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3) Complete the following Case Study and email your answers back to me.

 

Case Study: Emma Stracener

 

Emma Stracener, age 40, is the only child of Ms. Amelia Arlington, who is 75 years old. Emma is married and has three children ages 5, 7, and 10. She works full time and volunteers at the elementary school her children attend. Her husband works full-time and coaches the oldest child’s soccer team.

 

Emma lives 30 minutes away from her mother and typically visits every other Tuesday evening. Ms. Arlington called Emma on the morning of August 20 to ask her to come over because she had slipped in the bathroom but was okay. Emma changed her plans for the day and arrived just before lunch. As she was preparing the noon meal, Emma noticed her mother’s refrigerator had spoiled food. She also noticed clutter in many of the rooms. Emma became concerned because her mother had always kept her house tidy and clean. Emma also noticed her mother slurred some words during their conversation. She asked her mother how she was feeling. Her mother responded that her hips and back hurt from arthritis but she was taking a new medication prescribed by her primary care provider.

 

Emma asked to see the new medication; the label said tramadol hydrochloride (Ultram) 25 mg one tablet every 6 hours as needed. She noticed the date on the bottle was August 1, but only eight pills remained in the bottle on the day of her visit. When Emma asked her mother about the number of pills that were missing from the bottle, her mother replied, “I am taking the medication my doctor prescribed. He says it’s a low dose.” Emma knows her mother is acting differently than the last time she saw her and decides to take her to the primary care office for an examination and to discuss her concerns. Ms. Arlington is reluctant to go because she feels fine and doesn’t want to bother anyone at the office, but Emma insists. Emma takes her mother to the primary care office after lunch. 

 

1.  Pharmacology activity

 

Look up the medication, tramadol hydrochloride, for its purpose, mode of action, side effects, and contraindications.

Look up tramadol hydrochloride on the Beers List https://www.pharmacist.com/beers-revised-drugs-not-use-older-adults  and then discuss the appropriateness of prescribing it for older adults

 

 

Beers revised: Drugs not to use in older adults – American Pharmacists Association

Older adults are generally characterized as patients who may be at an increased risk for adverse drug events because of altered pharmacokinetics, increased exposure to multiple concomitant medications, and comorbid conditions. In 1991, Mark Beers, MD, and colleagues published criteria listing “potentially inappropriate medications” for older patients.

www.pharmacist.com

.

Emma and Ms. Arlington are sitting in the examination room when the nurse practitioner enters. She asks Ms. Arlington how she has been feeling and the reason for the visit. Ms. Arlington tells her about her hip and back pain, which improved with the pain medication. Then Emma tells the nurse practitioner the rest of the story…

 

Based on the situation, the NP understands there are multiple problems: (1) physical pain from arthritis, (2) possible cognitive impairment, (3) unintentional nonadherence to a habit-forming narcotic, and (4) high risk of fall. The NP also finds strengths in the situation, including a concerned daughter, a cooperative mother, and a willingness to seek help. The NP addresses the immediate problem, which is tramadol hydrochloride. She develops a weaning schedule and substitutes acetaminophen for the narcotic. She asks Ms. Arlington if she would like to receive physical therapy to help her arthritis. Ms. Arlington agrees. Then the NP asks Emma if she could return next week to discuss ways Emma could help her mother with assistive technology. Emma agrees immediately. 

 

2.  Interprofessional activity

Search the Internet for the latest technologies that could help older adults. Search for at least five technologies that could improve Ms. Arlington’s situation. List technologies, usage, and how the particular technologies assist the elderly population. Provide links to the sites where you obtained the information.

 

3) As patient’s families are also in the realm of nursing care you should be aware of how this situation may affect Ms. Arlington’s daughter.  Write 3 at-risk-for nursing diagnoses (NANDAs) for Emma. Use your nursing diagnosis book for proper diagnosis. 

4) whats 3 nursing diagnoses (NANDAs) for Ms. Arlington 3 interventions for each diagnosis, and goals for each. No – at risk for falls. Use your nursing diagnosis book for proper diagnosis. 

 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 120

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