Faculty of Social and Health Sciences Department of Nursing Bachelor of Nursing HEAL6011 NURSING PRACTICE OLDER ADULT SEMESTER 1 2016 GROUP 3 End of Course Summative Exam QUESTION BOOKLET Weighting: 60% of course mark You are required to answer ALL sections in permanent blue or black ink. All booklets MUST be handed back to invigilator at end of exam. This booklet contains 5 pages. SHORT ANSWER QUESTIONS: 100 Marks Time Allowed: 2 Hours excludes 10 minutes reading time 1
SHORT ANSWER QUESTIONS (100 Marks) 1. Older adults are particularly at risk for negative impacts upon their psychosocial function and well-being. Identify Miller s (2004) FOUR (4) distinguishing features of life events in the older person. 2. Identify THREE (3) goals of the New Zealand Positive Ageing Strategy AND give an example for each one. (6 Marks) 3. Explain the condition of compartment syndrome AND explain why a fasciotomy might be performed. 4. What are EIGHT (8) risk factors for peripheral arterial disease? 5. List EIGHT (8) interventions you would be prepared to perform in the nursing management of acute episodes of DVT 6. Mr Humphries is a 72 year old male admitted to your ward for treatment of recurrent chest infections and recurrent falls over the past eight months. A preliminary diagnosis of Parkinson s disease is given. a) How would a diagnosis of Parkinson s disease be made? b) Explain why Levodopa is given in combination with carbidopa? (Total Marks 4) 7. Explain with reference to pathophysiology what is meant by a chronic subdural haematoma. 2
8. Patient Profile: Mr Johnson is a 76 year old man who arrived in the emergency department lethargic, vomiting, unable to speak clearly, and with weakness on the right side of his body. His family (wife and daughter) reported: For the past 3months he has been having right-sided weakness and slurred speech that resolved within an hour of onset Approximately 3 days ago Mr Johnson stopped taking his blood pressure medications (Lisinopril and furosemide) because he had spent the money on a horse race. Two nights ago he started to experience more frequent numbness of the right arm and slurred speech, but she didn t think it was important because it disappeared after several hours Today his wife had difficulty in waking him up, and her daughter told her to call the ambulance Medical History: Hypertension Diabetes Type 2 Glaucoma Gout Atrial fibrillation (managed with medications at home) Medications: Digoxin Allopurinol Furosemide (Lasix) NPH insulin twice a day (an intermediate-acting insulin with a slower onset of action and a longer duration of activity) Lisinopril Cartia, (Baby acetylsalicylic acid -low dose aspirin) Potassium Chloride Eye-drops Vital Signs: Mr Johnson s blood pressure on admission was 220/120, mm Hg; Heart rate 126 beats/min Respiratory rate 28 breath/min Temperature was 37 C. He had right sided hemiparesis and hemiplegia. His speech was slurred and at times incomprehensible. Mr Johnson was able to maintain his airway at this time. 3
Interventions: Oxygen via nasal cannula is started at 2 L/min A peripheral intravenous line is started with normal saline at 80ml/hr. A 12 lead ECG CT scan of the head a) Indicate which symptoms Mr Johnson presents with that supports a diagnosis of stroke? (1 ½ marks) b) Identify five (5) risk factors that Mr Johnson presents for the development of stroke? (2 ½ Marks) c) Indicate the type of stroke Mr Johnson most likely had, and support your answer d) What evidence is presented to support that Mr Johnson had experienced previous TIA s? e) Explain why atrial fibrillation a risk factor for embolic stroke. (3 Marks) f) Explain the rationale for each of the interventions conducted for Mr Johnson. g) Describe the mechanism of action of each of the following drugs AND its relevance for Mr Johnson. Lisinopril ACE inhibitor Cartia Anti-platelet h) Identify THREE (3) high-priority nursing problems based on Mr Johnson s assessment AND develop an appropriate nursing care plan using the nursing process for ONE (1) of them with two interventions. (Total Marks 37) 9. Identify the THREE (3) isolation categories and give TWO (2) diseases that would require the identified isolation category. (6 Marks) 4
10. Describe the pathophysiology of Alzheimer s disease (AD). 11. (a) Name TWO (2) medications might you expect to give for dementia patients who become agitated? (b) What are the safety considerations nurses must be aware of with these types of medications? (Total Marks 4) 12. What is the rationale for bivalving a fresh Plaster of Paris (POP) cast? 13. Mrs Barlow aged 80 years, is a considerate and well respected member of the community who is due for a total hip joint replacement in 2 weeks time. During her preadmission preparation she and her family were encouraged (if they had not done so already) to assist her to take out an EPA as a precautionary measure. a) Explain what the initials EPA refer to? (1 Mark ). b) Discuss the two types of EPA s c) Explain why it is important to have an EPA? (1 Mark) (Total Marks 6) 14. What is the nurse s role in the rehabilitation of an older adult patient? END OF EXAM 5