NU142CL Unit 8 Case Study Analysis Example

One Intervention, Weighed Against the Evidence: A Case Study Analysis of Multicomponent Delirium Prevention for a Composite 81-Year-Old Woman Admitted After a Fall With a Pelvic Fracture Managed Without Surgery

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Purdue University Global

NU142CL: Medical-Surgical Nursing I Clinical

Unit 8 Case Study Analysis

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[Date]

The patient is composite; values are bracketed where illustrative, and the evidence is summarized from published reviews.

The Patient

Patient BB, a composite 81-year-old retired seamstress, slipped on her kitchen floor and fractured her pubic rami, a stable pelvic fracture treated with pain control and early walking rather than surgery. She lives alone, has mild memory problems managed with lists and calendar reminders, wears glasses and hearing aids, and takes a nightly sleeping pill. On admission she is oriented and anxious. Her pain is [7] out of 10 with movement.

Why Delirium Is a Concern

She has several risk factors for delirium: age, pre-existing memory impairment, a fracture, pain, a new environment, sensory impairment and a sedating medicine. Delirium in hospitalized older adults is common and is linked to falls, longer stays, loss of function and a higher chance of moving to long-term care (Inouye et al., 2014). Preventing it is easier than treating it once it starts.

The Intervention

A multicomponent nondrug bundle, based on the Hospital Elder Life Program model, with six elements: reorientation with a clock, calendar and orientation board; glasses and hearing aids in place every waking hour; early, repeated mobilization; sleep protection by reducing nighttime noise and interruptions and avoiding sedative sleeping pills; adequate fluids and nutrition; and pain management that controls pain without heavy sedation.

What the Evidence Shows

Pooling results from multicomponent nonpharmacological interventions across 14 studies found that they reduced the incidence of delirium by about half and reduced falls, compared with usual care, according to a meta-analysis by Hshieh and colleagues (Hshieh et al., 2015). The reduction in falls matters especially for her, since a fall brought her in. The interventions in those studies were delivered in medical and surgical units, often with trained volunteers or dedicated staff.

The strongest evidence is for the bundle, not for any one piece, so the unit's job is to deliver all six elements, not to pick the easiest.

How Well the Evidence Fits Her

The fit is strong in some ways and uncertain in others. Strong: she is an older adult on a general medical or surgical unit with typical risk factors, which matches the populations studied. Her pre-existing memory problems put her at higher risk, a group in which prevention can matter most. Uncertain: many studies used dedicated volunteers or staff, which this unit does not have, so delivery depends on nurses and assistants adding the steps to routine care. Her fracture also limits mobilization at first, though early walking is part of her treatment plan, which helps. Stopping her sleeping pill raises a practical question about her sleep and her own preferences.

How It Was Carried Out

Her glasses and hearing aids were kept on the bedside table with a note on the whiteboard. An orientation board was updated each shift. Physical therapy walked her twice a day, and nurses walked her to the bathroom rather than using a bedpan. Her nightly sleeping pill was not continued, after discussion with her and the provider; instead, lights were dimmed at [2200], vital signs were clustered to avoid waking her, and she was offered warm milk, which she preferred. Pain was managed with scheduled acetaminophen and a low-dose opioid before therapy. Her daughter was asked to visit in the afternoons and bring familiar photographs (Harding et al., 2023).

Barriers on the Unit

Three practical barriers appeared. Night shift had four admissions on her second night, and vital signs at [0200] and [0400] woke her twice; clustering slipped when the unit was busy. Her hearing aids were found in a drawer on day three after a shift change, because no one had reported where they were. And on day one she was given a bedpan by an assistant who did not know the plan was to walk her. Each barrier came from the same source: the bundle lived in the care plan but not in the handoff. Adding a line to the shift report, naming the six elements and whether each was done, fixed two of the three by day four.

What I Would Measure

To know whether the bundle was working on the unit and not just for her, I would track the share of shifts on which a delirium screen was done, the share of older patients with sensory aids in place at morning rounds, and the number of sleeping pills given to patients over 75. Those process measures show whether the intervention is actually delivered, which matters because the evidence supports the bundle only when it is delivered in full.

Outcome

She stayed oriented through her five-day stay, with negative delirium screens every shift. She walked [50] meters with a walker by discharge and went to a short rehabilitation stay. One case does not prove the bundle works, but her course fits what the evidence predicts.

References

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Hshieh, T. T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T., & Inouye, S. K. (2015). Effectiveness of multicomponent nonpharmacological delirium interventions: A meta-analysis. JAMA Internal Medicine, 175(4), 512-520. https://doi.org/10.1001/jamainternmed.2014.7779

Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922. https://doi.org/10.1016/S0140-6736(13)60688-1