UNIVERSITY OF CEBU – BANILAD

College of Nursing

NCM 114 Care of Older Adults

1st SEMESTER - SY 2023 -2024

ASSIGNMENT 4
CASE ANALYSIS

GROUP 8
MEMBERS:
OBLEANDA, KIM
OTAZA, JOSHUA JOSEPH
PABELONA, NEICAH ANGELIQUE
PARADIANG, GERARD DON
PARAGSA, PARCE BRENDIS

This is a group assignment. Use a long sheet of bond paper. Digital print. Carefully read and analyze the
Geriatric cases. Follow this format for your analysis.
A. Applied Concept
B. Applied Theory
C. Changes in Aging (Physical, Physiologic, Psychological and Social)
D. Nursing Diagnosis
E. Signs and Symptoms
F. FDAR (Present 2)

Case 1

Donna, 82 years old living in a far-flung Barangay Mahayahay. She was brought to a home for the aged
because no family member could take care of her. She was observed to have a grimace face and was
shouting every time an attention was given to her by the student nurses. She sat on a wheelchair with a
frowning face, pale and wrinkled skin, very thin, and was so quiet at a corner of the lounge area. Her
breathing is labored. No medications were prescribed.

Her vital signs read as follows:

T - 37◦C
PR - 69 beats per minute
RR – 28 cycles/breath/minute
BP - 100/70 mmHg

ANSWER:

A. Applied Concept
Person-centered care: This is a care concept that highlights the necessity of recognizing and respecting
older individuals' specific needs and preferences. When providing person-centered care, healthcare
providers collaborate with older persons and their families to create a care plan that is tailored to their
specific requirements. This is especially crucial for older persons who are experiencing cognitive
impairment or other issues that make communicating their needs challenging.

In this case, applying a person-centered approach would involve talking to the elderly woman and her
family to learn more about her needs and preferences. This information could then be used to develop a
care plan that includes activities and interventions that she enjoys and finds meaningful. For example, if the
woman enjoys listening to music, the care plan could include providing her with access to music and
musical activities. It is also important to consider her physical and cognitive abilities when developing the
care plan. For example, if the woman has difficulty moving, the care plan should include activities that are
accessible to her.

B. Applied Theory
In this case study, the elderly woman's grimace face, shouting, and frowned expression when given
attention by student nurses suggests that she may not feel comfortable or supported in her current
environment. She may also be feeling frustrated or overwhelmed by the attention. Additionally, her pale and
wrinkled skin, thinness, and labored breathing suggest that she may have underlying health conditions that
are not being adequately managed.

By applying the person-environment fit theory to this case study, the healthcare team could work to create
a more supportive environment for the elderly woman. This could involve making changes to her physical
environment, such as providing her with a more comfortable chair or bed, or it could involve making
changes to her social environment, such as placing her in a room with other residents who are calm and
quiet. The healthcare team could also work to better understand and manage the woman's underlying
health conditions. This could involve prescribing medications, providing physical therapy, or developing a
personalized care plan.

C. Changes in Aging (Physical, Physiologic, Psychological and Social)

● Physical
○ Musculoskeletal System:
■ Reduced muscle mass and strength, indicated by her reliance on a
wheelchair for mobility.
○ Skin:
■ Thin and wrinkled skin, which is a typical age-related change.
■ Possible decreased elasticity.
● Physiologic
○ Metabolism:
■ Donna might have experienced a slowed metabolic rate, contributing to
her thin build.
○ Cardiovascular System:
■ Donna's blood pressure is on the lower side (100/70 mmHg), which is a
common age-related change.
○ Respiratory System:
■ Donna's respiratory rate is elevated at 28 cycles/breath/minute, indicating
possible respiratory distress or a respiratory condition.
● Psychological
○ Emotional Well-being:
■ Donna's grimace, shouting, and frowning face may indicate emotional
distress or discomfort. These behaviors could be associated with various
psychological factors, including anxiety, depression, or cognitive changes.
● Social
○ Living Situation:
■ Donna has moved to a home for the aged, indicating a significant social
change which is due to the inability of family members to provide care,
which is a common scenario in aging populations.
○ Social Interaction:
■ Donna's behavior suggests a decreased tolerance for social interaction or
attention. This could be due to various factors, including sensory
sensitivity or emotional discomfort.
○ Community Involvement:
■ Given that Donna lives in a remote area, she might have limited
community involvement.
D. Nursing Diagnosis
- Social Isolation related to inadequate psychosocial support system as evidenced by easy
agitation and minimal interaction with other people
E. Signs and Symptoms
- Symptoms of Social Isolation include hostility, reduced eye contact, low levels of social
activities, minimal interaction with others, sense of alienation, social behavior incongruent
with cultural norms, social withdrawal, and major changes in eating patterns
 F. FDAR (Present 2)

FOCUS PROGRESS NOTES

● Nutritional insufficiency DATA:

● Frowning face, pale and wrinkled skin, very thin
ACTION:
● Assess the patient's nutritional status to identify lacking
nutrients and level of nutritional deficit
● Look for physical signs of poor nutritional intake to
immediately respond and prevent further complication
● Provide companionship during mealtime to encourage food
intake
● Consider six small nutrient-dense meals instead of three
larger meals daily to lessen the feeling of fullness to prevent
vomiting of the patient and to administer proper nutrients
● Administer the required vitamins and minerals to supply the
necessary nutrients
R:
● Patient shows an increase in weight
● Patient’s mood is more stabilized and she’s no longer seen
frowning
● Patient’s skin is back to its healthy appearance
● Patient has obtained necessary nutrients

FOCUS PROGRESS NOTES

● Feeling of abandonment DATA:

● She was observed to have a grimace face and was shouting
every time an attention was given to her by the student
nurses.
● frowning face and was so quiet at a corner of the lounge
area
ACTION:
● Assess the patient's emotional status to determine the
patient's emotional status in order to determine which
intervention to use
● Identify strained relationships or missing support systems.
● Offer yourself as a nonjudgmental listener in order for the
patient to express her emotions without the fear of being
judged.
● Encourage family members to visit patients or use
technology as a mode of interaction in order for the patient to
reconnect and feel the presence of her family member.
● Encourage support groups in order for the patient to
establish a group that allows her to feel that she is not alone.
R:
● Patients opened up to others and trusted the staff in the
home for the aged.
● Patients opened up and shared the things that are bothering
her.
● Patient is slowly interacting with other people.
● Patient no longer shows signs of agitation.
Case 2

Staring at a window pane in his farmhouse is a male elderly with white hair named Joshua ,75 years old,
engaged in farming for 20 years, widower and lives alone. He used the crutches during ambulation. He had
a car accident that affected both of his lower extremities. He has prostheses. A PT intern assists him for
mobility and exercises thrice a week.

His vital signs read as follows:

T – 36.5◦C
PR - 72 beats per minute
RR – 30 cycles/breath/minute
BP - 110/80 mmHg

A. Applied Concept
In Joshua's case, multidisciplinary care could be applied by involving a team of healthcare professionals in
his care. This team could work together to assess his needs and develop a care plan that addresses all of
his needs. For example, the doctor could assess his medical needs and prescribe any necessary
medications. The physical therapist could help him to improve his range of motion and strength. The
occupational therapist could help him to develop strategies for coping with his physical limitations and
activities of daily living. And the social worker could help him to connect with resources and support
services in the community.

By applying this concept and approaches to his care, healthcare providers can help Joshua to feel more
comfortable, supported, and understood. This may help to improve his overall well-being and quality of life.
It is also important to consider Joshua's social and emotional needs. He is a widower who lives alone, so
he may be at risk for social isolation and depression. It is important to make sure that Joshua has
opportunities to socialize with others and to participate in activities that he enjoys. The healthcare team can
also provide support and counseling to Joshua if needed. By holistically addressing Joshua's physical,
cognitive, social, and emotional needs, healthcare providers can help him to live a fulfilling life.

B. Applied Theory

Activity theory. This theory posits that older adults who remain active and engaged in their lives are more
likely to be happy and healthy.

In Joshua's case, finding activities that he enjoys and can participate in, despite his physical limitations,
could help to improve his well-being. Healthcare providers can help Joshua to identify activities that he is
interested in and that are appropriate for his physical abilities. For example, they could suggest activities
that can be done while seated, such as reading, playing board games, or gardening. They could also
suggest activities that can be done with the assistance of his PT intern. By helping Joshua to achieve a
better person-environment fit and to engage in meaningful activities, healthcare providers can help him to
live a more fulfilling and satisfying life.

C. Changes in Aging (Physical, Physiologic, Psychological and Social)

● Physical
○ Musculoskeletal System:
■ Joshua uses crutches for ambulation, indicating mobility challenges due to
his car accident. This suggests significant musculoskeletal changes and
the need for assistive devices.
■ He has prostheses, which implies he may have had amputations or
significant injuries to his lower extremities.
○ Hair Color:
■ Joshua has white hair, which is a common age-related change.
● Physiologic
○ Respiratory System:
 ■ Joshua's respiratory rate is slightly elevated at 30 cycles/breath/minute,
which may be due to factors such as his physical condition or any
respiratory challenges he may have.
● Psychological
○ Grief and Loss:
■ Joshua is a widower, which indicates that he has experienced a significant
loss. This can have psychological and emotional effects.
○ Coping with Disability:
■ Joshua has had a car accident that affected both of his lower extremities,
which can lead to various psychological adjustments, including coping
with the loss of mobility and adapting to prostheses.
○ Isolation:
■ Joshua lives alone in his farmhouse, which may lead to feelings of
loneliness or isolation. This could have psychological implications.
○ Engagement in Farming:
■ Joshua has been engaged in farming for 20 years. This activity could
provide a sense of purpose and routine, which can have positive
psychological effects.
● Social
○ Living Situation:
■ Joshua lives alone on a farmhouse, which may indicate a preference for
solitude or limited access to social interactions.
○ Occupation:
■ Joshua has been engaged in farming for two decades. This might be a
significant part of his identity and routine.
○ Support and Assistance:
■ Joshua receives assistance from a physical therapy intern for mobility and
exercises thrice a week, indicating that he may require some level of
support due to his physical condition.
○ Widowhood:
■ Being a widower may have led to changes in Joshua's social interactions
and support network.
D. Nursing Diagnosis
- impaired social interaction related to inadequacy or absence of significant purpose in life
as evidenced by decreased involvement with others as a result of being socially isolated
- ineffective coping related to multiple life changes or losses as evidenced by inability to deal
with the situation due to death of spouse
- risk for fall related to impaired physical mobility due to vehicular accident
E. Signs and Symptoms
- decreased social interaction
- range of motion limitation
- longing for companionship

F. FDAR (Present 2)

FOCUS PROGRESS NOTES

● Impaired social interaction DATA:

● Widower
● Lives alone
● Physical impairment which prevents social interaction
ACTION:
● Identify strained relationships or missing support systems to
identify the cause of isolation.
● Offer yourself as a nonjudgmental listener to let the patient
express his emotion without the fear of being judged.
● Encourage support groups in order for the patient to establish a
circle where he can relate and a group where he feels safe.
 ● Refer to therapy for deeper issues.
● Recommend adult daycare centers or facilities in order for a
health personnel to assist the patient especially now that he has
a disability and is already old.

R:
● Patient expressed a feeling of improved self-worth and
confidence
● Patient has expressed a desire to interact with others and sought
social engagement.
● Patient participated in activities with others that aligned with his
interests and mental/physical capabilities.

FOCUS PROGRESS NOTES

● Risk for fall DATA:

● Uses crutches
● Uses prostheses
● Both lower extremities are affected due to a car accident
ACTION:
● Assess mental status changes to know the patient's cognitive
capabilities.
● Assess the use of mobility assistive devices to know the patient’s
level of knowledge.
● Evaluate the patient’s environment to determine any possible risk
that may cause the patient to stumble and fall.
● Recommend the client to use a walker for maximum balance and
support in order to prevent falling since a walker is more stable.
● Instruct the client on how to properly use the crutches to help
patient understand the proper way to prevent injury, especially
falling.
● Consider physical and occupational therapy sessions to assist
with gait techniques to help client enhance his mobility.
● Explain the use of vitamin D supplements to strengthen client’s
bones.
R:
● Patient did not sustain a fall.
● Patient was able to relate the intent to use safety measures
to prevent falls.
REFERENCES:

Bsn, G. W., RN. (2023). Fall Risk and Fall Prevention Nursing Care Plan. Nurseslabs.

https://nurseslabs.com/risk-for-falls/

Bsn, G. W., RN. (2023b). Imbalanced nutrition nursing care plan and management. Nurseslabs.

https://nurseslabs.com/imbalanced-nutrition-less-body-requirements/

Doenges, M. E., Moorhouse, M., & Murr, A. C. (2022). Nurse's Pocket Guide: Diagnoses,

Prioritized Interventions, and Rationales (16th ed.). F.A Davis.

Impaired Physical Mobility Nursing Diagnosis & Care Plan. (2023, January 12). NurseTogether.

https://www.nursetogether.com/impaired-physical-mobility-nursing-diagnosis-care-plan/

Meiner, S. E., & Yeager, J. J. (2018). Gerontologic Nursing. Elsevier Health Sciences.