Elder Case Studies Situation- Mrs. Case Study

Sometimes, studies show that elderly patients are perceived not to be in pain because they do not complain about pain, or that the perceive it differently than younger people. In both receptive and non-receptive patients, one can observe facial tics and/or grimaces, blood pressure (elevated blood pressure sometimes indicates more pain), body temperature, and even mobility.

For the functional patient, assessment can be done by observation of body movement, gait, grimacing, and asking the patient to rate pain on a scale and describe the characteristics (burning, stabbing, aching, frequency, duration, etc.). If the patient is cognitively impaired, simple questions can be asked -- "do you feel a burning sensation, etc." If the patient is non-responsive or cannot understand, one can observe changes in behavior, agitation, facial expressions, or vocalizations. Note, too, that cognitively impaired patients can sometimes be overstimulated by their environment, so take that into account. Finally, involve family or caregivers and ask questions. Additionally, particularly for the elderly, pain assessment must be regular since many think that pain is a normal part of aging or are reluctant to report symptoms (Victor, 2001).

1. Assuming we are given the order to administer 500mg acetaminophen orally or .05 mg/kg IV or .1mg/kg IM of morphine to the patient. To properly assess whether any of the pain medications were successful would depend on the patient's condition, the medication given, and the timing. The oral dose of acetaminophen would likely not react for 30-60 minutes, the morphine far quicker. I would regularly monitor the patient's heart rate, blood pressure, and respiratory rate. I would compare these, likely at the 15, 30 and 60 minute interval after injection with pre-medication and actively look for signs showing decreasing heart rate, BP, and anxiety levels. After administration of the morphine, patient should be calmer, show fewer signs of distress, and potentially be asleep.

2. Assessing the geriatric patient is unlike assessing other ages because it must take into account a more multi-layered approach. One must use advocacy and care theory to assess not only the physical symptoms, but the mental and emotional state of the patient as well as cognitive functions. In elderly patients who are aware and cogent, this is not as difficult; but becomes increasingly so if the patient is cognitively unaware or otherwise unable to speak or understand basic health related questions. It takes a more patient and calm demeanor to work with geriatric patients -- many are anxious and fearful and do not understand; sometimes it is more difficult to draw blood and requires extra care, and at times it is difficult to focus on the relevant past issues and/or uncover the current situation. The key, I believe, is to utilize a more comprehensive approach combined with a thoughtful and caring tone in as relaxed an atmosphere as possible (Tufts University, 2010).

3. Collaborative team members -- included Emergency Room staff (nurses, technicians, physicians), respiratory specialists' as needed, x-ray personnel, phlebotomist, laboratory personnel moving into the patient's own doctor and/or nursing facility staff.

Works Cited

Brown, J. (2009, June). Everything You Need to Know About Hip Injuries. Retrieved from Corepeformance.com:: http://www.coreperformance.com / knowledge/injury-pain/hip-injuries.html

National Institute of Mental Health. (2011, March). Medications for Anxiety, Panic and Phobias. Retrieved from Psychcentral.com: http://psychcentral.com/lib/2006/medications-for-anxiety-panic-and-phobias/

Peck, P. (2003, February). Stroke Tests. Retrieved from WebMD: http://www.webmd.com/stroke/news/20030213/got-minute-you-could-diagnose-stroke

PubMed Health. (2012, September 15). Lisinopril. Retrieved from U.S. National Libary of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000917/

Tufts University. (2010, June). Comprehensive Geriatric Assessment. Retrieved from OCW.TUFTS.EDU: http://ocw.tufts.edu/data/42/499797.pdf

Victor, K. (2001, May). Properly Assessing Pain in the Elderly. Retrieved from Modern Medicine: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=127583