HLTENN013 Implement And Monitor Care Of The Older Person

Question:

Mrs Walker, 72, is an independent woman who lives alone. She was previously able to live in her home with a care package.

Mrs Walker was recently diagnosed with Alzheimer’s disease (4 months ago) and has suffered from mental and physical decline over the last 8 week. She regularly paces up-and-down, even though she is very unstable and seems pale and tired.

The Enduring Power of attorney has been established after Mrs Walker was declared unable to communicate by her Psychogeriatrican.

Mrs Walker’s family members and her medical team have all confirmed that she is dangerous to herself as well as others. They decided to place her in a secure residential facility.

Mrs Walker had to be physically escorted into a residential facility. She is extremely distressed.

Mrs Walker suffers from a severe contracture to her right arm, caused by burns that she sustained in her kitchen 11 month ago. She has not been able to comply with physiotherapy and her hand is now useless.

Mrs Walker weighed 62kgs one year ago. She now weighs 34.5kgs.

Her family informs you that she refuses food and they often find Mrs Walker’s dentures around the house. They also tell you that Mrs Walker continues to drink a lot.

Part A

1a) As Mrs Walker’s nurse you must complete a medical assessment.

Discuss possible sources to obtain information on Mrs Walker’s past medical history.

1b) Let’s discuss in detail the interview stage of a Health Assessment.

1c. Discuss the importance of using assessment tools for the elderly in a health assessment. Give at least 2 examples that you might use for Mrs Walker.

You are worried about Mrs Walker because she seems anxious and emotional.

You tried different communication techniques, but Mrs Walker does not engage and her family is distraught.

Identify the person who you would talk to immediately about your concerns, what you would need for them to relay and any assessment tools they may use.

Provide a brief explanation about the Standard for an Enrolled Nurse, which is related to decision making and the provision of care.

3a. Define restraint. Who is ultimately responsible?

3b. Discuss the type and consequences of Mrs Walker’s restraint.

4a. Mrs Walker is not able to weigh herself.

Discuss in detail the possible reasons Mrs Walker lost weight.

(Please note: It is not acceptable to make a list of reasons without giving specific reasons.

4b. Discuss whether Mrs Walker’s physical disability could be contributing to her weight loss.

4c. Discuss with Mrs Walker the specialist health professionals she may be referred too (at minimum 3).

5. With the help of your daughter, you finally get Mrs Walker to take a seat and enjoy a drink.

You decide that you will try to get Mrs Walker to sit down and have an oral assessment.

a) Write a list describing at least 4 instances of how poor oral health can cause poor health in an older person

b. Make a list with the items you will be looking at during Mrs Walker’s oral assessment

c. You examine Mrs Walker’s damaged and stained dentures. They are too large.

The daughter asks you how to care for dentures.

Discuss in detail with Mrs Walker what you will share with her.

6 Mrs Walker is not stable on her feet. Talk to Mrs Walker about what kind of assessment you could refer and who might do it.

7a. You are discussing the diagnosis with Mrs Walker’s son. He tells you that he doesn’t understand dementia and asks if there is any cure.

Please give a definition for dementia and a reference to Alzheimer’s disease.

7b) Mr Walker questions you about his mother’s imminent death. If so, what is the difference between end of life and palliative care?

8a. Mrs Walker continues to walk along the corridor despite not engaging in any activity after 2 weeks.

Talk to the activity officer about your concerns. She can suggest therapies for Mrs Walker.

8b. Discuss the need for Mrs. Walker to feel physically and emotionally safe.

Part B

Answer the questions below.

Why was the Carer’s Recognition Act 2010 put into effect?

List 3 legal and ethical considerations in the Carers recognition Act 2010.

What are the organisational policies and procedures you should be paying attention to when caring after a client who has passed away?

What precautions should you take when caring for a decomposing body?

You have a responsibility to comfort and support the grieving relatives or carers.

Two ways you can do this as an Enrolled nurse are listed below.

Answer:

Part A

It is possible to retrieve Mrs. Walker’s past medical history by visiting the hospital where she received her dementia diagnosis. You can also get information about her previous medical records and prescriptions.

Family members of Mrs. Walker should be contacted, as they can provide information about her, such as the symptoms, treatment, medication, or allergies.

In a health interview, nurses gather and document data to aid in the nursing diagnosis and assessment, planning interventions, and patient care.

It can be done verbally and non-verbally through open-ended or closed-ended questions.

It is crucial to have a health assessment interview because it gives information about the applicant’s personal and medical history, as well as the reasons they are seeking care.

It is important to communicate effectively with the patient during the interview. This will help them feel at ease and give details about their health history, such as past surgeries, immunizations and medications, and social and personal histories.

This will also help to determine the family history of any kind (Kring et. al., 2013,).

As part of the health assessment, the assessment tool provides an in-depth assessment. This allows for identification of potential health issues and possible interventions.

It’s done in order improve the quality of life for older people and their overall health.

Because Mrs. Walker is a dementia patient it is important to determine the risk factors as well as the broad factors that impact her physical, mental, and psychosocial well being.

There are two tools that can be used to assess her functional status: the Nutritional Questionnaire (to determine the patient’s eating habits and nutrition) and the Katz Index of Independence in Activities of Daily Living.

The person in charge of Mrs. Walker’s residential home care is the immediate contactable member of the healthcare staff.

This person should be the home caregiver who is taking care of Mrs. Walker and can be trusted.

As part of the health assessment tool, you can use the Health Questionnaire form to ask open-ended questions and close-ended questions about your home carer. This will allow you to provide information such as her current health and any risk factors. (Larsen, et al. 2015).

Australian Nursing and Midwifery Council’s (ANMC) competency standards state that nurses have to show reflective and critical thinking skills that lead to good decision-making.

Enrolled nurses are required to work together with Registered nurses in the Domain of Critical Thinking and Analysis 5 Competency Unit 5.

They must contribute to healthcare decision-making by providing accurate and relevant information for care delivery and decision-making (Dalton Gee & Levett Jones 2015).

Any device, material or other physical or mechanical device that is placed next to or attached to the resident’s bodies to restrict freedom of movement or access is called restraint.

People are made helpless by restraints that use straps, ropes, and handcuffs to keep them in captivity.

Two types of restraints are used to restrict or control behavior or movement, including chemical and physical restraints such as medications.

While it is illegal to use restraints in emergencies, the Medical Director or Police can authorize them (Muskett (2014)).

Mrs. Walker is underweight, weak and suffers from dementia. She has the potential for wandering and falls. Because her dentures were found in unusual places, environmental modifications are necessary to prevent her from falling and getting hurt.

It is possible to restrain Mrs. Walker by locking her door and using bed rails or a wheelchair. This will help keep her from wandering and falling and prevent her from getting into troublesome places.

A person with dementia may lose weight if they are unable to swallow the food properly.

Cachexia is when the patient doesn’t like the food because it has a bad taste or texture.

Bad oral hygiene can also cause it, such as poor fitting dentures or bad teeth.

Mrs. Walker may also experience anxiety, depression and emotional distress that can cause her to lose weight.

Because of advanced dementia, cachexia can occur. This is because she is no longer able to absorb food nutrients. This has caused weight loss (Saha and al., 2016).

4b).

She has a reduced muscle mass, and prescribed medications are making it difficult to eat.

The wrong consistency and desire to eat make it difficult to swallow.

A physical disability can cause anxiety, depression, and frustration, as Mrs. Walker has shown. Poor nutrition knowledge can also lead to poor eating habits (Williams and al., 2014).

Mrs. Walker lost weight thanks to the help of a professional dietician, nurse, and doctor.

For the right weight management program, it is important to consult the doctor about any allergies or pre-existing conditions.

A dietician would determine the most appropriate diet to help her gain weight, based on her medical conditions and age. Nurses would also provide education and motivation for patients.

Poor oral hygiene can cause poor health. It can also affect your overall health.

Bad oral hygiene can cause many health problems, including yellow dental plaque.

They can also get into the bloodstream and travel to other areas of the body. This can lead to infection and inflammation.

If older people don’t brush their teeth regularly, systemic inflammation may occur. Inflamed and bleeding gums can also cause this condition.

Oral bacteria can also lead to blood clots, narrowing of the vessels, and other complications (Gil Montoya.

During an oral assessment, it’s important to examine Mrs. Walker’s medical, dental and personal histories.

A clinical assessment of Mrs. Walker’s teeth, oral mucosa tissue, and orthodontic needs is done to determine her level of dental anxiety.

A risk assessment for periodontal or mucosal disease is also necessary.

Tooth surface abnormalities, loss or dental trauma are all factors that require oral assessment.

Also, a clinical examination of the gums, head, neck and tongue is necessary.

A clinical examination of the head, neck, tongue, and gums is required to determine if there are any ongoing medication or pain.

You should clean your dentures regularly and keep them free of any food particles.

It must also be free from any type of staining or damage to the denture.

After denture removal, it is important to clean the mouth thoroughly.

The denture is large, stained and chipped.

The denture needs to be cared for. It should be cleaned frequently, soaked in water overnight, and then brushed cleanly.

The denture should be kept in a denture soaking solution, free of any food particles or plaques.

It is important to rinse the mouth after removing dentures.

After each meal, dentures must be taken out and rinsed.

You should avoid using harsh chemicals, discolouring or bleaching agents, toothpastes whitening toothpastes, and hot water to clean your dentures.

For loose dentures, it is important to visit the dentist regularly (Ryu and colleagues 2015).

Mrs. Walker should have balance and gait assessments done as this could cause falls or impaired ability to do the ADL (Bauer, et. al., 2016).

It will help her assess her balance, unsteadiness and physical ability as well as determine the extent of impairment.

An orthopedic surgeon or physiotherapist could do this.

Dementia refers to a medical condition in which a person’s mental abilities decline and it interferes with their daily lives.

There are many symptoms that can affect thinking skills and memory, which may impact the ability to complete the ADL.

The impairments include impaired communication, memory and language as well as visual perception, judgment, reasoning, and attention.

Patients with dementia have short-term memory impairments that gradually worsen over time.

Alzheimer can also cause problems in thinking, memory, behavior.

The symptoms appear gradually and worsen over time.

Although it is not a common occurrence in aging, it does pose a risk for Alzheimer’s disease (Alzheimer 2015).

Mrs. Walker does not appear to be in imminent danger and was placed in residential home care as she is unable perform daily activities because of her Alzheimer dementia.

This is palliative and not end-of life care.

This is a way of improving the quality of their lives and protecting them from harm.

Palliative Care is necessary for her because she is experiencing physical and mental distress. She requires care to ease her pain and discomfort.

End-of life care is for patients who are in their last days due to any serious or life-limiting illness.

This is done to offer the best care and alleviate their sufferings in the final days of their lives.

Mrs. Walker has anxiety after she moved into the residential home. To help her get involved in activities, she needs stimulation and motivation.

Psychosocial interventions are non-pharmacological treatments that help to orient, train and relieve stress.

She would also benefit from these interventions, which would involve her in activities to divert her attention and maintain cognitive stability.

These activities would help her maintain balance between emotions, thoughts, behavior and as part of psychosocial interventions.

The dementia patients need to be assessed for their physical and mental environment.

Alzheimer patients become aggressive when they see changes in their environment. It is important to ensure safety as they are more prone to falling and wandering.

A noisy environment can also cause them irritation and make it difficult for them to adjust to new environments.

For her to feel emotionally safe and secure, she needs a secure environment.

It is important to have enough light and less clutter so there are fewer chances of falling. Mrs. Walker also needs a locked door to prevent wandering and avoid distractions.

Part B

About 2.7 million carers in Australia provided support to those who were disabled, elderly, or suffering from an illness or medical condition.

To increase recognition and appreciation of role carers, the Carers Recognition Act was introduced in 2010. It provides support and care to people with disabilities, mental illness, and individuals who are frail.

These guidelines are intended to help the Australian Public Service Agencies as well as the Commonwealth Government to provide funding to enable the role carers to fulfill the requirements of the Act.

This Act recognizes and supports the Act’s economic and social value.

It includes the definition and role of a carer in supporting individuals, their family members, and friends who live at the home and are connected to the outside world (McMillan, et al. 2017,).

The Carers Recognition Act 2010 does not create any legal enforcement or obligations.

The Act doesn’t create any rights or duties that are legally enforceable in any proceeding or judicial entitlement.

If a person fails to comply the Act, any decision will be valid. However, any appeals regarding such decisions cannot be made.

If an associated service provider or public agency of the Commonwealth is required by law to take into consideration the particular issues or exercise its powers and functions, then there is nothing in the Act that would require it (Lawn & McMahon (2015)).

Policy considerations for the care of a deceased client include the announcement of death and the informing of the Most Responsible Doctor (MRP) regarding the patent death by a Registered Nursing, or Licensed Practical nurse.

The family physician and the coroner are also informed in the case of unnatural deaths.

An Application for Notice of Death is filled out and sent to the Registry.

Nursing staff have an important duty in caring for the remains of the deceased.

It is based on local policies and includes information to post mortem, as well as caring for valuables and property.

When caring for the body of the deceased, it is important to take all precautions regarding the disposal and handling of the body.

The body must be properly washed, the limbs should be straightened, and all jewellery and mechanical equipment should be removed.

A waterproof dressing is applied to any wounds. Nursing staff take steps to protect themselves and the patient from blood and fluid contact while moving, handling, disposing of, or moving the body.

The body of the deceased should be covered in a shroud, or clothing with proper labeling and wrapped in a sheet (Moriarty and co., 2015).

A registered nurse can provide comfort to the grieving families by providing emotional support and bonding with them.

By maximizing their interaction with the family, they can do this by being sensitive and empathic to the family’s concerns.

They can offer comfort and support to grieving families by listening to their needs and acknowledging the loss.

They can offer continued support to the grieving family by offering information on bereavement and communication groups as well as caring and understanding for them (Ruth Jacob et. al., 2013).

References

2015 Alzheimer’s Disease facts and figures.

Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 11(3), 332.

The use of instrumented balance, gait analysis and balance analysis to predict the future falls among older adults in a community.

Simulation-based education combined with clinical reasoning to ‘flip the Enrolled Nurse Curriculum.

Australian Journal of Advanced Nursing. 33(2), 29.

UK study: Activities of daily life and quality of living at different stages of Alzheimer’s disease.

Aging and mental health, 19(1): 63-71.

J. Gil Montoya

Non-systematic review: Oral health and its effects on general well-being in elderly patients.

Final development and validation for the clinical assessment interview of negative symptoms (CAINS).

American Journal of Psychiatry. 170(2). 165-172.

The robust latent variable that measures healthy eating habits is formed by four dietary items from the School Physical Activity and Nutrition questionnaire (SPAN).

Journal of nutrition education & behavior, 47(3). 253-258.

Families caring for people with borderline personality disorder.

Journal of psychiatric, mental health nursing, 22(4). 234-243.

Caring for caregivers in community pharmacy.

Research in Social and Administrative Pharmacy 13, 1: 254-256.

Bereavement in the wake of informal caregiving: Assessment of mental health burden using linked population data.

American journal for public health, American Journal of Public Health, 105(8) 1630-1637.

Trauma-informed treatment in inpatient mental health facilities: A review of literature.

International Journal of Mental Health Nursing. 23(1), 51–59.

Identification of critically ill patients who would benefit the most from nutritional therapy: validation of modified NUTRIC’s nutritional risk assessment tool.

Clinical Nutrition, 35(1) 158-162.

Scope of practice in Australia for enrolled nurses: Evolution issues and practice issues.

Contemporary nurse, 45(2) 155-163.

The frequency of dental and denture cleanings is associated with personality in edentulous older people.

Geriatrics, Gerontology International, 15(12), 1258-1263.

In late-life depression, weight loss and appetite are predictors of dementia outcomes.

The American Journal of Geriatric Psychiatry 24, 10: 870-878.

The effects of weight loss and physical activity on later-life objective disability and self-reported disability over the past 20 years are changing.

International journal for epidemiology, 43(3) 856-865.