Ms. Cavallo, 97 years of age, has been a resident at the rehabilitation unit for 6 weeks. She has been receiving rehabilitation therapy following the repair of her fractured left hip. The nursing assistive personnel (NAP) tells you that Ms. Cavallo has not been finishing her meals over the past 2 days because of poor appetite.

 Ms. Cavallo, 97 years of age, has been a resident at the rehabilitation unit for 6 weeks. She has been receiving rehabilitation therapy following the repair of her fractured left hip. The nursing assistive personnel (NAP) tells you that Ms. Cavallo has not been finishing her meals over the past 2 days because of poor appetite. As you enter her room with a food tray today, she states, “Go away and take that tray of food with you. I’m tired of all of this, and I just want to stay in bed today.” You explore why she feels this way. You discover that she does not like the foods that are being prepared for her and she does not feel strong enough to use her walker. She states, “I’m afraid that I’m going to fall because I don’t feel strong enough to get out of bed and use my walker.”

1. On the basis of these data, you develop a nursing diagnosis of Deficient Knowledge (Imbalanced Nutrition: Less Than Body Requirements) related to lack of information. Identify one goal, two expected outcomes, and three related nursing interventions with rationales that will help her meet the identified goal and outcomes.

2. You finish teaching Ms. Cavallo about the importance of a balanced diet and how it will help her regain strength to ambulate. As you are doing her morning assessment, you notice that she has a reddened area on her coccyx.

1. Which risk factors contribute to this finding?
2. In addition to a balanced diet, which other nursing interventions would be good to include in her plan of care?

3. You convince Ms. Cavallo to eat a balanced diet of three meals and two snacks high in protein. Describe the decision-making process you use to ensure that Ms. Cavallo continues to recognize the importance of a balanced diet. Include essential assessment data that you need to ensure that she continues to have an intake of proper foods.

ANSWER

Promoting Balanced Nutrition in the Elderly: A Case Study

Introduction

In this case study, we explore the nursing diagnosis of Deficient Knowledge (Imbalanced Nutrition: Less Than Body Requirements) in Ms. Cavallo, a 97-year-old resident at a rehabilitation unit. We will outline a goal, two expected outcomes, and three related nursing interventions with rationales to address Ms. Cavallo’s poor appetite and lack of information regarding her nutritional needs (World Health Organization, 2013). Additionally, we will address a concurrent finding of a reddened area on her coccyx, discussing the risk factors contributing to it and suggesting additional nursing interventions to include in her care plan.

Goal and Expected Outcomes

Our goal is to help Ms. Cavallo achieve balanced nutrition and meet her body’s nutritional requirements, ultimately improving her overall well-being and aiding her recovery process. The expected outcomes are as follows:

Ms. Cavallo will demonstrate an understanding of the importance of a balanced diet by verbalizing the benefits of each food group within 48 hours.

Ms. Cavallo will consume three meals and two snacks per day, meeting her caloric and nutritional needs.

Nursing Interventions and Rationales

Provide nutritional education: Rationale: Lack of knowledge contributes to Ms. Cavallo’s poor appetite. By educating her about the importance of a balanced diet, we empower her to make informed choices regarding her meals and snacks. This intervention will address her Deficient Knowledge nursing diagnosis.

Collaborate with the dietary team to accommodate food preferences: Rationale: Ms. Cavallo expresses dissatisfaction with the foods being prepared for her, leading to decreased appetite. Collaborating with the dietary team to accommodate her preferences, within the bounds of her nutritional requirements, can enhance her motivation to consume meals and improve overall nutritional intake.

Assistive device assessment and training: Rationale: Ms. Cavallo states that she doesn’t feel strong enough to use her walker, which restricts her mobility and leads to a sedentary lifestyle (Khasnabis, 2010). By assessing her current assistive device and providing training on its correct usage, we can address her fear of falling, boost her confidence, and encourage her to be more active and engaged in her rehabilitation program.

Risk Factors for Coccyx Reddened Area

The reddened area on Ms. Cavallo’s coccyx indicates a potential pressure ulcer. The following risk factors contribute to this finding:

Immobility: Ms. Cavallo’s fear of falling and lack of strength to use her walker have resulted in decreased mobility, increasing her risk of developing pressure ulcers.

Prolonged pressure: Extended periods of bed rest and sitting without proper repositioning can cause pressure on the coccyx, leading to tissue damage and skin breakdown.

Additional Nursing Interventions

In addition to promoting a balanced diet, the following nursing interventions would be beneficial in Ms. Cavallo’s plan of care:

Regular repositioning and skin inspection: Rationale: To prevent pressure ulcers, it is crucial to reposition Ms. Cavallo frequently, ensuring relief from pressure on the coccyx area (West et al., 2015). Regular skin inspections will help detect early signs of skin breakdown and allow for prompt intervention.

Education on pressure ulcer prevention: Rationale: By educating Ms. Cavallo about the importance of maintaining proper skin hygiene, avoiding prolonged pressure, and using supportive cushions, we empower her to actively participate in the prevention of pressure ulcers and promote self-care.

Conclusion

By addressing Ms. Cavallo’s Deficient Knowledge nursing diagnosis through nutritional education, accommodating her food preferences, and addressing her fear of falling through assistive device assessment and training, we can help her achieve a balanced diet and meet her nutritional requirements. Simultaneously, implementing interventions to prevent pressure ulcers, such as regular repositioning and skin inspection, and providing education on pressure ulcer prevention, will contribute to her overall well-being and improve her recovery process. By combining these nursing interventions, Ms. Cavallo can regain her strength, improve her mobility, and experience a higher quality of life during her rehabilitation journey.

References

Khasnabis, C. (2010). Assistive devices. Community-Based Rehabilitation: CBR Guidelines – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK310951/ 

West, B. A., Bhat, G., Stevens, J. A., & Bergen, G. (2015). Assistive device use and mobility-related factors among adults aged≥65 years. Journal of Safety Research, 55, 147–150. https://doi.org/10.1016/j.jsr.2015.08.010 

World Health Organization. (2013). Interventions targeted at infants and young children (6–23 months of age). Essential Nutrition Actions – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK258729/