Case Study (Mrs Walker)
Mrs Walker is a 72 year old lady who lives alone and until recently was in her own home with a care package. Mrs Walker has a diagnosis of Alzheimer’s dementia (4 months) and has deteriorated both physically and mentally over the last 8 weeks, she habitually paces up and down even though she has very poor balance and appears very pale and tired.
Mrs Walker has been deemed to have ‘lost capacity’ by her Psychogeriatrican and the Enduring Power of Attorney has been enacted. Mrs Walker’s family and the health team caring for her have all agreed that she is a danger to herself and others, a decision has been made to place her in a residential facility within a secure environment. Mrs Walker has had to be physically escorted into the residential facility and is very distressed.
Mrs Walker has a severe contracture of her right hand caused by burns received in her kitchen 11 months ago, her noncompliance with physiotherapy have rendered that hand useless. Mrs Walker weighed 62kgs a year ago, today she weighs 34.5kgs. Her family advise you that she is refusing to eat and that they often find Mrs Walkers dentures in bizarre places around the house, they tell you that Mrs Walker is still drinking plenty.
Answer to Question 1a
On discuss sources that might be accessed to retrieve information about Mrs Walkers past medical history, below will be my step.
In order to retrieve information about Mrs Walker, firstly I will be contacting with her family members who have appropriate knowledge about her health conditions. Apart from this, I will also be collecting her past medical information along with all the details of her care treatment and medicines will also be analysed.
Answer to Question 1b
In the stage of interview of health assessment, being a nurse for Mrs Walker I will be asking many questions which are mentioned as under:
- Q1. Do you like eating food?
- Q2. Do you like being at this residential care home?
- Q3. Why you are so distressed residing at the care home?
- Q4. Do you remember any of your family members?
- Q5. What made you hurt on your hand?
After asking all such questions, I will be ensuring that I get all the detailed information about Mrs Walker so that I can refer prominent services for her treatment.
Since, Mrs Walker is unable to take care of her mental health; therefore I will be using different assessment tools to deliver suitable care to the patient.
Here, I will be asking Mrs Walker to draw a clock face with numbers and hands and after that I will be conducting screening test for Alzheimer. In the stage of screening it will show good sensitivity and specificity which will also help me to assess cognitive dysfunction that is seen in Alzheimer.
Montreal Cognitive assessment:
This assessment technique will assist in screening for mild cognitive impairment. I will be using this since it aids in assessing conceptual thinking, memory and attention (Ahmed & Haboubi, 2010).
Answer to Question 2a
Identify the person you would immediately discuss your concerns with, what you would need to relay and any assessment tools you may consider using. (100 words)
Looking towards the current situation of Mrs Walker, it can be said that nurses and care practitioners must focus on proper communication so that the patient can feel comfortable and can express what she wants.
Clear concise and adequate communication is essential between patient and care providers; therefore for that suitable use of language is also vital (Alzheimer’s Australia. n.d). The nurse is also required to make Mrs Walker feel safe and secure so that she can try to express her health problems. For better communication, I will also be using pictures, charts and diagrams to make communication highly interesting and comprehensive.
Answer to Question 2b
The enrolled nurse is required to collaborate through participating in multidisciplinary healthcare team meetings and case conferences. Accurate and authentic information is also required to be given to the clients as they shall also be informed about the treatment. Moreover, enrolled nurses should also deal properly with the clients and their queries. Moreover, nurses should also involve patients in nursing care procedure.
Answer to Question 3a
Since, the patient has Alzheimer disease; therefore nurses need to use appropriate tool whose capacity should be controlled and monitored so that it may not affect the overall treatment procedure. While using diverse techniques for Alzheimer disease, it is vital for nurses to control the overall authorisation so that related information can be safeguarded with specific people only (Australian Government. (2016). Thus, in the specific case of Mrs Walker, nurse is required to give consideration on physical restraint in which actions will be taken to reduce the risks of falls.
Answer to Question 3b
In the present case, enrolled nurse will give physical restraint wherein a lap belt will be used to help Mrs Walker to sit up and participate in any activity (Bava, 2017). However, there are several risks and challenges which might appear related to falls and along with that the patient may also get frustrated and restless.
Answer to Question 4a
- Olfactory changes occur in patients who have Alzheimer disease wherein food items are observed as less appealing; thus patients do not feel like eating.
- Degree in food consumption also transforms due to decreased energy intake; however each time this reason does not hold true (Bishop, 2017).
- Changes in oral supplements, medications, environmental aspects and food types may also alter the mood of patients; hence it reduces the intake of diet.
- Along with this, due to hypertension Mrs Walker might be having less desire to eat food. In, Alzheimer disease metabolic process also transforms; therefore it brings numerous changes in the body.
Answer to Question 4b
Mrs Walker’s physical disability is contributing in reducing her weight because she tends to use fewer calories through physical activity. On average every day, she needs to gain 2000 calories; however she is not physically fit; therefore she is unable to use the large leg muscles. Hence, due to this, fewer calories are needed to maintain a healthy weight which also affects physical fitness.
Answer to Question 4c
- Mrs Walker needs to visit dietician so that she can get recommendation about her diet which can also minimize her problems related to weight loss. She might be getting appropriate suggestions so that she can have good food according to her choice (Commonwealth of Australia. 2012).
- She should also consult a physician to identify the problems relating to problem of weight loss.
- Mental care professionals can also assist her in identifying the reasons for weight loss.
Answer to Question 5a
- In the care of older people, it is being identified that nurses and practitioners do not give them adequate hygienic services which spreads other health issues. Advice related to brushing and washing hands are not given in proper manner.
- Along with this, older people do not get appropriate facilities for clothing protection; hence this greatly contributes in poor health (MacLeod, 2017).
- Oral hygiene is also required while giving and receiving things to each other and such standards are not followed in the case of older people.
- Older people are not able to maintain clean and hygienic standards; therefore it contributes more in their health problems.
Answer to Question 5b
- While working during oral health assessment for Mrs Walker, nurses are required to develop suitable communication regarding brushing and cleaning standards. Along with this, direct assistance will also be given to her on oral hygiene.
- She will also be provided a hand sanitizer through which she will be able to make herself clean while receiving and giving things (Nursing and Midwifery Board of Australia. 2016).
- Along with this, every day washed clothes will be given to her and as per the schedule she will be asked to take bath. This will be carried out on regular basis.
- Dustbin will be placed near her bed so that she can dispose wastage materials without polluting the environment.
Answer to Question 5c
Through reviewing the case scenario it was found that Mrs. Walker has lose around 32 kg weight as she often refused to eat the food as Walker dentures were found at the strange places. In this situation Mrs. Walker daughter has asked to take care for dentures so that she may not often misplace the dentures around the house (Rosenberg, 2017). For this, I have tell her daughter to take care of dentures that is handling dentures properly and rinse them in the water overnight so that it may lead to protect the dentures.
Answer to Question 6
As per the situation Mrs. Walker is unsteady on her feet this has resulted in arising the situation of distress. For overcoming the unsteadiness on her feet it has been referred to Mrs. Walker that she might be provided with the wheel chair or other equipment so that she can easily walk at the residential home.
Answer to Question 7a
Mrs. Walker son doesn’t understand the term dementia for him dementia definition would be disclosed to son. Dementia is defined as chronic disorder that has resulted in memory disorder as well as personality change situation. Through reference to Alzheimer disease it has been assessed that it is defined as progressive mental deterioration that impact the health of the patients. Therefore, the disease has impacted the health and resulted in suffering.
Answer to Question 7b
Palliative care improves quality of life and it also gives relief from the pain. Patient feels optimistic because palliative care supports life and keeps people healthy as a normal life. However, it also applied to the earlier stages of illness with several therapies and treatment (Stainton & Koutoukidis, 2017). But, on the contrary, palliative care does not quicken or postpone death; therefore health situations may change with the problems.
In palliative care, nurse will also use a team approach which will address the needs of the person who is ill and who needs to have proper care. Similarly, it is also a care pattern which combines psychological and spiritual aspects of care. On the other hand end of life care is also crucial part of palliative care for people whose end of life is near. The concept helps people to die with dignity; thus during such stage additional support is given to the patient in all domains.
Answer to Question 8a
Considering the situation of Mrs Walker, it is essential to assist her through cognitive behavioural therapy for anxiety disorders. The therapy is useful in addressing negative patterns and distortions in the way people consider the world and other surrounded activities. In the situation of anxiety, the patient has thought challenges; hence with the use of cognitive therapy such problems will be replaced with positive and realistic thoughts (TAFE Queensland. 2016).
Along with this, nurse can also implement Exposure therapy for anxiety which exposes the patient with the objects or feeling which creates fear in the mind. The therapy continuously exposes repeated thoughts and as a result patient will be able to increase sense of control over the situation and ultimately anxiety will diminish. The therapy will be used in alone or it can also be conducted as a part of cognitive behavioural therapy.
Answer to Question 8b
Since Mrs Walker is not feeling safe and secure in the residential care home; therefore it is vital for the enrolled nurses and practitioners to give her homely environment so that she can reside safely with her interest. Moreover, it is also required for the nurses to arrange counselling sessions for her wherein she will be encouraged to share about her feelings. Proper relationship is ought to develop among patient and the care practitioners so that value of care services can be enhanced directly.
Moreover, nurses should also minimize the chances of risks and uncertainties by keeping everything safe and secure for the patient. In this domain, nurses should also communicate directly with Mrs Walker so that she can express her requirements while residing in the residential care home. Nonetheless, adequate information shall also be provided to the patient and family members regarding the treatment that is being delivered. This will also help in protecting the interest of all the clients (van der Ploeg, 2013).
Additional short answer questions
Carer’s recognition act 2010
Question: Why was the carer’s recognition act 2010 implemented?
Carer’s recognition act 2010 was implemented with the aim of amending recognition and awareness of care provider’s role in daily care and support for disable people. Since, they provide appropriate medical care services to the patients; therefore their contribution should also be supported in all domains especially while dealing with mentally ill and other disable people.
Legal or ethical considerations
Question: List 3 legal or ethical considerations included in the 10 key principles in the Carers recognition Act 2010?
Under the principles of the act, it is essential to include a broad and encompassing definition of carer and that should be integrated with Australia’s care standards. Furthermore, it also focuses on cultural and attitudinal changes throughout APS agencies and all associated providers (MacLeod, 2017). Thus, it states that carers should be treated with dignity and respect and all the carers should have same rights, choices and opportunities.
Organisational policies and procedures
Question: What organisational policies and procedures do you need to pay attention to when caring for a deceased client?
Herein, chief consideration is required to be laid on ward staff; hence specific tags should be given to each dead body. There should be appropriate use of hygienic materials so that the chances of infection can be avoided. Along with this, extreme caution should be exercised while removing intravenous catheters and other sharp devices. In the organisation, there should be specific classification of clinical wastes and that should be handled according to clinical procedures.
Specific standard precautions
Question: What specific standard precautions do you need to apply when caring for a deceased body?
- Person who handles dead bodies must wear protective clothes consisting gloves and aprons and the clothing should be kept separate from outdoor clothes.
- Smoking, drinking and eating is forbidden in the autopsy room.
- Personal hygiene is also vital while dealing with deceased body.
- Nurses and other associated people should also avoid direct contact with blood or body fluids from the dead body.
Scope as an Enrolled Nurse
Question: Part of your role is to provide support and comfort for the grieving family or carer. Within your scope as an Enrolled Nurse, list 2 ways you can achieve this.
Working as enrolled nurse, it is essential to support the client through providing them monetary as well as non-monetary support. In this area, carers should be supported to enjoy optimum health and social wellbeing and the family members should also participate in such assistance (Bava, 2017). Along with this, economic support shall also be provided to the patients and respective family members.
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