An 84-year-old female is admitted to your unit with possible sepsis following pneumonia. The family

An 84-year-old female is admitted to your unit with possible sepsis following pneumonia. The family tells you she has been living alone in an apartment and managing well, but now she seems to be experiencing pain. She is complaining of pain to her right upper arm. Her daughters report that she has not been eating the food that they prepare for her, and that she has been experiencing periods of incontinence of both stool and urine for the past week. She has been having mild diarrhea for the past three days.

A brief neurologic exam reveals no gross focal or cognitive deficits; however, it is difficult to get her to follow commands because she is in so much discomfort. She is tachycardic (124/min), and her BP is 88/45 mm Hg. She is admitted to the ICU for observation and management of her hypotension. She has a history of atrial fibrillation that is treated with digoxin and warfarin. She takes metoprolol (Lopressor) for her hypertension (last taken that morning). She had a myocardial infarction two years ago. She takes ibuprofen for osteoarthritis of her back and knees. Her 12-lead ECG is negative for acute ischemic changes; however, she is in atrial fibrillation.

The nurse inserts an indwelling urinary catheter, and her urine is found to be concentrated with a cloudy appearance and a foul odor. Her general appearance is of an elderly woman who is experiencing moderate to severe pain. She is holding her right upper arm and resists any type of movement of that extremity. She is moaning and tearful. Her daughters are concerned about her decreased level of alertness and ability to care for herself. She has a fever of 101.2°F. She is receiving two liters of oxygen per nasal prongs. Her SaO2 is 89 percent. She is asking for sips of water, but she becomes strangled and begins to cough when you give her a drink.

1.       What might be etiologies of her change in mental and functional status?


2.       What impact will her beta blocker use have on her compensatory responses to her injuries, illnesses, or hospitalization?


3.       What musculoskeletal changes of aging predispose this woman to fractures and falls?


4.       What might be possible etiologies of her less-than-optimal oxygenation level and hypotension?


5.       During your assessment, she is resistant to moving due to the pain in her arm. When planning her care, what factors does the nurse need to be aware of and incorporate into the care plan with regard to potential skin breakdown?