Running head: Aging Project Pratt 1

Aging Project

Shelby J. Pratt

Monroe County Community College

PNUR 121: Fundamentals of Practical Nursing

Holly’s Clinical Group

Kevin, Aleksa, Shelli

13 April 2020
Aging Project Pratt 2

Aging Project

Introduction

For this assignment, we were given a case-study client to do research on. Our main

objectives were to identify client needs and goals, and to provide resources that the client would

benefit from in order to meet these goals. To do this effectively, we needed to come up with

nursing diagnoses, or NANDAs, as our foundation. From there, we were able to compile a list of

resources to aid in meeting the client’s goals and needs. We also had to consider what obstacles

our client might face while trying to meet these outcomes. With that in mind, we had to think of

how we might be able to help the client overcome these obstacles for a positive outcome.

Meet the Client

For our scenario, we were assigned Milton Larsen. Mr. Larsen is an eighty four year old

African American man. He is a veteran. He lives with his step-daughter, Dina, in the basement of

her small home. Mr. Larsen has a cat named Snuggles as a companion. Dina does not like this

cat because of the strong smell associated with the litter box. Milton has high blood pressure, for

which he takes metoprolol tartrate and spironolactone. He also suffers from osteoarthritis of his

left knee. Having to walk upstairs frequently to use the bathroom aggravates his knee and causes

pain flare-ups. Milton takes ibuprofen for this knee pain. At his last visit to his primary care

provider, Milton told his nurse that Dina gets mad at his cat, Snuggles, and takes it out on him.

Nursing Diagnoses

Given the information in our client scenario, Aleksa was able to come up with several

NANDAs, or nursing diagnoses, and Kevin was able to help assist her in completing them.

The ​priority nursing diagnosis​ for Mr. Milton Larsen is: ​risk for unstable blood pressure,
Aging Project Pratt 3

related to inadequate blood pumped to the heart to meet metabolic demands, as evidenced by

high blood pressure.​ The overall goal of this nursing diagnosis is that Mr. Larsen will maintain

blood pressure within acceptable ranges daily. The three outcomes or goals associated with that

are: patient will understand the importance of and maintain regular exercise and adhere to dietary

changes; patient will understand the importance of hypertension medications and take as

prescribed; and patient will have blood pressure taken daily and readings will be within normal

limits, or WNL. Based off of that information, Aleksa was able to decide upon three

individualized nursing actions, as follows: during visits to PCP, nurse will educate the patient on

the importance of diet and exercise in association with high blood pressure; nurse will give the

patient hypertension medications as prescribed by physician; nurse will monitor patient’s blood

pressure and vitals every four hours and as needed, to ensure that they are within normal limits.

Since nursing utilized evidence-based practices, there are also three documented scientific

rationales to back up the goals and interventions. These rationales were found in our student

textbooks, “Nursing Diagnosis Handbook”, on page 169: modifications in diet and exercise can

help the heart and lower blood pressure; patients who understand the importance of medication

are more likely to cooperate and take as prescribed; monitoring blood pressure before and after

medications can show effectiveness of said medication.

Next is the ​second nursing diagnosis​ is ​deficient knowledge related to insufficient

knowledge of medication, as evidenced by the patient taking ibuprofen for knee pain, which

decreases the effectiveness of his hypertension medication.​ Overall, the goal is that Mr. Larsen

will learn about medication interactions. This is achieved by outcome number one - patient is

open and demonstrates readiness to learn the importance of interactions between drugs. The
Aging Project Pratt 4

individualized nursing action associated with this is that the nurse will teach the patient about his

prescribed medicines. The documented scientific rationale is from page 585 in our handbook,

“patients with readiness will be able to focus and learn”. Outcome number two is that Milton will

find an alternative way to decrease his knee pain that does not cause interactions with his

antihypertensive medicines. The associated nursing action is that the nurse will suggest the use

of tylenol instead of ibuprofen, as tylenol does not decrease the effectiveness of his blood

pressure medications. The rationale for this comes from our student drug resource, Lexicomp,

which states that tylenol has no interactions with metoprolol. The last goal for this nursing

diagnosis is that the patient will seek help from healthcare professionals when uncertain about

medications. The nurse will explain telehealth, and let Milton know about resources available to

him regarding medication questions and concerns. The rationale is from page 586 in our

handbook, and it states that technology is most desired and it is easy for patients to call about

questions (telehealth), and is effective in answering client questions.

The ​third nursing diagnosis​ is ​impaired physical mobility related to musculoskeletal

impairment, as evidenced by osteoarthritis, pain in left knee, taking ibuprofen for pain, and

trouble ambulating to the upstairs bathroom.​ The goal is that the patient will maintain his current

level of mobility without any worsening. Outcomes include: describe feeling stronger and more

mobile without fear of falling within a week; engage in neuromotor exercises 20 to 30 minutes

per day; perform resistance exercises that involve all major muscle groups twice a week with an

in home physical therapist. The individualized nursing actions include: consider patients'

self-reported fear of falling, monitor and record the client’s response to activity by obtaining

vitals before and after; assess muscle strength and other factors affecting balance, mobility, and
Aging Project Pratt 5

endurance. The scientific rationales come from pages 621 and 622 in our handbook, and they

say: self-reporting fear of falling has been shown to be a sensitive predictor for fall risk;

immobility can affect tissue perfusion and increase risk of postural hypotension, shortness of

breath, and decrease endurance; and if patient has osteoarthritis or rheumatoid arthritis consult

with a physical therapist on ways to integrate aerobic, resistance, and flexibility exercises into

the plan or care. “Health-related quality of life (HRQOL) is of great interest, both with respect to

individuals themselves as well as a primary concern of public health administrations and

professionals. The remarkable increase in life expectancy in the twentieth century implies a need

to focus on factors capable of promoting a high level of HRQOL into old age” (Bjerk). We want

to prevent our client from worsening physical mobility, as well as improve his health-related

quality of life.

The ​fourth nursing diagnosis​ is ​risk for injury related to environment conditions, as

evidenced by ambulating up and down the staircase.​ The overall goal here is that we want Mr.

Larsen to remain free from injury. One outcome is that Milton will wear proper non-slip

footwear when ambulating up and down the stairs. The nurse will teach him the importance of

wearing proper, supportive, low-heeled shoes with traction during ambulation. The scientific

rationale states, “supportive shoes provide clients with better balance and protect from instability

leading to an injury”. Another outcome is that a home nurse will practice safe ambulation

exercises with Milton weekly. The nurse will do routine home therapy exercises and evaluate

safe mobility around the home. The rationale says that light exercise can prevent injury in older

people. The last outcome for this nanda is that the patient will use assistive devices, such as

handrails, when walking up and down the stairs. The nurse will ensure that there is a plan for
Aging Project Pratt 6

placing handrails along the stairs and around the house, and also follow up to make sure that they

are installed within a reasonable time frame. The documented scientific rationale behind this is

that assistive devices can help with preventing future injury. All rationales for this NANDA were

found on page 560 in the Nursing Diagnosis Handbook text.

The ​fifth nursing diagnosis​ is ​risk for loneliness related to social isolation, as evidenced

by spending a fair amount of time alone in the basement with only a cat.​ Overall, we want the

client to show no signs of feeling lonely. This is achieved by goal number one, which is that Mr.

Larsen will participate in social activities daily or as scheduled, depending upon preference. The

nurse can organize or find activity groups for seniors that interes Milton. The science along with

this is that senior center activities help facilitate socialization. The second goal is that the client

will demonstrate positive use of time alone. The nurse will suggest independent activities that the

patient will enjoy doing and participating in alone. “Older people who take pleasure in life tend

to live longer”. The third and final goal is that the patient will have family and/or friend support

systems in daily visits. The nurse can help facilitate this by reaching out to family, friends, and

peers or Mr. Larsen and arranging daily meetings and visits so that he is not alone. Peer

relationships have been shown to play a significant role in self-esteem development. All

rationales for this NANDA are found in our text on page 603.

Nursing diagnosis number six​ is ​post trauma syndrome related to being a veteran, as

evidenced by spending most of his time alone with his cat in his step-daughter’s basement.​ The

overall goal here is that Milton will show no signs of mental health disability. Outcomes are;

patient will return to the pre-trauma level of functioning as quickly as possible; patient will

acknowledge traumatic event and begin to work with the trauma by talking about the experience
Aging Project Pratt 7

and expressing feelings of fear, anger, anxiety, guilt, and helplessness; patient will assimilate

event and move forward to set and pursue life goals. The nursing actions include: help the patient

use positive cognitive restructuring to reestablish feelings of self-worth; provide the clients the

means for the client to express feelings through therapeutic activities like drawing; encourage the

patient to return to his normal routine as quickly as possible and instill hope. The documented

scientific rationales are found on pages 716 and 717 in our handbook, and they include: cognitive

therapy was well tolerated and led to a very large improvement in PTSD symptoms like

depression, and anxiety most clients showed a significant improvement that was clinically

significant; traumatic events are many times difficult to describe in words, art therapy gives

victims another avenue by which they can project their emotions; hope was intentionally used in

the study as an intervention in a group setting in a nursing home; it was evident the hope is not

static and can change over time.

The ​final nursing diagnosis, number seven​, is ​dysfunctional family process, related to

verbal abuse, as evidenced by Milton’s step-daughter, Dina, projecting her aggressions towards

his cat onto him.​ The overall outcome of this is that Milton will remain free from verbal abuse.

Goal one is that Milton will use healthy coping methods daily. The nurse will find counseling

resources and suggest ways that Milton can cope with his step-daughter’s behavior. Our nanda

book says that coping can be an effective way to learn and practice communication. Secondly,

Mr. Larsen will have open communication with Dina. The nurse will have Milton practice

responding to Dina’s behavior. This is because open communication can improve relationships,

as stated in our nanda text. Lastly, Mr. Larsen will understand his step-daughter’s concerns and

seek help when needed. The nurse will ensure that Milton knows that he can ask questions about
Aging Project Pratt 8

Dina’s concerns and show that he acknowledges them. Our Nursing Diagnosis Handbook says

that showing interest in one’s opinions can open a line of healthy communication. All

documented scientific rationales for nursing diagnosis number seven come from page 379 in the

Nursing Diagnosis Handbook text.

To go along with this nursing diagnosis, I was able to find a peer-reviewed, scholarly article,

titled “The Effects of Education on Nurses' Ability to Recognize Elder Abuse Induced by Family

Members”. The article states “education significantly improves nurses' ability to recognize

domestic elder abuse. Health-care managers and policymakers can improve nurses' elder abuse

recognition ability through implementing in-service continuing education programs, improving

their attitudes toward elder abuse reporting, integrating elder abuse into nursing academic

curriculum, and developing protocols and systems for reporting and managing elder abuse”

(Ghaffari). It is important for us as nursing students to understand and recognize all types of

abuse that we may see in our practice. As healthcare professionals, we are each mandated

reporters. Recognizing abuse and knowing how to report it is essential in protecting patients.

Resources to Help

Now that key nursing diagnoses and goals have been established, we can easily identify

resources available locally to help Mr. Larsen and his family. Multiple services and agencies are

available, and we have provided specific descriptions of how they will benefit the client. Shelli

compiled a list of available resources local to Milton in Monroe County, Michigan.

One agency is AARP. AARP’s mission is “to enhance the quality of life for all as we age,

leading and delivering to our members through information, advocacy and service”. They have a
Aging Project Pratt 9

Monroe chapter, and I was able to find a section of their website with local events that Milton

may enjoy: ​https://local.aarp.org/monroe-mi/events/​.

Since we are not sure about Milton’s financial situation solely based on the assignment

information given to us, we wanted to ensure that his food and nutritional needs are able to be

met. God Works is a coalition of people with a common goal of serving food to the homeless and

working poor in the Monroe area. God Works is non-denominational and currently includes

representatives from dozens of churches and secular groups and continues to welcome new

members. Everyone in the God Works group believes that hungry people deserve to eat. God

Works will benefit our client by providing a meal to eat if needed.

The Aging & Adult Services Agency (AASA) is Michigan's designated state unit on

aging. AASA's mission is to provide statewide leadership, direction, and resources to support

Michigan's aging, adult services, and disability networks, with the aim of helping residents live

with dignity, meaning, purpose, and independence. AASA's vision is for Michigan residents to

live well and thrive as they age. AASA will benefit our client by providing adult services and

resources to support his needs.

Area Agency on Aging 1B is another agency that will benefit Mr. Larsen by providing

resources for in-home care, meals on wheels, community dining, transportation for seniors, and

more! ​https://aaa1b.org/services-and-seniors/

Monroe County Opportunity Program (MCOP) is another great establishment that can

benefit Milton. MCOP can assist with groceries, home care, housing, and a volunteer caregiver

to relieve Dina. ​https://monroecountyop.org

Aging Project Pratt 10

Adult Protective Services protects vulnerable adults from abuse, neglect, and exploitation

by investigating allegations and finding support for victims. To report abuse, neglect or

exploitation call the 24/7 hotline below. 855-444-3911. Adult Protective Services will assist our

client if he is being or feeling abused. Anyone can call and report suspected abuse anonymously.

Because Mr. Larsen is a veteran, we wanted to ensure that he is getting all benefits

entitled to him and that he has earned and deserved. County of Monroe Department of Veterans

Affairs, 965 S. Raisinville Rd., Monroe, MI 48161, (734) 240-3287, can help with that.

Obstacles to Overcome

Since resources have been made accessible to Milton, we recognize that there still may be

obstacles that prevent him from utilizing them to their full potential. Here, we have come up with

adversities and how he may overcome them to make the most of his resources.

We know that elders may suffer from loneliness, and subsequently depression. One of

our NANDAs includes this, and suggests interventions to Milton that help him improve his risk

for loneliness by partaking in activities with his peers. We have established that AARP posts a

calendar of events on their website, which we have linked.

We also recognize that we do not know how Milton gets around town, which is why we

have a solution for lack of transportation as well. Area Agency on Aging 1B provides

transportation for seniors. Another option is the local public transportation system, Lake Erie

Transit, or LET. Lake Erie Transit offers a variety of fast and easily accessible transportation

services for Monroe County residents. With 8 Fixed Routes, Frenchtown and Bedford
Aging Project Pratt 11

Dial-A-Ride services, ADA and Essential Transportation Services, Lake Erie Transit is a great

option for Milton to utilize for getting around town.

Final Discussion

Throughout this project, we were able to identify ways in which we can improve Milton

Larsen’s life. We discussed nursing diagnoses, goals and interventions, and backed up our data

with rationales from our text. We determined local resources available to help our client live his

very best life. We also recognized obstacles that he may face, as well as options for achieving

success in overcoming those obstacles. Overall, we believe that this information would greatly

help our assigned client, Mr. Milton Larsen.

Aging Project Pratt 12

References

Ackley, B. J., Ladwig, G. B., Beth, M. F. M., Martinez-Kratz, M. R., & Zanotti, M. (2020).

Nursing diagnosis handbook: an evidence-based guide to planning care (12th ed.). St.

Louis, MO: Elsevier.

Bjerk, M., Brovold, T., Skelton, D. A., & Bergland, A. (2017). A falls prevention programme to

improve quality of life, physical function and falls efficacy in older people receiving

home help services: study protocol for a randomised controlled trial. BMC Health

Services Research, 17(1). Retrieved from

https://link-gale-com.monroeccc.idm.oclc.org/apps/doc/A511281328/PPNU?u=lom_mon

roecccl&sid=PPNU&xid=2dbab499

Ghaffari, F., Alipour, A., & Fotokian, Z. (2020). The effects of education on nurses' ability to

recognize elder abuse induced by family members. Nursing and Midwifery Studies, 9(1),

1. Retrieved from

https://link-gale-com.monroeccc.idm.oclc.org/apps/doc/A611792275/PPNU?u=lom_mon

roecccl&sid=PPNU&xid=680ce483

We also utilized Lexicomp as a reference to research the medications that Mr. Larsen takes.

However, I am unsure how to cite the following Lexicomp website as a whole, or at all:

https://online.lexi.com/lco/action/home?refid=2