but it had had little impact, indicating insufficient pain management.
· Vital Signs: The patient's blood pressure was high (140/93 mmHg), heart rate was within acceptable limits, breathing rate was 18 breaths per minute, and oxygen saturation in the air was 98%. These vital indicators outline his physiological state.
· Temperature: The tympanic temperature of Mr. Johnson was 37.0 °C.
· Blood Glucose Level (BGL): His BGL was high at 9 mmol/L, which meant he needed to control his diabetes (Schwerzmann et al., 2020).
· Cognitive Function: His Mini-Mental State Examination (MMSE) score was 23/30, which may or may not be early dementia and implies cognitive decline.
· Knee X-ray: His left knee's X-ray revealed no obvious abnormalities.
· Urinalysis: Potential urinary tract infection was indicated by the presence of nitrite and dark concentrated yellow urine with positive leukocytes.
In light of these results, it is necessary to investigate a number of probable reasons for Mr. Johnson's sporadic cognitive impairment. Early onset dementia is a serious concern, but more aspects need to be looked into:
· Urinary Tract Infection (UTI): The likelihood of a UTI increases with the presence of leukocytes and nitrite in the urine analysis. UTIs can make people feel disoriented, especially elderly people (Hodkinson et al., 2022).
· Medications: Mr. Johnson is taking a number of medications, and these side effects or combinations might be causing him disorientation.
· Dehydration and Malnutrition: His untidy appearance, undernutrition, and black concentrated urine point to dehydration and poor nutrition, which might impair cognitive performance.
· Chronic Pain: Guarding his left knee, a sign of untreated or improperly controlled pain, can cause bewilderment and anguish.
· Hypertension: Increased blood pressure may cause cerebral hypoperfusion, which may impair cognition (Enskär et al., 2020).
Before validating Mr. Johnson's diagnosis of early onset dementia, it is important to proceed with care and take into account any potentially treatable conditions, such as the UTI, adverse effects from medications, and dehydration. To make a firm diagnosis, a more thorough cognitive evaluation that includes neuroimaging and neuropsychological testing should be conducted.
Misdiagnosis of dementia can have serious repercussions, including delaying treatment for treatable illnesses and causing the patient unneeded mental suffering. Therefore, in order to give Mr. Johnson the best treatment possible, a thorough and evidence-based assessment is crucial.
In conclusion, Mr.

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