NSG 370: Gerontological Nursing
Assessment Task 2: Complex Geriatric Case Study Analysis
Course Code: NSG 370
Course Title: Gerontological Nursing
Assessment Type: Written Case Study Analysis
Word Count: 1,000–1,250 words
Weighting: 30% of final grade
Due Date: Week 5, Day 7 (Sunday 11:59 PM)
Task Overview
Analyze the provided case study of Mr. M., a 70-year-old male presenting with multisystem complexity including cognitive impairment, altered mobility, polypharmacy, and suspected infection. Apply the nursing process to develop evidence-based interventions, prioritize nursing diagnoses, and evaluate pharmacological risks using current geriatric assessment frameworks.
Learning Objectives
- Apply the nursing process to a complex geriatric case involving multiple comorbidities
- Prioritize nursing diagnoses using NANDA-I taxonomy for the older adult population
- Evaluate polypharmacy risks using the 2023 AGS Beers Criteria
- Differentiate between dementia, delirium, and depression in assessment findings
- Develop evidence-based interventions for infection management and falls prevention
Task Description
Compose a 1,000–1,250-word academic paper analyzing Mr. M.’s case. Your submission must address the following sections:
- Pathophysiological Analysis (250–300 words)Analyze Mr. M.’s objective and subjective data. Identify:
- The clinical significance of WBC 19.2 (1,000/uL) and lymphocyte count 6,700 (cells/uL) in the context of his presentation
- The relationship between cloudy urinalysis with substantial leukocytes and his cognitive symptoms
- Potential medication interactions between Lisinopril, Lipitor, and Zolpidem
- Risk factors for falls based on his unsteady gait, tibial fracture history, and current medications
- Nursing Diagnoses and Prioritization (300–350 words)Identify three priority nursing diagnoses using NANDA-I 2021–2023 classifications. For each diagnosis:
- State the diagnostic label with related to and as evidenced by clauses
- Prioritize using Maslow’s hierarchy and patient safety considerations
- Justify the prioritization with reference to Mr. M.’s specific risk factors (BMI 28.4, prehypertension BP 123/78, memory lapses)
- Pharmacological Risk Assessment (250–300 words)Evaluate Mr. M.’s medication regimen using the 2023 AGS Beers Criteria. Address:
- Specific Beers Criteria warnings applicable to Zolpidem use in older adults
- Renal considerations for Lisinopril and Lipitor metabolism
- Anticholinergic burden assessment
- Deprescribing recommendations with rationale
- Interdisciplinary Care Plan (200–250 words)Develop a comprehensive care plan addressing:
- Non-pharmacological interventions for sleep disturbance to reduce Zolpidem dependency
- Fall prevention strategies for unsteady gait and wandering behavior
- Family education regarding delirium versus dementia differentiation
- Referrals to geriatric psychiatry, pharmacy, and physical therapy
Formatting Requirements
- Format: APA 7th Edition
- Font: 12-point Times New Roman or 11-point Arial
- Spacing: Double-spaced throughout
- Margins: 2.54cm (1 inch) all sides
- Structure: Title page, headings (Level 1 and 2), reference list
- Citations: Minimum of five peer-reviewed sources (2018–2026)
- File Format: .docx submitted via Learning Management System
Marking Criteria and Standards
| Criteria | High Distinction (85–100%) | Distinction (75–84%) | Credit (65–74%) | Pass (50–64%) |
|---|---|---|---|---|
| Pathophysiological Analysis (25%) |
Demonstrates comprehensive understanding of lab values and disease processes; accurately connects UTI to delirium presentation; identifies all relevant drug interactions | Demonstrates solid understanding with minor gaps in lab interpretation; generally accurate drug interaction identification | Demonstrates adequate understanding; some misinterpretation of lab values or incomplete drug interaction analysis | Basic understanding with significant errors in pathophysiological interpretation |
| Nursing Diagnoses (30%) |
Three NANDA-I diagnoses are precise, correctly formatted, and logically prioritized using Maslow and safety frameworks; related factors and defining characteristics are specific to Mr. M. | Three NANDA-I diagnoses are correct with minor formatting errors; prioritization is logical but justification is limited | Three diagnoses present but may include medical rather than nursing diagnoses; prioritization lacks clear rationale | Incorrect use of NANDA-I taxonomy; medical diagnoses used; no clear prioritization |
| Pharmacological Assessment (25%) |
Accurate application of 2023 Beers Criteria to all three medications; specific recommendations for deprescribing with renal considerations | Correct application of Beers Criteria to most medications; general deprescribing recommendations | Limited application of Beers Criteria; missing key risks for one or more medications | Minimal or incorrect application of Beers Criteria; unsafe recommendations |
| Academic Presentation (20%) |
Flawless APA formatting; sophisticated academic prose; seamless integration of citations; error-free mechanics | Minor APA inconsistencies; clear academic prose; appropriate citations; minimal mechanical errors | Noticeable APA errors; adequate prose; citations present but inconsistently applied; some mechanical errors | Significant APA deviations; unclear expression; missing or incorrect citations; frequent mechanical errors |
Sample Content Excerpt
Mr. M.’s presentation exemplifies the complex interplay between physiological insult and cognitive decline in older adults. His elevated WBC count of 19.2 (1,000/uL) combined with cloudy urinalysis showing substantial leukocytes indicates an active urinary tract infection, which likely precipitated his acute confusion and aggressive behavior. According to the Registered Nurses’ Association of Ontario (2016), infections commonly trigger delirium in older adults, particularly those with underlying cognitive impairment. His unsteady gait and history of tibial fracture further compound his risk profile, requiring immediate fall precautions and environmental modifications. The combination of Zolpidem for sleep management and potential anticholinergic effects creates a pharmacological burden that may exacerbate rather than alleviate his cognitive symptoms.
Current evidence suggests that non-pharmacological sleep hygiene interventions should replace or reduce Zolpidem dosing in geriatric patients, given the 2023 AGS Beers Criteria warning against hypnotic use in older adults. Family education regarding the reversible nature of delirium versus the progressive trajectory of dementia becomes essential for appropriate care planning and decision-making. Nurses must advocate for comprehensive medication reconciliation and deprescribing protocols that prioritize cognitive preservation over symptomatic management.
References
American Geriatrics Society. (2023). 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372
Gleadhill, S. (2024). Implications of UTI in geriatric patients. Nursing CE Central. https://nursingcecentral.com/lessons/implications-of-uti-in-geriatric-patients/
NANDA International. (2021). NANDA International nursing diagnoses: Definitions and classification 2021–2023 (12th ed.). Thieme.
Registered Nurses’ Association of Ontario. (2016). Delirium, dementia, and depression in older adults: Assessment and care (2nd ed.). Registered Nurses’ Association of Ontario. https://rnao.ca/sites/rnao-ca/files/Delirium_dementia_and_depression_in_older_adults_LTC_case_study_and_discussion_guide.pdf
Salvatore, T., Cerasuolo, J., & Paolucci, S. (2024). Fall risk assessment and prevention strategies in nursing homes: A narrative review. Journal of Frailty, Sarcopenia and Falls, 9(1), 29–43. https://doi.org/10.22540/jfsf-09-029