Medical-Surgical Nursing 9th Edition by Sharon Lewis ,Shannon Ruff Dirksen,Margaret McLean Heitkemper,Linda Bucher

Exercise 1

Patient Profile
L.X., a 79-year-old Chinese woman, was admitted through the emergency department with shortness of breath. She was diagnosed with community acquired pneumonia. Her history also indicates she has chronic obstructive pulmonary disease (COPD), hypertension, diabetes, mild cognitive impairment, depression, macular degeneration, and significant hearing loss.
Subjective Data
• Had a stroke 5 years ago and has right-sided weakness
• Has a 100 pack-year history of tobacco use but quit smoking after her stroke
• Has not seen primary care physician in 1 year
• In past year has had an unplanned weight loss of 20 pounds
• Spends her days either in bed or in a recliner watching television
Psychosocial Data
• Came to the United States 15 years ago from China.
• Speaks Mandarin with limited English proficiency.
• Lives with her unemployed adult son who provides assistance with ADLs and IADLs.
• Has three daughters who live within a 2-hour drive.
• Has limited financial resources but has Medicare and Medicaid benefits.
• Her son has not visited her in the hospital, but her daughters raise concerns about their mother's care and safety at home, given their brother's history of anger issues and a gambling addiction.
• When daughters ask their brother about how he is caring for his mother, he says, "I'm doing the best I can. She refuses help. She refuses to go to the doctor. What do you want me to do She's old. She's crazy. She's going to die anyway!"
Objective Data
• Matted hair, poor oral hygiene, overgrown toenails
• Two stage III sacral ulcers
• Unstageable right heel ulcer
• Multiple small bruises on her forearms and shins
• 5 × 10-cm bruise in the middle of her back
1. Compare L.X.'s experience as an older woman to known gender differences for older adults.
2. Identify the stage(s) of Corbin and Strauss chronic illness trajectory that describe L.X.'s current status. Which stage(s) is the goal of your nursing care
3. Given the tasks of people with chronic illness as described by Corbin and Strauss, what is your assessment of L.X.'s ability to successfully complete these tasks What will you include in your care planning to optimize her ability to complete these tasks
4. Define ageism, and explain how it may be manifested in this case.
5. What risk factors does L.X. have for development of frailty Which of these factors are modifiable
6. Priority Decision: Based on your assessment of L.X., what are the priority nursing diagnoses
7. Priority Decision: What are the priority nursing interventions for L.X.
8. Explain ethnogeriatrics considerations that affect L.X. and how they will influence your nursing care.
9. Based on your knowledge of care alternatives for older adults, what setting(s) might be appropriate for L.X. on hospital discharge
10. What risk factors does L.X. have for becoming a victim of elder mistreatment