Mr Saheed Bott is a 69 year old semi-retired university professor. His wife passed away 12 months ago and Saheed has kept himself busy marking papers from the university, reading and travelling. He has a son who has recently moved interstate for work.
Mr Bott wears glasses for reading and other than a permanent colostomy (resulting from a large bowel infarction in 2005) he has nil significant medical history to report.
Last night Mr Bott was at dinner with friends when he suddenly became unwell and had difficulties speaking. Mr Bott was brought in by ambulance to the emergency department and was diagnosed as having had a cerebrovascular accident (CVA) with residual right (R) sided hemiplegia, dysphagia and dysphasia.
Mr Bott is transferred to the acute medical ward where you work.
Mr Bott appears drowsy but is responsive with a GCS of 13. He is currently Nil by Mouth (NBM) whilst awaiting a speech pathology review.
His vital signs on arrival are: Oral temperature 36.5 degrees C ; P 108 bpm; R 26 bpm; SpO2 96% on room air and BP 180/90 mmHg.
- You are to help Mr Bott have an assisted shower in his room this morning to which he has consented. Identify 6 factors you should consider during the undressing and dressing process, offering a brief explanation of why with each.
During the afternoon, Mr Bott indicates that he wishes to lie down. Once Mr Bott has been returned to bed you notice that his right heel is red and non-blanching.
- a) Identify a type of screening assessment, commonly used in the prevention and management of pressure injuries. Provide a brief explanation of the assessment tool you have chosen.