Elderly Abuse (13 Questions)

1. Mme Gagnon, 78 years old, is admitted to the ER for a "fall down the stairs." She is quiet and avoids eye contact. During your physical assessment, you note bruising in various stages of healing on her torso and what appear to be finger marks on her upper arms. Her grandson, who lives with her, is in the room and insists on answering all your questions.

Question:
What is your priority nursing intervention? *
2. You are a home health nurse visiting M. Tremblay, 82 years old. He is alert and oriented. You notice his refrigerator is empty, he has no winter coat, and he mentions he cannot afford his heart medication this month. You know he receives a substantial pension. His nephew, who has Power of Attorney, drives a new luxury car and manages M. Tremblay's finances.

Question:
What type of mistreatment do these signs suggest? *
4. You are caring for M. Bouchard, 75 years old, who is recovering from a stroke. While standing outside his room, you hear his son yelling: "You are a useless burden! I hope you die in here so I don't have to take care of you anymore!" You enter the room and find M. Bouchard crying and trembling.

Question:
What is your immediate action? *
5. Mme Roy, 88 years old, is brought to the hospital from her daughter’s home. She is bedbound. Upon assessment, you find a Stage 4 pressure injury on her sacrum that is necrotic and smells foul. Her diaper is heavily soiled with dried feces. The daughter states, "I didn't know she had a sore, I don't look back there."

Question:
This clinical presentation is most indicative of which form of maltreatment? *
6. Mme Poirier, 79 years old, has advanced Alzheimer’s and lives in a long-term care facility. She has recently become terrified during perineal care, striking out at staff. You notice fresh bruising on her inner thighs and she has been diagnosed with a new Sexually Transmitted Infection (STI), despite being bedbound.

Question:
What must you suspect and report immediately? *
7. You witness a colleague slap M. Cloutier, a confused 85-year-old patient, on the hand because he spilled his soup. The colleague says, "He needs to learn."

Question:
According to the Act to Combat Maltreatment of Seniors, what is your obligation? *
8. Mme Dubé, 74 years old, lives alone. She is alert, oriented, and competent. A community nurse visits and finds the house is cluttered with garbage, and there are 20 cats. The smell is overpowering. Mme Dubé says, "I am happy how I live. I don't want any help. Leave me alone."

Question:
How should the nurse approach this situation? *
9. M. Fortin, 90 years old, has mild cognitive impairment. A new "friend" who is 30 years younger has recently moved in with him. M. Fortin suddenly requests to revoke his children's Power of Attorney and give full financial control to this new friend. He seems coached and looks at the friend for answers.

Question:
What is the nurse's role in this situation? *
10. Mme Caron is the sole caregiver for her husband who has severe Parkinson's and incontinence. She brings him to the clinic. She looks exhausted, disheveled, and says, "I grabbed him too hard yesterday to get him on the toilet. I almost wanted to throw him on the floor. I can't do this anymore."

Question:
What is the most preventative intervention to avoid future abuse? *
11. You are working the night shift in a long-term care facility (CHSLD). You walk past the room of Mme Blanchette, an 84-year-old resident with severe expressive aphasia (post-stroke) who cannot speak. The door is slightly ajar. You observe the orderly (PAB) changing Mme Blanchette’s incontinence brief. The orderly is visibly angry, yells, "You are disgusting! Stop moving!" and roughly shoves Mme Blanchette onto her side, causing her to grimace and cry out silently. You enter the room immediately, stop the care, and dismiss the orderly from the room.

Question:
Beyond ensuring the immediate safety and comfort of the patient, what is your mandatory ethical and administrative obligation regarding this event? *
12.1 Mme Desjardins, 80 years old, arrives at the emergency department with a spiral fracture of her right humerus (upper arm). Her son, who is her primary caregiver, states: "She is very clumsy. She tripped on the carpet and fell against the doorframe."
Assessment: You notice Mme Desjardins appears malnourished and dehydrated. She avoids eye contact, trembles when you approach, and constantly looks at her son before answering any simple questions. The son answers most questions for her and refuses to leave the room, saying, "She gets confused without me." You know that a spiral fracture is often caused by a twisting force rather than a simple fall.

Question:
You suspect physical abuse. What is your priority nursing strategy to validate this suspicion? *
12.2 Following your assessment of Mme Desjardins, you successfully separated her from her son. In private, she tearfully admitted that her son twisted her arm because she was "too slow" eating her dinner. She states, "Please don't tell him I told you, he will kill me. But I am scared to go home." The physician has treated the fracture. The son is in the waiting room asking when he can take his mother home.

Question:
Given the confirmed abuse and the patient's fear, what is your priority administrative and clinical action regarding her disposition? *