Case Study: Mrs Martinez is an 83-year-old Mexican American widow

NURS 6540: Advanced Practice Care of Frail Elders | Week 3

Interdisciplinary geriatric care teams are a critical component of geriatrics, and I truly believe that geriatrics really does interdisciplinary care probably better than most other areas of health care because we have to—because we need to. Older adults have care needs that require the expertise of a community. No single provider can do it all well. The needs are just so vast.

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—Dr. Barbara Resnick, CRNP, FAAN, FAANP, AGSF, President of the American Geriatrics Society

Dr. Resnick emphasizes the importance of interdisciplinary geriatric care teams, as geriatric patients often have complex health needs. NURS 6540: Week 3: Geriatric Care Teams Assignment. This was the case for 90-year-old Gus Snare. A diagnosis of bile duct cancer resulted in the need for surgery to remove parts of his stomach, duodenum, pancreas, bile duct, and gallbladder. Snare’s care team included a geriatrician, surgical oncologist, and a team of nurses, including an advanced practice nurse. Together, they determined his eligibility for surgery, performed the surgery, and developed a treatment and management plan post-surgery (The University of Chicago Medicine, 2011). As an advanced practice nurse, you must identify your role within care teams for patients like Snare to ensure patients receive comprehensive care.

This week you explore models of interdisciplinary geriatric care teams and compare the roles of advanced practice nurses at various sites of care. Then, as you complete your first SOAP Note, you examine the assessment, diagnosis, and treatment of a geriatric patient from your practicum site.

Learning Objectives – NURS 6540: Week 3: Geriatric Care Teams Assignment, Case Study: Mrs Martinez is an 83-year-old Mexican American widow

By the end of this week, students will:

• Compare models of interdisciplinary geriatric care teams
• Analyze models of interdisciplinary geriatric care teams used in various sites
• Analyze the roles of advanced practice nurses in different clinical sites
• Evaluate diagnoses for patients*
• Evaluate treatment and management plans*

*These Learning Objectives support assignments that are assigned this week, but due in Week 4.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

• • Chapter 18, “Hospital Care” (pp. 134-145)

This chapter explores systems of care for assessing and managing hospitalized older patients. It also examines alternatives to hospital care and transitions from hospital care.

• • Chapter 20, “Rehabilitation” (pp. 152-166)

This chapter describes essential components of geriatric rehabilitation, including sites of rehabilitation, roles of core health care providers on rehabilitation teams, and disease-specific care plans for older adults. It also explores mobility aids, orthotics, adaptive methods, and environmental modifications for older adults with disabilities.

• • Chapter 21, “Nursing-Home Care” (pp. 167-174)

This chapter identifies the demographic and functional characteristics of older adults living in nursing homes as well as the availability of nursing homes in the United States. It also describes staffing patterns, quality issues, and legislation related to nursing home care.

• • Chapter 22, “Community-Based Care” (pp. 175-180)

This chapter explores characteristics of care in communities, including home care, community-based services not requiring a change in residence, and community-based services requiring a change in residence. It examines older adult populations, health care issues, and the primary provider’s role in these sites of care.

• • Chapter 23, “Outpatient Care Systems” (pp. 181-185)

This chapter describes current approaches that maximize patient outcomes in geriatric outpatient care systems. It also examines new approaches that may benefit older adults in outpatient care systems.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Mosby.

• • Chapter 26, “Recording Information” (pp. 792–813)

This chapter outlines the components of SOAP notes and provides guidelines for writing SOAP notes after patient examinations.

Note: You should have this textbook in your personal library, as it was the required text in NURS 6512: Advanced Health Assessment and Diagnostic Reasoning.

Arbaje, A., Maron, D., Yu, Q., Wendel, V., Tanner, E., Boult, C., & … Durso, S. (2010). The geriatric floating interdisciplinary transition team. Journal of the American Geriatrics Society, 58(2), 364–370.

The geriatric floating interdisciplinary transition team. Journal of the American Geriatrics Society, 58(2), by Arbaje, A., Maron, D., Yu, Q., Wendel, V., Tanner, E., Boult, C., & … Durso, S. Copyright 2010 by John Wiley& Sons, Inc. Journals. Reprinted by permission John Wiley & Sons, Inc. Journals via the Copyright Clearance Center.

This article examines the Geriatric Floating Interdisciplinary Transition Team, a geriatric transitional care model. It describes the roles of health care providers on this care team and identifies potential benefits of this model.

Gagan, M. (2009). The SOAP format enhances communication. Nursing New Zealand, 15(5), 15.

This article outlines the four parts of SOAP notes and examines the importance and effectiveness of SOAP notes in clinical settings.

American Geriatrics Society 2015 Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., … & Giovannetti, E. (2015). American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(11), 2227–2246.

American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society 2015 Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., … & Giovannetti, E., in Journal of the American Geriatrics Society, Vol. 63/Issue 11. Copyright 2015 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article examines three categories of medications that impact older adults: those that are potentially inappropriate and must be avoided, those that are potentially inappropriate and must be avoided in older adults with certain diseases, and those that must be used with caution.

Wasserman, M. R. (2018). Geriatrics review syllabus: Outpatient care systems. Retrieved from https://geriatricscareonline.org/FullText/B023/B023_VOL001_PART001_SEC003_CH022#CH022_SEC003

Document: Comprehensive SOAP Note Template (Word document)

Required Media – NURS 6540: Week 3: Geriatric Care Teams Assignment

Laureate Education (Producer). (2013b). Care team models [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 16:29 minutes.

In this video program, Dr. Kristen Mauk and Dr. Barbara Resnick discuss the importance of interdisciplinary geriatric care teams, as well as the role of the advanced practice nurse within these teams.

Discussion: Models of Interdisciplinary Geriatric Care Teams

With the growing population of frail elders, there is an increase of geriatric patients requiring ongoing care for multiple medical conditions. This creates the need for interdisciplinary geriatric care teams. Often, the dynamics and culture of these teams differ across various sites of care, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities. As an advanced practice nurse, it is important to understand your role in the care team as well as your potential impact on patient care. In this Discussion, you explore models of interdisciplinary geriatric care teams for different sites of care and the varying roles of the advanced practice nurse.

Consider the following three case studies:

Case Study 1

Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”

Case Study 2

Mr. Williams, a 79-year-old African American widower, resides in a foster care home. He has lived there for 4 years since his wife died. He is a former minister. His medical history includes long-term diabetes, high blood pressure, and benign prostatic hypertrophy. The home care provider has requested a home visit to evaluate Mr. Williams’s ability to remain in the home. The provider states that because Mr. Williams’s vision is seriously compromised (he is nearly blind), and because he has been unable to get to the toilet as quickly as necessary (he is very unsteady on his feet), his care is becoming burdensome. According to the home care provider, for safety reasons, Mr. Williams may not fit the criteria for remaining in the foster care home.

Case Study 3

Mrs. Randall is a 77-year-old female who resides in a long-term care facility. She has a history of frequent falls and is severely cognitively impaired. The nursing staff at the long-term care facility called the nurse practitioner at the medical home office to report the recent development of productive cough and high fever. There have been cases of flu in the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner in the office requests a chest x-ray in the long-term care facility. The nurse on duty in the facility states that there is no portable chest x-ray equipment available. She further requests that Mrs. Randall be transferred to the emergency room of the local hospital. Mrs. Randall’s daughter has durable power of attorney for health care decisions for her mother. The long-term care facility has notified the daughter of the change in her mother’s condition. The daughter says whatever the nursing home wants is fine with her. NURS 6540: Week 3: Geriatric Care Teams Assignment

To prepare:

• Review this week’s media presentation, as well as the American Geriatrics Society and Arbaje et al. articles in the Learning Resources.
• Research models of interdisciplinary geriatric care teams that are used at various sites, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities.
• Consider the model used for the interdisciplinary geriatric care teams at your current practicum site. Compare this model to models used at other sites.
• Reflect on how the role of the advanced practice nurse differs according to the site of care.
• Select one of the three case studies. Consider how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric care teams at your practicum site.

By Day 3

Post a comparison of the model used for the interdisciplinary geriatric teams at your current practicum site to models used at other sites. Then, explain how the role of the advanced practice nurse differs according to the site of care. Finally, explain how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric teams at your practicum site.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Offer and support an alternative perspective based on your own experience and additional literature search.
• Validate an idea with your own experience and additional literature search.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6540: Week 3: Case Study: Mrs Martinez is an 83-year-old Mexican American widow.