Implement and monitor nursing care of older clients

CASE STUDY

Client Background

Nellie is 80 years old. She was admitted to high care three days ago, after living in a low care facility for 12 months. She had eight (8) children with six surviving. Her husband was killed many years ago in a tragic accident at his work place. Nellie has one unmarried son who sees her most days. She remains close to her daughters who take it in turns to see her each day. Nellie was an active person in the community and very involved in the church where she was an elder.

Question 1

The Aged Care Client Record indicates that Nellie has a history of cerebro vascular accidents (strokes) (1995, 1997, and 2005), vascular dementia, hypertension, Type 2 diabetes, osteoarthritis, cataracts and oesophagitis.

a. Select three of the above diagnosis and provide a brief definition of the condition and list two signs and/or symptoms for each condition.

b. For Nellie's multiple diagnoses, prioritise her health needs.

b. Vascular dementia is the second most common form of dementia after Alzheimer's.

i. What are the risk factors for vascular dementia?

ii. List the common signs and symptoms of dementia

iii. Describe the 3 stages of dementia

Question 2

Nellie is finding it hard settling into her new home in the high care facility. She has hit out at staff on a number of occasions during her morning hygiene needs. Her family are upset as her aggression is completely out of character.

a. List the ways you could monitor, assess and review Nellie's aggressive episodes.

b. What are two non pharmacological interventions you could implement when dealing with dementia clients with difficult behaviour?

Question 3

A group of high school students are visiting Nellie's aged care facility for the first time. List two positive and two negative stereotypes on ageing these students may have.

Question 4

Nellie has vision impairment and a hearing deficit. She has been fitted with a hearing aid which she to wear most of the time. She wears bifocal glasses at all times.

a. Describe two communication strategies to adopt for clients with impaired hearing and two communication strategies to adopt for clients with impaired vision.

b. Briefly explain the steps the EN could take to assist Nellie in caring for these aids.

Question 5

At the time of admission to the aged care facility, Nellie was noted to be confused with poor short memory. Her family stated she had wandered from the low care facility on 2 occasions in the past month. Safety is a priority for Nellie.

a. How could a safe physical environment be provided for Nellie?

b. Briefly discuss the importance of providing a supportive physical, social and emotional for people with dementia.

Question 6

Nellie's mobility is affected by her fragility, poor eyesight and arthritis and stroke. Nellie uses a wheelie walker. Care staff in the facility are required to locate and encourage Nellie to use her walker as she leaves it in the corridor. Nellie needs one to one physical assistance getting in and out of bed and chairs. She sometimes tries to get out of bed unassisted.

a. What assessment tools would you use to assess Nellie's mobility and where would you your findings?

b. List four strategies that you could implement to decrease the risk of Nellie falling.

c. Briefly outline the legal requirements for the use of restraint. Include in your answer one example of each of the following: physical, chemical and psychological restraint.

Question 7

Nellie has been experiencing urinary incontinence since her move to acute care.

a. What are some strategies you could put in place to reduce the episodes of incontinence?

b. What type of continence aids would be most effective for Nellie?

Question 8

Nellie's medication regime has changed with her admission to the high care facility. Following a pharmacy review she has had a number of medications ceased including a night time sedative which was increasing her risk of falls.

a. Outline the principles of safe medication administration.

b. What are the benefits of using the Webster Pak system of medication packaging and dispensing?

Question 9

Due to Nellie's osteoarthritis, she has considerable pain in both hips. She also has arthritic nodes in her fingers that make it difficult to grasp things. She used a hot pack at home and enjoys a liniment rub at night to settle. She has Panadol 500mg ii TDS with the last dose taken just before she goes to sleep.

a. What assessment tools could you use to monitor Nellie's analgesia requirements?

b. Identify two non-medication strategies that you could implement to increase Nellie's comfort and reduce her pain level.

Question 10

Some client groups of dementia sufferers such as Nellie are provided the support to remain in their home for longer.

a. What support services are available in the community to care for dementia clients who remain living in their own home?

b. What counselling resources are available for the clients and their carers in the community?

Question 11

The current Federal government aged care reforms, ‘Living longer living better' have introduced to the 1997 aged care act. Briefly outline these changes.

Question 12

When caring for elderly clients with complex or special needs, residential care facilities adopt best guidelines for client needs.

a. What is best practice?

b. Provide two examples of best practice guidelines for residential aged care.