Case study - Elder abuse and neglect: Nursing

Last updated: May 15, 2025

Notes

CASE STUDY - ELDER ABUSE AND NEGLECT

KEY POINTS
MY NOTES
INTRODUCTION
  • Primary care office
  • History of Alzheimer disease
  • Presents for medication refill appointment

RECOGNIZING AND ANALYZING CLUES
  • Recognize cues:
    • Temperature 97.6 F or 36.4 C
    • Heart rate 70 beats per minute
    • Respirations 14 breaths per minute
    • Blood pressure 126/72 mmHg
    • Oriented to person, place; not time
    • Flat affect
    • Avoids eye contact
    • Strong body odor
    • Incontinence underwear is saturated with urine
    • Vulva bright red
    • Circular bruise on arm
    • Son keeps patient in her bedroom all day
    • Son changes her incontinence underwear twice per day
  • Analyze cues:
    • Lost 10 pounds (4.5 kilograms) since visit 6 months ago
    • Rescheduled appointment 4 times
    • Suspects dependent elder abuse and neglect 
    • Recognizes patient needs safe living environment, attentive caregiver

PRIORITIZING HYPOTHESES, GENERATING SOLUTIONS, AND TAKING ACTIONS
  • Priority hypothesis:
    • Elder abuse and neglect
  • Generate solutions: 
    • Judy will have a safe living environment arranged by the end of the office visit
  • Take action:
    • Head-to-toe assessment by RN with son out of room
    • Include pictures for electronic health record (EHR)
    • Unlicensed assistive personnel (UAP) stay with patient remainder of visit
    • Contact adult protective services agency
    • Social work referral

EVALUATING OUTCOMES
  • Skilled nursing facility with Alzheimer unit
  • Inform son that patient won't return home with him
  • Social worker helps patient transition to new living arrangement
  • Outcome met

Transcript

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Content Reviewers

Paige Randall, MS, RN, CNE, CEN,Lisa Miklush, PhD, RNC, CNS,Maria Pfrommer, DNP, Ph.D., FNP-BC, RN,Kelsey LaFayette, DNP, ARNP, FNP-C

Nurse Kyle works in a primary care office and is caring for Judy, a 78-year-old female with a history of Alzheimer disease, who was brought in for a medication refill by her son, Darrell. In collaboration with the registered nurse, RN Fatima, Nurse Kyle goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Judy’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Kyle recognizes important cues, including Judy’s vital signs, which are temperature 97.6 F or 36.4 C, heart rate 70 beats per minute, respirations 14 breaths per minute, and blood pressure 126/72 mmHg. Judy is oriented to person and place but not time. Nurse Kyle also notices Judy has a flat affect and avoids direct eye contact.

Nurse Kyle: Alright, Judy, the healthcare provider ordered a urine sample to help monitor how your medication is working. Can I assist you to the bathroom?

Nurse Kyle begins to assist Judy to the bathroom and notes she has a strong body odor. When helping Judy remove her incontinence underwear, he notices it’s saturated with urine, and her vulva is bright red with a surrounding rash. After collecting the sample, Nurse Kyle helps Judy clean up and put on a fresh pair of underwear. While Judy washes her hands, Nurse Kyle notes a circular bruise on her right arm.

Nurse Kyle: Judy, I see you have a bruise on your arm. What happened?

Judy: Oh, I don’t remember. It’s fine.

He then helps Judy return to the exam room to wait for the healthcare provider.

Nurse Kyle: Darrell, I noticed your mom has a bruise on her right arm. How did she get that?

Darrell: Let me see it. Oh, yeah - that looks like the spot where she always hits on the doorknob. It’s nothing.

Nurse Kyle: Okay, tell me more about what you mean.

Sources

  1. "Basic geriatric nursing (8th ed.)" Elsevier (2023)