Implement And Monitor Care Of The Older Person


Case Study

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.

Part A

1a) You are the nurse receiving Mrs Walker and as such, will need to complete a health assessment.

Discuss sources that you might access to retrieve information about Mrs Walkers past medical history.

1b) In detail, discuss what the interview stage of a health assessment is.

1c) Discuss why the use of assessment tools specific to the older person are important in a health assessment and name at least 2 you would consider using for Mrs Walker.

2a). You are concerned about Mrs Walker who seems very anxious and emotional. You have tried various types of communication, however, Mrs Walker is not engaging and her family are distressed.

Identify the person you would immediately discuss your concerns with, what you would need to relay and any assessment tools you may consider using.

2b). Identify and provide a brief explanation of the Standard for the Enrolled Nurse which relates to decision making and provision of care.

3a) Define restraint and describe who is ultimately responsible for authorising its use.

3b) Discuss the type of restraint used for Mrs Walker and describe your obligations once it is in place.

4a) You are unable to weigh Mrs Walker as she is not compliant. Discuss in detail at least 4 possible reasons for Mrs Walkers weight loss. (Please note that it is not acceptable to produce a list without detailing giving reasons)

4b) Discuss how Mrs Walker’s physical disability may be a contributing factor to her weight loss.

4c) Discuss the specialist health professionals Mrs Walker may be referred to (at least 3) for her weight loss.

5 With her daughter’s help, you are finally able to get Mrs Walker to sit down and have a drink. You decide to try and take the opportunity to complete an oral assessment.

  1. a) Create a list detailing at least 4 examples of how poor oral care can contribute to poor health in the older person
  2. b) Create a list of things you will look for during the oral health assessment for Mrs Walker
  3. c) You check Mrs Walker’s dentures which are chipped and stained and look too big. The daughter asks you the best way to care for dentures. Discuss in detail what you will tell Mrs Walker’s daughter.

6 Mrs Walker is unsteady on her feet, discuss what type of assessment you might refer Mrs Walker for and who might undertake this.

7a) You are discussing the diagnosis of Alzheimer’s disease with Mrs Walker’s son, he tells you he doesn’t understand what dementia means and asks you if there is a cure. Provide a definition of dementia with particular reference to what Alzheimer’s disease is.

7b) Mr Walker asks you if his mother will die soon, discuss the difference between palliative and end of life care

8a) After 2 weeks of residing in the facility, Mrs Walker has not engaged in any activities and continues to pace the corridor, although not with the same level of anxiety. You discuss your concerns with the activity officer, what therapies might she suggest for Mrs Walker?

8b) Discuss the need for the Mrs Walker to feel as though her environment is both physically and emotionally safe

Part B

Complete the following short answer questions

  1. Why was the carer’s recognition act 2010 implemented?
  1. List 3 legal or ethical considerations included in the 10 key principles in the Carers recognition Act 2010?
  1. What organisational policies and procedures do you need to pay attention to when caring for a deceased client?
  1. What specific standard precautions do you need to apply when caring for a deceased body
  1. 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.