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.

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

• 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.

2. Physiological changes of ageing and identify patient issues  

• 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

• 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.)