Topic 5 DQ 1Feb 5-7, 2024
You are a Home Health RN who is making an initial visit to the home of an elderly couple to assess and
develop a plan of care. Mr. Juarez, an 88-year-old man, broke his right tibia due to a fall. He was recently
discharged from a skilled rehabilitation center where he had developed a catheter-associated urinary
tract infection (CAUTI) from his indwelling urinary catheter. The infection has resolved, and he has now
been discharged home with an indwelling urinary catheter. He remains in a cast and has graduated to
limited use of crutches but is still unable to perform routine activities of daily living (ADLs).You will be
coming to the home once a week.
Based on this scenario, describe the infection control measures that need to be observed and the
personal protective equipment (PPE) that would be used during these visits. Explain how some of the
characteristics of the aging process may lead to vulnerabilities related to independent living, elder
abuse, social connections, etc.
Initial discussion question posts should be a minimum of 200 words and include at least two
references cited using APA format. Responses to peers or faculty should be 100-150 words and
include one reference. Refer to “RN-BSN DQ Rubric” and “RN-BSN Participation Rubric,” located in
Class Resources, to understand the expectations for initial discussion question posts and participation
posts, respectively.
Peer replay
Shelby Baumgart
During the weekly home visits to Mr. Juarez, infection control is very important. The nurse
needs to wash hands frequently including before and after interacting with the patient and
his environment. The nurse should always wear the proper PPE. Gloves need to be worn and
changed out anytime they are soiled and moving from one task to another. The environment
and any surfaces should be disinfected before and after use. The catheter and the patient
should be assessed each visit for signs of a UTI. The catheter needs to be changed regularly to
reduce the risk of a UTI by 65% (Kranz et al., 2020). Education is a major factor in CAUTI
prevention since the patient will be maintaining the catheter at home. The nurse needs to
ensure the patient understands how to properly clean the catheter, the frequency of cleaning,
proper hygiene, and signs of a UTI.
The characteristics of the aging process such as physical decline, changes in hearing and
eyesight, and changes in mental status can lead to vulnerabilities related to independent
living, elder abuse, and social connections. Along with these aging factors, Mr. Juarez also has
the catheter and the crutches that could hinder his ability to ambulate independently and
safely complete his ADLs. These factors could also impact the patient’s social interactions
because he is not able to leave his home as easily. Social isolation and the patient’s home
environment can also affect the patient’s ability to perform ADLs (Edemekong et al., 2023).
References
Edemekong, P. F., Bomgaars, D. L., & Levy, S. B. (2023, June 26). Activities of daily living (ADLs). NCBI;
StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470404/
Kranz, J., Schmidt, S., Wagenlehner, F., & Schneidewind, L. (2020). Catheter-associated urinary
tract infections in adult patients: Preventive strategies and treatment options. Deutsches
Ärzteblatt International, 117(6), 83. https://doi.org/10.3238%2Farztebl.2020.0083
Josephine Otieno
In ensuring infection control measures during visits to Mr. Juarez’s home, strict adherence to
protocols outlined in research is crucial. For instance, given Mr. Juarez’s recent history of
catheter-associated urinary tract infection (CAUTI), it’s imperative to follow recommendations
outlined in studies such as that by Werneburg (2022). These recommendations may include
maintaining proper hand hygiene, using appropriate personal protective equipment (PPE) such
as gloves and gowns when handling the urinary catheter or conducting any procedures that
may involve contact with bodily fluids, and implementing stringent catheter care procedures to
minimize the risk of infection recurrence. Furthermore, environmental cleaning and
disinfection protocols should be rigorously followed to prevent the spread of pathogens and
maintain a safe home environment for Mr. Juarez.
The aging process can render individuals more vulnerable to various challenges, including
those related to independent living, elder abuse, and social connections. Research, such as the
study conducted by Cakir et al. (2023), sheds light on these vulnerabilities and underscores the
importance of addressing them in the care plan. For instance, physical limitations resulting
from aging, such as decreased mobility and impaired balance, may heighten the risk of falls
and injuries, as evidenced by Mr. Juarez’s situation. Additionally, cognitive decline and
communication barriers associated with aging can make it difficult for older adults to express
their needs or report instances of abuse or neglect, highlighting the need for vigilant
monitoring and advocacy on the part of healthcare professionals. By recognizing and
addressing these vulnerabilities, home health RNs can contribute to promoting the safety, wellbeing, and overall quality of life of elderly patients like Mr. Juarez.
References
Cakir, N. , Mandiracioglu, A. , Hassoy, H. & Horasan, G. (2023). home safety, quality of life,
fall, and fear of falling among older home care recipients. Topics in Geriatric
Rehabilitation, 39 (1), 12-18. https://doi.org/10.1097/TGR.0000000000000378.
Werneburg, G. T. (2022). Catheter-associated urinary tract infections: current challenges and
future prospects. Research and Reports in Urology, 109133. https://doi.org/10.2147/RRU.S273663
Alex Nyambura
The implementation of infection control measures in the home health setting for Mr.
Juarez is of the utmost significance to avoid potential complications, especially considering his
recent diagnosis of a catheter-associated urinary tract infection (CAUTI). A home health RN
must always use strict aseptic technique while dealing with patients who have an indwelling
urinary catheter (Kranz et al., 2020). The nurse should always wash her hands thoroughly
before and after handling a catheter. She should also take precautions by donning PPE like
disposable gloves to lessen the possibility of infection. As an added precaution, you should
check the area around the catheter site for signs of infection on a regular basis (Kranz et al.,
2020). Make sure to notify the healthcare provider right away if anything seems out of the
ordinary. Thorough hand hygiene and proper disposal of any contaminated materials are
essential after concluding care duties. This will help in the fight against infections even more.
Strict adherence to infection control protocols is a crucial part of delivering safe and effective
home healthcare (Kranz et al., 2020). The elderly, especially those with mobility challenges
and recent hospitalizations, are at a higher risk, making this a very important consideration.
Characteristics of aging may, in fact, put elderly persons at risk while they continue to
live on their own. Some people may find it difficult to do ADLs due to physical limitations,
such as reduced strength and movement, which can lead to an increased reliance on outside
help (Werneburg, 2022). An individual’s ability to independently manage their healthcare may
be affected by age-related cognitive impairment, which in turn increases the likelihood of
complications and the need for ongoing help. Given his current condition, Mr. Juarez need help
with ADLs due to his limited mobility and recent injuries (Werneburg, 2022). This incident
exemplifies how susceptible the elderly are to dependency and functional deterioration. Not to
mention that social isolation is a real possibility for the elderly, which can have serious
consequences for their emotional and physical health. Healthcare professionals providing inhome services to the elderly should take the time to consider the social and psychological
aspects of their condition in addition to their physical health (Werneburg, 2022). They should
also look out for signs of elder abuse or neglect and help get the elderly person the help they
need so they can stay healthy the whole time.
References
Kranz, J., Schmidt, S., Wagenlehner, F., & Schneidewind, L. (2020). Catheter-associated
urinary tract infections in adult patients: Preventive strategies and treatment
options. Deutsches Ärzteblatt International, 117(6),
83. https://doi.org/10.3238%2Farztebl.2020.0083
Werneburg, G. T. (2022). Catheter-associated urinary tract infections: current challenges and
future prospects. Research and Reports in Urology, 109133. https://doi.org/10.2147/RRU.S273663
Topic 5 DQ 2
Feb 5-9, 2024
End-of-life care becomes an issue at some point for elderly patients. Discuss the difference between
palliative care and hospice care programs. Discuss what you can do as a nurse to support your
patients regarding end-of-life care in accordance with their wishes. Explain the use of advance
directives versus Physician Order for Life Sustaining Treatment (POLST) and their legal implications
when providing care for elderly patients.
Initial discussion question posts should be a minimum of 200 words and include at least two
references cited using APA format. Responses to peers or faculty should be 100-150 words and
include one reference. Refer to “RN-BSN DQ Rubric” and “RN-BSN Participation Rubric,” located in
Class Resources, to understand the expectations for initial discussion question posts and participation
posts, respectively.
Replay peer
Madyson Jones
The Georgia Department of Community Health says Palliative care is the treatment of
patients of all ages and conditions to preserve their best possible quality of life while
reducing or eliminating the symptoms of a disease or illness (Georgia Department of
Community Health, 2022). It’s not necessary to wait until the very end of a serious illness
to begin palliative care. In addition to symptom management, patients receiving palliative
care may still pursue curative therapies. Samaritan Life-Enhancing Care says those who
have chosen hospice care at the end of their life and have been given a diagnosis of six
months or less are cared for by a hospice nurse. A hospice nurse places a strong emphasis
on comfort and quality of life as part of the hospice care philosophy. They offer customized
care based on the particular requirements of every individual (What Is a Hospice Nurse and
What Does a Hospice Nurse Do?, 2020). The primary goals are to give the dying process
dignity, comfort, and support. As a nurse in this atmosphere, it is our job to medicate the
symptoms of the patient, assist with emotional problems, and abide by the patient’s end-oflife care. To improve the patient’s comfort and quality of life, give effective symptom
management a top priority. An Advanced Directive is a document where people can state
their healthcare preferences in advance with the help of these legal documents, which
include living wills and durable powers of attorney for healthcare. When the patient is
unable to express their preferences, they serve as a guide for healthcare decisions. A
POLST, or physician order for life-sustaining treatment, is a legal document that converts a
patient’s wishes into legally binding directives. It is intended to be more precise and useful
than advance directives and is frequently utilized for patients with severe illnesses. Always
be aware of the Nursing end-of-life care laws inside of your state!
References
Georgia Department of Community Health. (2022, April 25). What is Palliative
Care? https://dch.georgia.gov/palliative-care-and-quality-life-advisory-council/what-palliativecare#:~:text=Palliative%20care%20is%20for%20people%20of%20any%20age%20and%20at,care%
20consult%20might%20be%20helpful.
What is a Hospice Nurse and What Does a Hospice Nurse Do? (2020, July 14).
Samaritan. https://www.samaritannj.org/hospice-care/what-is-hospice-care/hospice-teammembers/hospice-nurse/
Daisy Partida
End-of-life care often becomes a critical consideration for elderly patients as they
navigate complex health issues associated with aging. Palliative care and hospice care
programs offer distinct approaches to addressing the needs of patients nearing the end of their
lives. Palliative care focuses on relieving symptoms and improving quality of life for
individuals with serious illnesses, regardless of prognosis (Osakwe et al., 2023). In contrast,
hospice care provides comprehensive support for patients with a prognosis of six months or
less, emphasizing comfort and dignity in their final days (Osakwe et al., 2023). Understanding
these differences is essential for healthcare professionals to tailor care plans that align with
patients’ preferences and goals
Nurses play a crucial role in supporting elderly patients regarding end-of-life care by
advocating for their autonomy and ensuring their wishes are respected. This involves open
communication to explore patients’ values, beliefs, and treatment preferences. Nurses can
facilitate discussions about advance directives, legal documents that outline preferences for
medical treatment in the event patients become unable to express their wishes (Battista et al.,
2023). Additionally, nurses can help implement physician orders for life-sustaining treatment
(POLST), which provide specific medical orders based on patients’ preferences and are legally
binding documents that guide healthcare decisions at the end of life. By actively engaging in
discussions about end-of-life care and advocating for patients’ autonomy, nurses can provide
compassionate support that honors patients’ wishes and enhances their quality of life during
this challenging time.
References:
Battista, V., & Sciacca, K. (2023). Professional Standards and the Role of the Advanced
Practice Registered Nurse in Hospice and Palliative Care. Journal of Hospice & Palliative
Nursing, 25(5), 249–254. https://doiorg.lopes.idm.oclc.org/10.1097/NJH.0000000000000968
Osakwe, Z. , Jacobowitz, W. , Horton, J. , Klainberg, M. , Calixte, R. , Jacobs, C. & Hickey,
M. (2023). Hospice and Palliative Care for Undergraduate Nursing Education. Home
Healthcare Now, 41 (4), 197-206. doi: 10.1097/NHH.0000000000001178.
Meena Jose
Palliative care and hospice care are two critical components of end-of-life care. While they
share the same goal of improving patients’ quality of life, their approach differs. Palliative care
seeks to enhance the quality of life for patients facing serious illnesses by managing symptoms,
addressing emotional and spiritual needs, and providing overall support. It is not limited to the
final stages of a disease and can be initiated at any point. Patients receiving palliative care can
still pursue curative treatments while receiving symptom management (Rome et al., 2011).
Hospice care, on the other hand, is specifically for patients with terminal illnesses for whom
curative treatments are no longer effective or desired. The primary goal of hospice care is to
provide comfort, support, and dignity in the final stages of life. It is usually initiated when the
patient has a prognosis of six months or less to live if the disease follows its natural course.
Hospice care typically focuses on alleviating symptoms and providing comfort rather than
pursuing aggressive treatments.
Nurses caring for elderly patients at the end of their lives must communicate openly and
regularly assess their physical, emotional, and spiritual needs. Advocating for their wishes and
collaborating with the healthcare team is crucial to aligning their care plan with their values.
Educating patients and families on palliative and hospice care options, including advance care
planning and symptom management, is also essential. Respecting patients’ autonomy and
preferences, especially regarding end-of-life decisions, is crucial. Nurses must navigate ethical
challenges sensitively and with consideration for patients’ best interests and cultural beliefs
(Hagan et al., 2018). Implementing these strategies ensures compassionate, holistic care that
honors patients’ dignity and wishes.
Advance directives and Physician Orders for Life-Sustaining Treatment (POLST) are crucial
legal documents that direct end-of-life care for seniors. They enable individuals to outline their
healthcare preferences beforehand, guiding medical decisions when they cannot express their
wishes. POLST is a medical order that converts a patient’s preferences into actionable
directives (Hickman et al., 2021). Both documents hold significant weight and must be
followed by healthcare providers. Nurses must understand the legal frameworks governing
end-of-life care in their jurisdiction to ensure compliance and honor patient autonomy.
Effective communication, advocacy, education, and ethical decision-making by the nurse
support elderly patients in alignment with their wishes and legal guidelines.
References
Hagan, T. L., Xu, J., Lopez, R. P., & Bressler, T. (2018). Nursing’s role in leading palliative
care: A call to action. Nurse Education Today, 61, 216–219.
https://doi.org/10.1016/j.nedt.2017.11.037
Hickman, S. E., Steinberg, K., Carney, J., & Lum, H. D. (2021). POLST Is More Than a Code
Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care. Journal of
the American Medical Directors
Association. https://doi.org/10.1016/j.jamda.2021.04.020
Rome, R. B., Luminais, H. H., Bourgeois, D. A., & Blais, C. M. (2011). The Role of Palliative
Care at the End of Life. Ochsner Journal, 11(4), 348–352. https://doi.org/10.1043/TOJ-11-4348
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