Download San Antonio College Department of Nursing Education Immobility

San Antonio College Department of Nursing Education Immobility Case Study Mary Ellen an 89 year old has been admitted to a long term care facility after falling and fracturing her hip one week ago. Prior to her admission she lived with one of her daughters and was able to care for herself. She was hospitalized for 4 days after her fall for surgical pinning. During her hospitalization she became increasingly confused and incontinent of urine. It was determined that Mary would be hospitalized for Physical Therapy. After two weeks in the long term facility, it was determined by staff and family that Mary could not complete Physical therapy due to her diagnosis of moderate level dementia with associated confusion and inability to follow commands. Her family has decided to forego physical therapy which means that Mary will be wheel-chair bound and need assistance with activities of daily living (ADLs). Mary has a history of osteoarthritis and hypertension in addition to dementia of the Alzheimer’s type. Mary wears glasses and bilateral hearing aids for age related hearing loss. Her two daughters live within 5 miles of the facility and visit with her on a daily basis. Her medications include furosemide (Lasix) 20mg every morning, acetylsalicylic acid (aspirin) 81mg every morning, and acetaminophen (Tylenol) 650mg every 4 hours as needed. Mary has the ability to suffer the complications related to decreased mobility based on her age as well as physical health condition. As a nurse you are aware of the potential complications of immobility and develop a nursing care plan that will prevent these complications. 1. What is the impact of decreased mobility on functional status? 2. What are cardiovascular complications of immobility that may affect Mary? 3. A major complication that you want to prevent is skin breakdown. The NANDA diagnosis is: risk for impaired skin integrity. Identify 5 nursing interventions that you can implement independently to prevent skin breakdown. 4. In addition to the skin breakdown, Mary has the potential to become dehydrated. Identify normal age related changes that may predispose her to dehydration. 5. What are the causes of dehydration in a long-term care setting for patient with dementia? 6. What assessment measures will you need to perform for a person who has the potential for dehydration? 7. What nursing interventions must be instituted to maintain hydration status? As a nurse you know that pneumonia is the 4th most common cause of death in the older adult population and is a potential complication of immobility. Mary has decreased mobility which may also lead to the potential complication of pneumonia. 8. What are normal age-related changes that may increase Mary’s potential to develop pneumonia in addition to decreased mobility? 9. Identify five nursing interventions to prevent pneumonia in an older adult who also has a decreased level of mobility?