Providing Appropriate Care for Mr. O’Sullivan: Nursing Actions for Optimal Management

QUESTION

Scenario: Mr. O’Sullivan is a 94-year-old long-term care resident. He was admitted to the facility 4 months ago following hospitalization for pneumonia. He has a history of Parkinson’s disease, multi-infarct dementia, and hypertension. During care he grabs at the hair of caregivers who have long hair and will not let go. He grabs stethoscopes and will not let go. He pinches caregivers. He grinds his teeth together and makes repetitive sounds. When in bed, he lays in fetal position and grabs at his covers and pulls on them, with his face in a grimace. He has flexion contractures in all extremities. He is fed by assistive personnel, with his head tilted to the right and chin down. Mr. O’Sullivan is 6′4″ tall and weighs 140 lb (BMI 17.04 kg/m²). Last month he weighed 150 lb (BMI 18.26 kg/m²). His blood pressure is 145/88 mm Hg, heart rate 92 beats per minute, respirations 16 breathes per minute, and temperature 97.3°F. His medications carbidopa/levodopa 25 mg/250 mg 3 times a day; pramipexole 1.5 mg 3 times a day; memantine 10 mg twice a day; donepezil 10 mg each evening; clopidogrel 75 mg daily; aspirin 81 mg daily; valsartan 160 mg daily; acetaminophen 500 mg every 4 hours as needed for pain. His lab work reveals:

Blood urea nitrogen (BUN)/Creatinine: 28 mg/dL/1.6 mg/dL

Sodium: 145 mEq/L

Potassium: 5.2 mgEq/L

Hemoglobin/hematocrit: 12 g/dL/36%

WBC: 11.0 × 10⁹/L

Lymphocytes: 40%

Cholesterol: 140 mg/dL

Albumin: 3.0 g/dL

Prealbumin: 10 mg/dL

Transferrin: 180 mg/dL

TSH: 7.0 µU/mL

Urinalysis: Urine is amber and clear, pH 5.0, nitrite positive and leukocyte esterase trace, RBC 2/hpf, WBC 5/hpf, and bacteria occasional

Which nursing actions listed below are indicated (appropriate or necessary) for the clients care at this time?

Group of answer choices

Request consult for feeding tube placement

Evaluate medications for drug-drug and drug-nutrient interactions

Refer to physical therapy

Request order for megestrol

Calorie supplementation with med pass

Feed in an environment free of clutter/distraction

Discuss with family removing fat and sodium restrictions from diet

ANSWER

 Providing Appropriate Care for Mr. O’Sullivan: Nursing Actions for Optimal Management

Introduction

This scenario presents Mr. O’Sullivan, a 94-year-old long-term care resident with a complex medical history, including Parkinson’s disease, multi-infarct dementia, and hypertension. Addressing his unique needs and challenges requires a comprehensive approach. This essay delves into the nursing actions that are indicated for Mr. O’Sullivan’s care, ensuring his well-being and quality of life.

Evaluation of Nursing Actions

1. Evaluate Medications for Interactions
Mr. O’Sullivan’s medication regimen is extensive, with a combination of drugs for his conditions. Given his multi-infarct dementia and comorbidities, it is crucial to assess for potential drug-drug and drug-nutrient interactions. This evaluation ensures his safety and minimizes adverse effects.

2. Feed in an Environment Free of Clutter/Distraction
Mr. O’Sullivan’s behavior, such as grabbing and pinching, might be influenced by sensory stimulation. Providing a calm and distraction-free environment during feeding can reduce anxiety and disruptive behaviors. This practice promotes a positive meal experience.

3. Refer to Physical Therapy
Given Mr. O’Sullivan’s history of Parkinson’s disease and flexion contractures, involving physical therapy can help maintain his mobility and prevent further contractures. Tailored exercises can improve his overall comfort and reduce the risk of complications.

4. Calorie Supplementation with Med Pass
Mr. O’Sullivan’s recent weight loss and decreased BMI signal the need for nutritional support. Offering calorie supplementation during medication administration can help meet his nutritional requirements and address his declining weight.

Conclusion

Providing optimal care for Mr. O’Sullivan requires a well-rounded approach that considers his medical history, cognitive decline, and nutritional status. Nursing actions such as evaluating medication interactions, creating a calming meal environment, involving physical therapy, and offering calorie supplementation reflect a comprehensive approach to his care. By addressing his unique needs, nurses can enhance Mr. O’Sullivan’s quality of life and overall well-being.