Daylamis Gonzalez Discussion 4 Prepare a 350 word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with "The problem is...", and a purpose to your project. Post this as your Initial response. (Essential I-IX). The problem is falls among elderly and its relation with their health problems and surrounding environmental factors. Falls are one of the most common problems in the elderly around the world. A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or at another lower level. Currently, there is no numerical criterion that classifies people as "elderly." However, the United Nations has determined that the age of 60+ should be used to refer to people as being "elderly. This is in spite of the fact that most developed countries take the chronological age of 65 years to define the ‘elderly. In the United States, falls are a leading cause of morbidity and mortality among mature adults. It is the second leading cause of accidental or unintentional injury/death after road traffic injuries. For example, of the 11 million adults aged 65 years and over living in the UK, around 30% of community-dwelling mature adults fall at least once in their lifetime. It was found in a study conducted in the Eastern Mediterranean Region that 30%–40% of adults older than 65 years residing in the community fall each year. The rates were higher in hospitalized patients and nursing home residents. Moreover, the incidence of falls rose steadily from middle-age onward peaking in persons older than 80 years. Falls may be associated with various contiguous environmental hazards such as carpets and rugs. Most falls (72.8%) occur at home. Women represented 80.2% of fall injury victims. Not surprisingly, perhaps, the most common location for fall injuries in the home is the bathroom (35.7%). Other environmental hazards include poor stairway design and disrepair, inadequate lighting, clutter, slippery floors, unsecured mats, and the lack of nonskid surfaces in bathtubs. There is a paucity of literature on the important topic of falls amongst the elderly in the Kingdom of Saudi Arabia. However, our study will focus on estimating the true extent of falls among the elderly within the community alone and examine the relationship between the health status of elderly people as well as the impact of the environment on their propensity to experience falls. References Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7 Research Chair of Health Education and Health Promotion, The College of Medicine, HTTPs://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774040   Maritza Leon Urinary Tract Infections in the Elderly Prepare a 350-word dra.

1. Daylamis Gonzalez
Discussion 4
Prepare a 350 word draft of a clinical problem that you would
like to use for your Research project. There should be an
introduction to the problem (as to why it is a problem) that is
documented with literature, a clear problem statement (one
declarative sentence that begins with "The problem is...", and a
purpose to your project. Post this as your Initial response.
(Essential I-IX).
The problem is falls among elderly and its relation with their
health problems and surrounding environmental factors. Falls
are one of the most common problems in the elderly around the
world. A fall is defined as an event which results in a person
coming to rest inadvertently on the ground or floor or at another
lower level. Currently, there is no numerical criterion that
classifies people as "elderly." However, the United Nations has
determined that the age of 60+ should be used to refer to people
as being "elderly. This is in spite of the fact that most
developed countries take the chronological age of 65 years to
define the ‘elderly. In the United States, falls are a leading
cause of morbidity and mortality among mature adults. It is the
second leading cause of accidental or unintentional injury/death
after road traffic injuries. For example, of the 11 million adults
aged 65 years and over living in the UK, around 30% of
community-dwelling mature adults fall at least once in their
lifetime. It was found in a study conducted in the Eastern
Mediterranean Region that 30%–40% of adults older than 65
years residing in the community fall each year. The rates were
higher in hospitalized patients and nursing home residents.
Moreover, the incidence of falls rose steadily from middle-age
onward peaking in persons older than 80 years.

2. Falls may be associated with various contiguous environmental
hazards such as carpets and rugs. Most falls (72.8%) occur at
home. Women represented 80.2% of fall injury victims. Not
surprisingly, perhaps, the most common location for fall
injuries in the home is the bathroom (35.7%). Other
environmental hazards include poor stairway design and
disrepair, inadequate lighting, clutter, slippery floors, unsecured
mats, and the lack of nonskid surfaces in bathtubs. There is a
paucity of literature on the important topic of falls amongst the
elderly in the Kingdom of Saudi Arabia. However, our study
will focus on estimating the true extent of falls among the
elderly within the community alone and examine the
relationship between the health status of elderly people as well
as the impact of the environment on their propensity to
experience falls.
References
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls
among elderly persons living in the community. N Engl J Med.
1988;319:1701–7
Research Chair of Health Education and Health Promotion, The
College of Medicine,
HTTPs://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774040
Maritza Leon
Urinary Tract Infections in the Elderly

3. Prepare a 350-word draft of a clinical problem that you would
like to use for your Research project. There should be an
introduction to the problem (as to why it is a problem) that is
documented with literature, a clear problem statement (one
declarative sentence that begins with "The problem is...", and a
purpose to your project. Post this as your Initial
response. (Essential I-
IX).
Urinary tract infections (UTI) occur frequently in older
people. UTIs are generally caused by bacteria, but can also
result from certain viruses and fungi. Mainly noted symptoms
include burning sensation during urination, frequent urge to
urinate, and pain in the back or lower abdomen. If left
untreated, a UTI can lead to acute or chronic kidney infections,
which could permanently damage these vital organs and even
lead to kidney failure. This common infection is also a leading
cause of sepsis, a potentially life-threatening infection of the
bloodstream. Non-specific symptoms, such as confusion, are
often suspected to be caused by urinary tract infection (UTI)
and continues to be the most common reason for suspecting a
UTI despite many other potential causes. The problem is that
this can leads to significant overdiagnosis of UTI, inappropriate
antibiotic use and potential harmful outcomes. An alternative
method for prophylaxis of patients who suffer from recurrent
infections must be found while minimizing the risk of
developing or propagating antibiotic resistance. This problem
is particularly prevalent in nursing home settings. The elderly is
particularly susceptible to urinary tract infections. Older
individuals are more vulnerable for many reasons, including
their overall susceptibility to infections due to a weakened
immune system. “As you get older your immune response
changes; it’s part of normal aging,” says Anna Treinkman, a

4. nurse practitioner at the Rush Alzheimer’s Disease Center in
Chicago and president of the National Conference of
Gerontological Nurse Practitioners.
Elderly men and women also experience a weakening of
the muscles of the bladder and pelvic floor, which can lead to
increased urine retention (incomplete emptying of the bladder)
and incontinence. These things all contribute to infection. It has
been noticed that women are more prone to this infection.
Because, due to the short distance between urethra and bladder,
it is easy for bacteria to travel to the bladder in women as
compared to men. Furthermore, another risk factor attached to
women is their sexual behaviors. If they are more likely to
change their sexual partner, it is a higher probability for them to
get infected. For the elderly living in the community, UTIs
compromise the second most common infection, whereas in
residents of long-term care facilities (LTCFs) and hospitalized
subjects, it is the number one cause of infection. There may be
difficulties with proper collection of samples from elderly
patients, as well as from those patients who have physical or
other types of impairments, which adds to the importance of
collecting specimens properly to avoid contamination.
Physicians distinguish UTI from other diseases that have similar
clinical presentations with use of a small number of tests, none
of which, is used individually, have adequate sensitivity and
specificity. Among the diagnostic test, urinalysis is useful
mainly for excluding bacteriuria. However, a pee test is
frequently gathered for culture. To guarantee a solid test
outcome, it is fundamental that the pee test is appropriately
taken. Urine culture may not be necessary as part of the
evaluation of outpatients with uncomplicated UTIs, but it is
necessary for outpatients who have recurrent infections,
experience treatment failures or have complicated UTI's, as well
as for patients who develop UTIs. The purpose of the research
is to analyze risk factor and the prevalence of the problem. To
point out the risk factors attached to this infection and to find
its more effective cure and quick prevention. Furthermore, this

5. research focuses on a more accurate and precise diagnosis of
UTI in elderly population to avoid the unnecessary use of
antibiotic.
Magdaleine Selondieu
COLLAPSE
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Recently, transitional nursing has been a challenge in many
countries hence becoming an issue of concern in the world.
Transitional nursing refers to the act of giving care to the
patients all the way from the hospitals to the homes of the
patients (Toles et al, 2016). Therefore, the lack of proper
transitional nursing is involving some elements of medical
error. The medical error includes a lack of proper care to the
patients including lack of quality treatment. In this context,
medical error is one of the crucial reasons for the increased
death in the world. However, some medical practitioners
defined transitional nursing as an act of changing the location
of giving health care to the patients after being transferred to
another place of health care. In this context, the patients require
great care of the nurses who should visit their homes regularly
to check the ongoing of the client. The reason for the need of
this great care is because some patients are very old and they
cannot control the use of medicine as prescribed by the doctors.
For instance, the patients who are aged seventy years and above
find difficult in following all the instructions hence the need of
nurses becoming essential.
The health care problems among the patients are crucial and
require the immediate effect of bringing the medical personnel
to help the patients (Toles et al, 2016). However, the main
challenge is that in most countries there has been a small
number of available nurses who can manage to cake of the
patients from the hospital up to their homes. In most cases, you

6. find that one nurse is serving a variety of patients thus
becoming very difficult to the patient who relocated from one
place to another in the process of medication to receive the
same service he used to get. Furthermore, the transitional
nursing becomes more complex when the transition of nurses
occurs because there is a possibility that patients may start
receiving services from a nurse who is not well experienced as
the one used to give them services of health care. In this
context, the most transition done in the field of nursing includes
promoting the more experienced nursing and finally getting the
less experienced to occupy the space of more experienced.
Reference:
Toles, M., Colón-Emeric, C., Naylor, M. D., Barroso, J., &
Anderson, R. A. (2016). Transitional care in skilled nursing
facilities: a multiple case study. BMC health services
research, 16(1), 186.
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Guillermo Carabeo
Discussion 4
Pneumonia
Prepare a 350-word draft of a clinical problem that you
would like to use for your Research project. There should be an
introduction to the problem (as to why it is a problem) that is
documented with literature, a clear problem statement (one
declarative sentence that begins with "The problem is...", and a
purpose to your project. Post this as your Initial response.
(Essential I-IX).
Community-acquired pneumonia continues to have a
significant impact on elderly individuals, who are affected more
frequently and with more severe consequences than younger
populations. As the population ages it is expected that the
medical and economic impact of this disease will increase.

7. Despite these concerns, little progress has been made in
research specifically focusing on community-acquired
pneumonia in the elderly. The problem is Community-acquired
pneumonia in elderly patients. Despite widespread availability
of antibiotic therapy and sophisticated severity of illness
assessments, community-acquired pneumonia (CAP) continues
to be a leading cause of death worldwide. In the elderly
population, defined as those aged over 65 years, the impact of
pneumonia is far greater than in other age groups. The annual
incidence of pneumonia in the elderly is four-times that of
younger populations. In addition, older adults have higher rates
of hospitalization and are more likely to die as a result of CAP.
The elderly population is increasing at twice the rate of the
general population, necessitating a better understanding of the
pathophysiology, microbiology, treatment and prevention of this
common affliction. The mechanisms behind the disproportionate
incidence and mortality rates in elderly pneumonia patients are
not fully understood. Several physiologic changes in older
adults have been implicated as risk factors for CAP. Changes in
basic lung physiology as a result of aging include decreased
elastic recoil, increased air trapping (senile emphysema),
decreased chest wall compliance and reduced respiratory muscle
strength. These factors may act to increase baseline work of
breathing, giving older individuals less reserve to cope with
bacterial infections in the lung. In addition, reduced
mucocilliary clearance and diminished cough reflex have been
described. These findings, combined with greater upper airway
colonization with virulent organisms, may predispose this
population to develop lower respiratory tract infections.

8. References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917114/
Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R,
Linde-Zwirble WT. Hospitalized community-acquired
pneumonia in the elderly: age- and sex-related patterns of care
and outcome in the United States. Am. J. Respir. Crit Care Med.
2002;165(6):766–772.
Muller Sanon
ICU nurses are often confronted with critical events
from the caring of patients who are exposed to infection
because the central line dressing was not changed on the
required day or it was found soiled or loose and the nurse does
not change it. CLABSIs are preventable, yet they result in
thousands of deaths every year with billions of dollars dedicated
to addressing these adverse events. In many facilities
throughout the country, the number of ClABSIs have increased
in recent years, despite efforts to lower its incidence (Ista et al.,
2016).
The practice issue is that none maintenance was found
in my current practice because the central line dressing was not
changed on the required day or it was found soiled or loose and
the nurse does not change it. In the future, I’d like to conduct a
search by identifying the major elements of my PICOT question
and find subject descriptors, MeSH terms, or descriptors that
identify the elements of my research. I want to start with a
broad search and move to a narrower search with terms for the

9. comparison, outcome, and time factors of my study. By using
database filters, I will be able to make the evidence more
specific and target the studies I am looking for.
References
Ista, E., van der Hoven, B., Kornelisse, R. F., van der Starre,
C., Vos, M. C., Boersma, E., & Helder, O. K.
(2016). Effectiveness of insertion and maintenance bundles to
prevent central-line-associated bloodstream infections in
critically ill patients of all ages: a systematic review and meta-
analysis. The Lancet. Infectious Diseases, 16(6), 724-734.
doi:10.1016/S1473-3099(15)00409-0. Retrieved
from: http://proxy.chamberlain.edu:8080/login?url=http://search
.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26907734
&site=eds-live&scope=site
Laura Saldivar
The development of pressure ulcers, or bed sores,
remains one of the biggest problems in nursing care for
immobile patients today (Sharp, Schulz, & McLaws, 2019). It is
a definite problem in the health care system, which affects both
patients, their families, medical staff and healthcare facilities.
For the patient, they may experience severe pain, helplessness,
as well as financial difficulties from increased cost of treatment
(Gill, 2015). Unfortunately, medical staff may find great
challenges to prevent these skin issues, as well and treat them
after they have occurred. Pressure ulcers are also referred to as
bed sores, skin tears, or deep tissue injuries that happen due to
constant pressure, shearing, or friction for prolonged periods of
time (Gillespie, Chaboyer, McInnes, Kent, & Whitty, 2014).
These wounds are common in the geriatric population and
immobile patients who spend a great amount of time laying or
sitting down (Sharp, Schulz, & McLaws, 2019).
The decreased physical movement, immobility and
inability to turn are the main cause of pressure ulcers, there is a

10. variety of strategies practiced by nursing staff to prevent them
from occurring (Gillespie, Chaboyer, McInnes, Kent, & Whitty,
2014). Most hospital protocols enforce staff to manually turn
the patient which is the most common mode of prevention. By
shifting a patient’s position in bed every 2 hours, it promotes
blood flow, which is necessary for healthy skin (MedlinePlus,
2017). Due to lack of turning, blood and waste tend to pool in
the tissues which inhibits nutrient exchange from healthy
tissues. Frequently turning a patient helps the release of waste
build up and promotes healthy skin (Hess, 2009). Every hospital
or healthcare facility has their own scheduled repositioning
protocol. Although, intensive care units as well as long term
care facilities whose population has decreased mobility, the
standard time is two hours (John Maynard, 2015).
Unfortunately, staff tends to be unaware of the turn Q2 rules or
fails to perform the task which has led to this becoming one of
the largest occurrences of hospital acquired injuries or
HAI’s (Fletcher, 2017).
References
Cooper, K. L. (2013). Evidence-Based Prevention of Pressure
Ulcers in the Intensive Care Unit. Critical Care Nurse, 57-66.
Fletcher, J. (2017). Reposition Patients Effectively to Prevent
Pressure Ulcers. Wounds International, 7-10.
Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in
intensive care. Biomedical Journal, doi:
10.1136/bmjquality.u205599.w3015.
Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., &
Whitty, J. A. (2014). Repositioning for pressure ulcer
prevention in adults. Cochrane Systematic Review.
Hess, C. T. (2009). Take Steps to Prevent Pressure
Ulcers. Nursing, 61.
John Maynard. (2015, November 18). Move Every Two:
Repositioning Patients to Prevent Pressure Injuries. Retrieved

11. from Shield Healthcare
Community: http://www.shieldhealthcare.com/community/popul
ar/2015/11/18/move-every-two-repositioning-patients-to-
prevent-pressure-ulcers/
MedlinePlus. (2017, November 15). Turning patients over in
bed. Retrieved
from MedlinePlus.Gov: https://medlineplus.gov/ency/patientinst
ructions/000426.htm
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