HLTENN013 Implement and monitor care of the older person

Case Study 1

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 Psychogeriatrcian 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.

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

Discuss sources that you might access to retrieve information about Mrs Walkers past medical history. (50 words)

Sources  that need to be accessed to retrieve information about Mrs Walkers past medical hidsory include her health team who is caring for her, her family and knowing the history of the family, knowing about any past surgical history of Mrs Walker, her social history and any history of allergies (Bickley & Szilagyi, 2012). 

1b) In detail, discuss what the interview stage of a health assessment is. (100 words)

The interview stage of a health assessment is crucial in generating an established plan of treatment and to prevent potential health problems. During the interview stage, the patient is asked open ended question to establish a rapport and to allow them to open up. During the course of the interview, the questions are made more specific to gain an insight into the patient’s physical and mental status and to measure the progress the patient is making along with the need to idenitify any changes that need to be implemented to favour the patient which can aid their process of recovery (Estes, 2013). 

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. (100 words)

Use of specific assessmen tools is important in a health assessment of the older adults as it provides a more complete and a relevant assessment of the functional, psychological, and social issues faced by the elderly (Altin, Finke, Kautz-Freimuth & Stock, 2014). Such tools are important for completion of a geriratric assessment. Two tools to be considered for Mrs Walker include : the 4-item Simplified Nutrition Assessment Questionnaire (SNAQ) tool, which asks about appetite and how food tastes and is used to assess sudden weight loss (Lau et al., 2020), and the basic activities of daily living (BADLs) tool for functional assessment which provide an estimate of the basic activities that the patient is capable/incapable of performing on their own (Lowe et al., 2013).

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. (100 words)

The nursing care professionals and her health care team should be the first ones to discuss the communication problems faced by Mrs Walker. To care for patients suffering from Alzheimers and dementia, clear, concise and open communication along with use of easy language is needed so that the patients can understand the conversation and respond appropriately. Mrs Walker needs to feel safe and secure so that she can express her thoughts without any fear of being judges or mocked. The body language and the tone of the nursing staff should be proper and a two way conversation should be encouraged which can then lead to Mrs Walker communicating successfully (Cassel, 2010). For better communication, assessment tools that can be utilised include usage of using pictures and charts to make communication comprehensive and highly interesting.

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

The Standard for the Enrolled Nurse that relates to decision making and provision of care is the Standard 6 of The Nrsing and Midwifery Board of Australia (NMBA) code of conduct (NMBA, Australia, 2017). This standard states that enrolled nurses should provide timely and skilled care to the patients and should involve in decision- making care. This involves provision of care for patients who are incompetent to meet their own physical needs, active participation of enrolled nurse with registered nurse in the evaluation of the progress of the patient and reporting and seeking appropriate assistance to recognise the deterioration of physical/ mental health of the patient (NMBA, Australia, 2017).

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

Restraints are devices that are used to limit the movement of a patient. They are used in order to prevent self harm to the patient or to prevent the patient from harming others and is usually the last resort. The physician or an authorized independent practitioner who is responsible for the patient’s ongoing care can order a restraint. The organization then initiates restraint based on the order of the physician/ independent practitioner (Perkins, Prosser, Riley & Whittington, 2012).

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

Since Mrs Walker habitually paces up and down even though she has very poor balance hence the type of restraint used for her is a belt that is placed around her wasit and connected to a chair or a bed to limit her movement (Luo, Lin & Castle, 2011). Limiting her movement will wlloe her to participiate fully in the care process and will als prevent risk of fall related issues. The obligations once the restraint is placed include monitoring Mrs Walker’s physical, mental and emotional state and her response to the restraint.

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) 

Possible reasons for Mrs Walkers weight loss include:

1. Being a dementia paitent she wanders around aimlessly and is always in motion. These activites burn excessive calories and cause weight loss (Franx, Arnoldussen, Kiliaan & Gustafson, 2017).
2. Forgetting to have meals is also a major issue which can lead to Mrs Walker skipping meals resulting in her weight loss (Franx, Arnoldussen, Kiliaan & Gustafson, 2017).
3. The hypothalamic system of the brain gets affected in dementia which leads to decreased apetite and drastic weight reduction is hence observed (Hanson, Ersek, Lin & Carey, 2013).
4. Oral supplements and medications that are administered to Mrs Walker may cause changes in her taste buds and her mood which overall affects her daily food intake leading to weight reduction (Hanson, Ersek, Lin & Carey, 2013).
   
   

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

Mrs Walker’s physical disability is a contributing factor to he weight loss. Her contracture on her hand makes it tough for her to perform normal movement. She requires daily intake of enough calories to remain fit however her diability affects the body’s metabolism and causes weight loss.

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

The specialist health professionals Mrs Walker needs to be referred to for her weigth loss are nutrition specialist who will implement a nutritional intervention for her to meet her requirements and help her gain weight, a geriatrician who is a specialist in managing conditions such as dementia and will provide Mrs Walker help so that she follows her care plan sincerely. Another specialist includes the psychiatrist who will talk to Mrs Walker and ask her about her concerns and will ensure that she will recover if she fllows her care plan. The psychiatrist will act as a support system for her and will ensure she is eating her meals on time to achieve the desired goals.

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. (100 words)

1. a) Create a list detailing at least 4 examples of how poor oral care can contribute to poor health in the older person
   
   

Poor oral health contributes to poor health in the elderly

1. Poor oral health can cause pain in teeth which can reduce the desire or the ability to eat by affecting chewing/ swallowing capacity thereby affecting the health.
2. Poor oral health can cause oral cancer which is a chronic disorder commonly affecting the healh of the edelrly (Niesten, van Mourik & van der Sanden, 2013).
3. Denture status can contribute to dietary changes. Id dentures are painful due to oral complications then the food options for intake also get limited. Soft, easily masticatble foods are prefferd which are high in carbohydrates and predispose the elderly to development of other disorders (Lindqvist, Seleskog, Wårdh & Von Bültzingslöwen, 2013).
4. Gum disease which arsies due to lack of proper oral hygiene is associated with other conditions such as diabetes, stroke and cardiovasucalr disease and hence affects the overall health of an individual.
   
   

List of things that will be looked for during the oral health assessment for Mrs Walkers include observing her dentures and noticing any signs of teeth decay, the colour of her teeth should be noticed, any gum decay if present, any bacterial or fungal comtamination of the teeth should be looked for. Apart from these she should be asked about her daily brushing technique, and how she removes and cares for her dentures (Ribeiro, Costa,  Ambrosano & Garcia, 2012).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.

The best way to clean dentures includes removing them and rinsing them after each meal. This will help in the removal of the food debris that has settled on it. Careful handling of the dentures is another important aspect that should be followed to prevent their damage or breakage. Dentures should be brushed at least daily with a soft tootbrush and a non- abrasive cleaner. Denture adhesives if used by Mrs Walker should be cleaned regularly around the grooves to remove any left over adhesive. Dentures need to stay moist to retain their shape. Hence it is necessary to soak them in water or in a denture-soaking solution overnight. Before placing the dentures back into the mouth they should be rinsed once specially they have been soaked in denture soaking solution overnight as it may conatin harmful chemicals that if swallowed can lead to vomiting or pain (Kosuru et al., 2017).

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

The Timed Up and Go (TUG) test can be used to asses Mrs Walker. This test is based on performance and identifies balance and mobility impairments in the elderly. Mrs Walker’s physical therapist or her physician should undertake this test (Zakaria et al., 2015).

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. 

Dementia is a term that refers to all conditions that result in loss of memory, altered performance of daily activites and lack of proper communication abilities. It affects the mental abilities of an individual and impairs them from performing mental cognitive tasks such as reasoning or those that require memory (Livingston et al., 2017). Dementia is a group of symptoms the underlying cause of which is not known.

Alzheimers disease is the most common cause of dementia. Alzheimers is a progressive degenerative disease that affects the brain cells. It causes atrophy and the brain cells die. This results in continual declining of thinking and behavioural skills which affects the individual’s ability to perform their everyday functions independently. With the progression of the disease, severe memory impairment occurs. Medications help in maximizing function and in maintaining independence but there is no definite cure of Alzheimers (Long & Holtzman, 2019). Sever complicatins ultimately lead to death.

7b) Mr Walker asks you if his mother will die soon, discuss the difference between palliative and end of life care (150 words)

End of life care on the other hand is the care that is provided to patients who are in their last months or years of life. This type of care aims to provide comfort as much as possible to the patient to allow them to lead a life with less discomfort and to die with dignity. End of life care includes physical, mental, spiritual and emotional comfort and assistance.

Palliative care is a specialized form of medical care for people who are suffering from a serious chronic illnesss which usually does not involve a treatment that can guarantee recovery. This form of care hence aims to relieve stress of the patient and to help them in managing the symptoms of the disease rather than curing the disease. Palliative care improves the quality of life for both the patient as well as the family. It is provided by a group of specially trained nurses, doctors and specialists and is a personalized care plan that depends on the disease and the prognosis of the patient. It can be provided along with an ongoing curative treatment. Palliative care includes end of life care but also includes much more aspects (El-Jawahri et al., 2020).

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? 

The activity officer might suggest a cognitive behavioural therapy (CBT). CBT is usually the first line psychotherapy treatment that can help in further reducing the anxiety levels of Mrs Walker. It will address the distortions and negative thoughts of Mrs Walker and will enable her to think positively and realistically. It will help her to identify her thoughts and behaviours that affect her relationship with her kids and her surroundings. It will influence her thoughts for the better. Another therapy taht can be used for Mrs Walker is the Exposure Therapy that will expose Mrs Walker to her fears. The repeated exposure to her thoughts that she fears will lead to an increased sense of control and her anxiety will gradually reduce. Both these therapies can be used individually or together.

8b) Discuss the need for the Mrs Walker to feel as though her environment is both physically and emotionally safe (150 words)

Safety is a basic human need. Dementia can lead to feelings of decreased safety which can affect the mental, physical as well as the emotional status of the patient. It is crucial for the nursing staff and other health care professionals to ensure that a homely environment in the residential aged care facility is maintained so that the patients can reside without any fear of safety. It is important to maintain a physically healthy and a positive environment in the bresidential setting because patients with dementia rely on the cues provided to them by the environmental setting which supports them cognitively, emotionally, physically and mentally. An environment that is not safe or appears not to be safe to the patients can alleviate their stress and hamper their recovery process. It can be stressfull for the patients and cause disorientation, anxiety and mental confusion.

References

Aggar, C., & Broady, T. (2017). Carer legislation, policy support initiatives and future implications. Journal of the Australasian Rehabilitation Nurses Association, 20(1), 26-31. https://search.informit.org/doi/abs/10.3316/informit.084493282691399 

Altin, S. V., Finke, I., Kautz-Freimuth, S., & Stock, S. (2014). The evolution of health literacy assessment tools: a systematic review. BMC public health, 14(1), 1-13. https://link.springer.com/article/10.1186/1471-2458-14-1207 

Bickley, L., & Szilagyi, P. G. (2012). Bates' guide to physical examination and history-taking. Lippincott Williams & Wilkins. 

Cassel, C. K. (2010). Ethical foundations of palliative care for Alzheimer disease. JHU Press. 

El-Jawahri, A., Nelson, A. M., Gray, T. F., Lee, S. J., & LeBlanc, T. W. (2020). Palliative and end-of-life care for patients with hematologic malignancies. Journal of Clinical Oncology, 38(9), 944-953. https://ascopubs.org/doi/abs/10.1200/JCO.18.02386 

Estes, M. E. Z. (2013). Health assessment and physical examination. Cengage Learning. 

Franx, B. A., Arnoldussen, I. A., Kiliaan, A. J., & Gustafson, D. R. (2017). Weight loss in patients with dementia: considering the potential impact of pharmacotherapy. Drugs & aging, 34(6), 425-436. https://link.springer.com/article/10.1007%2Fs40266-017-0462-x 

Hanson, L. C., Ersek, M., Lin, F. C., & Carey, T. S. (2013). Outcomes of feeding problems in advanced dementia in a nursing home population. Journal of the American Geriatrics Society, 61(10), 1692-1697. https://doi.org/10.1111/jgs.12448 

Kosuru Sr, K. R. V., Devi Sr, G., Grandhi, V., Prasan, K. K., Yasangi, M. K., & Dhanalakshmi, M. (2017). Denture care practices and perceived denture status among complete denture wearers. Journal of International Society of Preventive & Community Dentistry, 7(1), 41. https://dx.doi.org/10.4103%2F2231-0762.200705 

Lau, S., Pek, K., Chew, J., Lim, J. P., Ismail, N. H., Ding, Y. Y., ... & Lim, W. S. (2020). The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults. Nutrients, 12(9), 2885. https://doi.org/10.3390/nu12092885 

Lindqvist, L., Seleskog, B., Wårdh, I., & Von Bültzingslöwen, I. (2013). Oral care perspectives of professionals in nursing homes for the elderly. International Journal of Dental Hygiene, 11(4), 298-305. https://doi.org/10.1111/idh.12016 

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Mukadam, N. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6 

Long, J. M., & Holtzman, D. M. (2019). Alzheimer disease: an update on pathobiology and treatment strategies. Cell, 179(2), 312-339. https://doi.org/10.1016/j.cell.2019.09.001 

Lowe, S. A., Rodríguez-Molinero, A., Glynn, L., Breen, P. P., Baker, P. M., Sanford, J., ... & ÓLaighin, G. (2013). New technology–based functional assessment tools should avoid the weaknesses and proliferation of manual functional assessments. Journal of clinical epidemiology, 66(6), 619-632. https://doi.org/10.1016/j.jclinepi.2012.12.003 

Luo, H., Lin, M., & Castle, N. (2011). Physical restraint use and falls in nursing homes: a comparison between residents with and without dementia. American Journal of Alzheimer's Disease & Other Dementias®, 26(1), 44-50. https://doi.org/10.1177%2F1533317510387585 

Niesten, D., van Mourik, K., & van der Sanden, W. (2013). The impact of frailty on oral care behavior of older people: a qualitative study. BMC oral health, 13(1), 1-12. https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-13-61 

NMBA, Australia. (2017). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. Retrieved 15 April 2021, from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx 

Perkins, E., Prosser, H., Riley, D., & Whittington, R. (2012). Physical restraint in a therapeutic setting; a necessary evil?. International journal of law and psychiatry, 35(1), 43-49. https://doi.org/10.1016/j.ijlp.2011.11.008 

Ribeiro, G. R., Costa, J. L. R., Ambrosano, G. M. B., & Garcia, R. C. M. R. (2012). Oral health of the elderly with Alzheimer's disease. Oral surgery, oral medicine, oral pathology and oral radiology, 114(3), 338-343. https://doi.org/10.1016/j.oooo.2012.03.028 

Zakaria, N. A., Kuwae, Y., Tamura, T., Minato, K., & Kanaya, S. (2015). Quantitative analysis of fall risk using TUG test. Computer methods in biomechanics and biomedical engineering, 18(4), 426-437. https://doi.org/10.1080/10255842.2013.805211 

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