Gnur500: Negative Functional Consequence Assessment Answer

PART ONE: Introducing Mrs. Beth Riley

Beth Riley is a 93 year old widow who lives alone in a small apartment in a senior’s housing complex. She has been approved to receive services from a Home Health Care team. Her history is as follows:

She has significant osteoarthritis in her shoulders, elbows, wrists, hands, hips, and knees. She struggles to feed herself with her right hand, and the flexion in her right shoulder is 900 (normal is 1800). She has difficulty preparing food (cutting, lifting, using a can opener, twisting off lids etc.). She experiences pain and stiffness in her hips and knees and is afraid to use stairs. She often sits for long periods as getting in and out of her recliner is challenging and she gets fatigued easily. She is 5’2’’ (3” shorter than when she was in her 50’s), and weighs 102 lbs (46.3 kg.). She mainly eats small meals of toast with butter, tea with sugar and cream, and occasionally a small commercially prepared microwaved meal.

Mrs. Riley can dress herself, but requires large buttons or snaps on her blouses and elastic wasted pants/skirts. She wears slip-on shoes and she tends to shuffle, especially when she is tired or sore. You notice that Mrs. Riley has a wide-based gait and has complained of feeling dizzy on numerous occasions over the last few months. She also states she is having shortness of breath (SOB), occasional chest pain, and increased fatigue. She is reluctant to use a walker or cane and often supports herself by hanging onto counters, rails, or other people when moving around. She reports that she has fallen serval times over the past 6 months. She wears an incontinence pad and states she “occasionally wets a little”. She prefers not to drink anything after about 5:30 pm because she has trouble getting to the toilet in time during the night.

Mrs. Riley’s son, Mike, comes every Sunday afternoon and prepares her weekly medications in a dosette. She states that she takes her medications although she has forgotten “now and again”.

Beth’s oral care is hampered by wrists and hand pain. Her last dental check-up was over 10 years ago. Beth showers once or twice a week but states that she is scared of slipping in the tub so prefers to clean herself at the sink.

Beth states that her joint pain is getting worse and that she will end up in a wheelchair. She watches a lot of television and often asks her healthcare providers about medications that are advertised. She has heard about a new drug for rheumatoid arthritis (Humira) that she thinks might help with her discomfort and would like to talk to the doctor about getting a prescription as soon as possible.

Mrs. Riley seldom goes out of her apartment. She states that her vision has gotten “really bad” and she is fearful of unfamiliar surroundings. She is not used to the bus system and relies on her son to get her to appointments (which she tries to limit so that she is not a “bother”).

Beth’s hearing is also declining and she finds it difficult to participate in social situations. She can, however, manage well with one-to-one conversations if there is minimal background noise.

Her son (Mike) is very attentive and visits every weekend. He has Power of Attorney and helps her pay her bills. Her relationship with him is described as “good”. She appreciates the help he provides, but sometimes she gets frustrated when he tells her what to do. Mike states that she often misinterprets his assistance to help as attempts to run her life. He states that his mom has always been staunching independent and has quite a strong will. He is not sure of his mom is starting to go “senile” but is worried that she is becoming more forgetful and less attentive to her personal hygiene. Lately he has taken on the task of checking her blood pressure each time he visits as Beth is no longer doing it. Mike also thinks that his mother has fallen more than she admits and is forgetting to take her medications.

You are to imagine that you are the Community Nurse assigned to Mrs. Riley.

1. What risk factors does Mrs. Riley have for negative functional consequences? (include age-related, disease related and treatment/medication related risk factors).

2. What further subjective data would you want to obtain and what assessments (objective data) will you do on your initial visit?

3. What nursing diagnoses take priority and what interneurons might be appropriate at this time

4. What gerontological standards and competencies take priority at this time?

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