Implement and monitor nursing care for older clients Assessment - Scenarios

You must answer the questions for all 3 scenarios

SCENARIO 1 - Mrs. West is a 79- year old widowed female admitted to your rehabilitation ward.

Past Medical History:

Hypertension

DM Type II - Oral Medication

Anxiety

Osteoarthritis

The nursing handover states: Right hip fracture and internal fixation. Her wound is healed.

Nutrition: If items are in reach Mrs. West is self-sufficient .She only consumes 50% of her food at each meal. She weighs 48kg and is 170cm

Hygiene: Requires assistance to dry between toes (Diabetic) but can in general manage once set up

Mobility: She requires help to get her legs out of bed and to put stockings on. Can use a  pick up tool / extension arm to put slippers on,  if they are in reach.

She is admitted with the main goal of increasing her mobility prior to returning home. She is not yet safe enough to step up and down a pavement or door step

Social: Normally lives alone. Her daughter lives close by and visits frequently.    

The following day the progress notes read.

Refused to sit out of bed "I just don't want to get out of bed yet".

Mary refuses analgesia, "it's too much trouble for those little girls, they are busy."

She is usually continent of urine but has occasionally been found to be wet when staff have changed her position. Mary is noted to have a 1.0 CM X 2.0 cm non-blancheable reddened area on coccyx.

Physio reports that when she allows nurses to get her out of bed she demands assistance of two for safe transfers.  The patient sits out usually only once a day over lunchtime. 

She reports pain in right hip 5/10 and 2/10 in left knee from arthritis.

1. What stage is her pressure area -

2. Identify nursing actions to prevent further deterioration of the pressure area.

3. What specific documents should be completed in relation to her pressure area?

4. What nursing interventions should be carried out in view of her recent incontinence episodes?

5. Access a BMI calculator and score her BMI -

6. Identify 3 interventions that should be carried out to monitor and improve her nutritional status.

7. Complete the Barthel chart including the total

8. Based on the assessment, list 3 ways in which you can best help Mrs West get home quickly; and give explanations for each

SCENARIO 2 - Jim has Alzheimer's and is able to feed himself; but needs constant prompting otherwise he wanders or mixes his food.

He has had a fractured hip and has since been unstable on his feet. He insists he can walk but staff use the ceiling hoist to transfer him and staff transport him in a wheelchair around the building.

1. Complete the rating score based on the ACFI guidelines below by circling the correct answer

2. What is the name for the commonly occurring behaviour of increased restlessness by clients with Dementia during the evening.

3. What is the name of the therapy that is used by staff in dementia care to redirect behaviour; especially repetitive eg 'I want to go home', that is causing anger or frustration.

SCENARIO 3 -  

Mrs. Ruth Simmons is a right-handed, 70 year-old widow who lives alone in her own home,   a two-storey single-family home. The kitchen and living room are on the main floor, along with the laundry, and the bedroom and bathroom are on the second floor.

Mrs. Simmons drives her own car. She is a member of a local handicraft club and enjoys needlework. Mrs. Simmons has two adult children who live in another suburb. Her daughter, phones weekly to talk to her mother. She hears from her son once or twice per month.

Medical Information

Mrs. Simmons called an ambulance after discovering that she was having difficulty walking and speaking. She was admitted to hospital, diagnosed with a left cerebral vascular accident (CVA).Mrs. Simmons suffers from hypertension and is taking prescribed diuretics. She takes Paracetamol 2 tabs 3 times daily for Osteo arthritis and hormone replacement medication .

Four days after admission, a Stroke-Rehabilitation Team Case meeting is due to take place. You are assigned as the case manager. You have already identified goals as follows:-

Client Goals

1. Mrs. Simmons wants to return to living alone 

2. She wants to continue driving.

3. She wishes to continue leisure interest in needlework.

4. Mrs. Simmons wants to be able to speak more clearly;

5. Use of affected limbs, as much as future muscle tone allows

6. Reduce shoulder discomfort

7. Regain standing balance, and walking ability

1. Identify members of the multidisciplinary team required to meet the client goals and what specific contributions will they manage.

2. What specific education should be given to a family if they wish to help with dressing their relative after a stroke; to prevent injury and make the task easier?

SCENARIO 4 - Mary has terminal cancer and no longer is able to eat adequate amounts of food. The Dr has recommended a naso-gastric tube be inserted but Mary is resistant to this suggestion,

What are the patient's rights in this situation?

What is our responsibility as Mary's nurse in this situation?

Attachment:- Assignment File.rar