The difficulties encountered in assessing both young children and older adults

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Discuss the difficulties encountered in assessing both young children and older adults. Remember that these age groups have different emotional and cognitive developments or impairments.
The emergency department nurse is assessing a 38-year-old man who was in a motor vehicle accident. The patient was an unrestrained driver of the vehicle. The vehicle was traveling approximately 42 miles per hour. Upon impact, the driver collided with the windshield and sustained a head injury. The patient is now stable, complaining of pain 9/10 in the head, neck, and shoulder region. Neurologic status: cranial nerves 2-12 intact; patient is awake, alert, and oriented; computed tomography scan was negative for hematoma or hemorrhage. Vital signs: T 97.5, P 68, R 16, BP 130/70. The patient is asking the nurse for pain medication; however, the nurse smells alcohol on the patient’s breath. Toxicology reports are pending.
Based on the information presented, what subjective data will assist the nurse in making a decision to treat this patient’s pain?
The laboratory findings showed evidence of chronic alcohol abuse. What risk factors are associated with this patient’s alcohol use?
What interventions should the nurse incorporate into the plan of care for this patient?
Discuss “red flags” of abuse and neglect that may be found during an assessment.
Discuss Standard Precautions and infection control methods for the protection of both the patient and the examiner.

 

Sample Solution

Difficulties in Assessing Different Age Groups

Young Children:

  • Limited communication skills: Difficulty expressing pain, fear, or other symptoms verbally.
  • Cognitive development: May not understand medical procedures or terminology.
  • Emotional dependence: Separation anxiety and fear of unfamiliar settings can hinder cooperation.
  • Physical constraints: May be difficult to restrain or position for examinations.

Older Adults:

  • Sensory decline: Diminished vision, hearing, or touch can affect interpretation of instructions or assessments.
  • Comorbidities: Multiple medical conditions and medications can complicate symptoms and diagnosis.
  • Cognitive impairments: Dementia or memory loss can hinder communication and cooperation.
  • Fear of dependence: May deny symptoms or refuse treatment to avoid losing independence.

Emergency Department Scenario

Subjective Data for Pain Management Decision:

  • Character of pain: Sharp, dull, throbbing, constant, intermittent?
  • Pain severity: Numeric scale (0-10), descriptive words (mild, moderate, severe), impact on daily activities.
  • Aggravating factors: Movement, specific positions, touch, light.
  • Alleviating factors: Rest, medication, specific positions.
  • Past experiences with pain: Tolerance, response to previous treatment.
  • Fear of medication or addiction: Concerns about opioids or interactions with other medications.

Risk Factors Associated with Chronic Alcohol Abuse:

  • Increased head injury severity: Alcohol can worsen brain swelling and damage.
  • Risk of withdrawal symptoms: Seizures, delirium, hallucinations.
  • **Potential for intoxication affecting pain perception and cooperation.
  • **Liver damage: **Reduced ability to metabolize medications, increasing potential for side effects.
  • Increased risk of infections: Compromised immune system due to alcohol’s impact.

Nursing Interventions:

  • Monitor vital signs and neurological status closely.
  • Implement pain management plan based on subjective data and objective findings.
  • Address potential for alcohol withdrawal with appropriate medications and monitoring.
  • Provide supportive care and education about head injury recovery.
  • Refer for addiction counseling and support resources after discharge.

Red Flags of Abuse and Neglect

Physical Abuse:

  • Unexplained bruises, burns, fractures, or wounds.
  • Multiple injuries in different stages of healing.
  • Fear or flinching when approached.

Neglect:

  • Undernourishment, dehydration, or poor hygiene.
  • Inappropriate clothing for the weather.
  • Lack of medical care or untreated medical conditions.
  • Social isolation or withdrawal.

Emotional Abuse:

  • Withdrawn or fearful behavior.
  • Difficulty trusting adults.
  • Self-deprecating language or statements.
  • Age-inappropriate sexual knowledge or behavior.

Financial Abuse:

  • Missing financial documents or belongings.
  • Sudden changes in spending patterns.
  • Unexplained withdrawals from bank accounts.

It’s important to note that these are not exhaustive lists, and any suspicion of abuse or neglect should be reported to the appropriate authorities immediately.

Remember, a thorough assessment that considers both subjective and objective data is crucial for accurate diagnosis and effective care in all age groups, especially those with potential vulnerabilities like chronic alcohol abuse.

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