Video Case Study - Elder Abuse and Neglect

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.

Darrell: Well, since mom gets confused, she started wandering into the street a lot. I’m trying to run my business from home, so I can’t keep chasing after her. So, during my work hours, I keep her in her bedroom. I have a camera on to make sure she’s okay, but I’ve noticed she paces around and runs into things like the doorknob, which explains the mark.