Mrs. Walker's Health Assessment: A Case Study Essay." (57 Characters)

Sources for medical history

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. 

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

Complete the following short answer questions

1. Why was the carer’s recognition act 2010 implemented?

2. List 3 legal or ethical considerations included in the 10 key principles in the Carers recognition Act 2010?

3. What organisational policies and procedures do you need to pay attention to when caring for a deceased client?

4. What specific standard precautions do you need to apply when caring for a deceased body

5. 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.

1a). The past medical history of Mrs. Walker can be retrieved by consulting the hospital where she has undergone her dementia diagnosis and getting information about her past medical records and prescribed treatment and medications. Mrs. Walker family members should also be contacted as they are helpful in providing the information about her like the symptoms, undergone diagnosis, treatment and medications or any kind of allergies.

1b). In a health assessment interview, the data is collected and documented by the nurses for the nursing diagnosis, assessment and planning interventions and care from the patient. It is done in the form of verbal and non-verbal communication through open and closed-ended questions. Health assessment interview is important as it provide information about the biographical data, reasons for the seeking of health care, present health concern and the family health history. The interview requires effective communication skills that is required to make the patient comfortable and provide the components of health history, any past immunizations, surgeries, social and personal history, past and ongoing medication or any kind of allergies. This also helps to reveal the family history for any kind of illnesses (Kring et al., 2013).

1c). The assessment tool is important for the older people as a part of health assessment as it provide an in-depth assessment to identify the health conditions and issues that require potential interventions and preventable measures to be taken. It is done in order to improve the quality of life and overall health of the older people. As Mrs. Walker is a dementia patient, it is also required to identify the risk factors and the broad factors that influence the physical, social and psychosocial well-being of her. Tow specific assessment tools for her are Nutritional Questionnaire to know about the eating behavior, nutrition and Katz Index of Independence in Activities of Daily Living (ADL) for assessing the functional status of the patient (Giebel, Sutcliffe & Challis, 2015).

2a). The immediate person who can be contacted to discuss the concerns about the anxiety and emotions of Mrs. Walker is the member of the healthcare team who is taking care of her in the residential home care. This member should be the home carer who is personally taking care of her who can be relied on. Health Questionnaire form as a part of health assessment tool can be used by asking open and close-ended questions to the home carer that would provide her health needs, current health status and involved risk factors (Larsen et al., 2015).

Importance of assessment tools

2b). According to Australian Nursing and Midwifery Council (ANMC), competency standards states that they have the responsibility to demonstrate reflective and critical thinking skills that contribute to effective decision-making. In the Domain of Critical Thinking and Analysis, under the Competency Unit 5, enrolled nurses should work in collaboration with Registered nurses and assist in decision-making. They should contribute to decision-making with the healthcare team with relevant and accurate information in the provision of care and decision-making (Dalton, Gee & Levett-Jones, 2015).

3a). Restraint is any physical or mechanical device or material that is adjacent or attached to the resident’s body to restrict the freedom of movement and access. A practice renders people helpless and keeps them in captivity by use of straps, ropes and handcuffs. Two main restrain types that control or restrict behavior or movement like physical and chemical restraints like medications. Although, it is not legal to use restraint, however, in case of emergency, it is authorized by Medical director or police (Muskett, 2014).  

3b). As Mrs. Walker is weak, underweight and suffering from dementia, she has risk for falls and wandering, her dentures found in bizarre places and so environmental modifications are made as restraints. The restraint used is a locked door, use of bed rails and wheelchair that would be helpful in restraining her from wandering, falls and getting into bizarre places.  

4a). In dementia, weight loss is caused as the patient is not able to eat the food due to difficulty in swallowing. They also do not like the food due to its taste or wrong consistency and is not able to eat the food called cachexia. It can also occur due to poor oral hygiene like bad fitting dentures, bad teeth or moth ulcers. Depression, anxiety and emotional distress is also a reason for Mrs. Walker to lose weight. As cachexia occurs due to advancing dementia, she is not able to absorb the food nutrients and lose appetite that has led to weight loss in her (Saha et al., 2016).

4b). Physical disability contribute to weight loss as a medical condition, like dementia in Mrs. Walker is affecting her body metabolism. She is having reduced muscle mass and the prescribed medications is making her lose appetite. There is difficulty in swallowing due to wrong consistency of food and willingness to eat. Physical disability also causes anxiety, depression or frustration as witnessed in Mrs. Walker that also alters the eating habits along with poor nutrition knowledge (Williams et al., 2014).  

Types of restraints

4c). For the weight loss that is witnessed in Mrs. Walker, the specialist health professionals include the doctor, professional dietician and nurse who would help her to gain weight through proper diet and weight management regime. The doctor needs to be consulted for the pre-existing condition and medications or any kind of allergies to choose the patient-centered weight management regime. Dietician would prescribe the right kind of diet for weight gain according to her medical condition and age and nurse would provide patient education along with motivation and moral support.

5a). Poor oral care can contribute to poor health and affect in many ways as bacteria sustain the homeostasis and cultivate in the mouth that lead to gum disease or periodontitis. They cause various health problems and leads to formation of yellow dental plaque due to poor oral hygiene. These bacteria can also enter the bloodstream, can travel to other parts of the body, and can cause infection and inflammation. Systemic inflammation is also caused when older people do not brush and a condition arises due to bleeding and inflamed gums. Oral bacteria is also a reason for causing blood clots and narrowing of arteries (Gil Montoya et al., 2015).

5b). During the oral assessment, it is important to look for Mrs.Walker’s history like dental, medical and personal history. The dental anxiety level with clinical assessment of teeth, oral mucosa tissue and orthodontic needs of Mrs. Walker is also assessed. The risk assessment is also important for the periodontal or oral mucosal disease. Oral assessment is also required for tooth surface abnormalities, loss, dental trauma or occlusion. Head, neck, tongue and gum clinical examination is also required. It is also important to look for any kind of pain, food limitations, dentures and ongoing medications for the oral pain or discomfort (Rahman et al., 2016).

5c). Dentures should be cleaned properly at a regular basis and should be free from any kind of food particles. It should also be free from stains and any kind of damage to the denture. The mouth should be cleaned properly after the denture removal. The denture is big, stained and chipped. Therefore, care is required for the denture where it should be cleaned regularly, soaked overnight in water, brushed and free from any kind of stains. It should be kept in denture soaking solution and free from any kind of food particles or plaques. Dentures should be handled carefully with rinsing of mouth before using them. After every meal, dentures should be removed and washed along with the rinsing of mouth. The dentures should not be cleaned with abrasive materials, discolouring or bleaching products, whitening toothpastes and hot water. Regular dentist visits are also required to prevent discomfort and slippage of dentures in case of loose fit (Ryu et al., 2015).

Weight loss and Mrs. Walker

6). Balance and gait assessment is important for Mrs. Walker as it might lead to falls or reduced level of functioning in performing the ADL (Bauer et al., 2016). It would help to evaluate the unsteadiness level, balance and physical ability of her and the assessment of level of impairment. This can be done by physiotherapist or an orthopedic.

7a). Dementia is a medical condition where there is decline in the mental ability of an individual that interferes with their daily living. It encompasses a range of symptoms that affect the thinking skills and memory affecting the ability to perform the ADL. There is significant impairment in the communication, memory, language, attention and focus, visual perception, judgment and reasoning.  Dementia patients have short-term memory problems that start slowly and get worsening gradually. Alzheimer is also a type of dementia that causes problems with the thinking, memory and behavior. The symptoms develop gradually and them worsens with time. It is not a normal phenomenon in aging; however, age acts as a risk factor for Alzheimer (Alzheimer’s, 2015).

7b). Mrs. Walker shows no sign of death and she had been kept in the residential home care, as she is not able to perform her daily activities due to loss of physical and mental ability because of Alzheimer dementia. This is an example of palliative care and not end of life care. This is a way to improve the quality of life and protect them from any kind of harm as their memory and thinking ability is impaired. Palliative care is important for her as she is suffering from physical and mental distress and require care to relieve her of pain and discomfort. On a contrary, end-of-life care is given to those patients who are leading last few days of their life due to any life-threatening or life-limiting illness. This is given to provide the appropriate care and relieve their sufferings during the last days of their life.

8a). After residing in the residential home, Mrs. Walker is experiencing anxiety and thus, requires motivation and stimulatory therapy to engage her in activities. Psychosocial interventions in the form of non-pharmacological treatment to orient her, train her in specific skills and relieve stress. These interventions would also help her, as she would be engaged in activities, divert her thoughts and maintain cognitive stability. These activities as a part of psychosocial interventions would also help her to maintain balance between the emotions, thoughts and behavior.

Mental health concerns

8b). Physical environment assessment is important for the dementia patients that affect their physical and mental well-being. They become aggressive due to sudden changes in the environment and safety is of utmost importance as Alzheimer patients are prone to falls and wandering. Moreover, noisy environment irritates them and they are unable to adjust to a disturbed environment. Positive and secured environment is required for her so that she feels safe and emotionally protected. Ample of light is required along with reduction of cluttering of room with objects so that there are reduced chances of falls, locked door to restrict wandering and avoiding distraction and confusion in Mrs. Walker.

1. In Australia about 2.7 million carers provided assistance to the people who are disabled, aged and suffering from medical condition or illness. Therefore, Carers recognition act 2010 was implemented to increase awareness and recognition among the role carers while providing daily support and care to the people with disabilities, mental illness and medical conditions or individuals who are frail aged. The guidelines have been implemented to assist the funded providers in Commonwealth Government and Australian Public Service Agencies so that they are able to make the role carers to meet the responsibilities outlined in this Act. This Act acknowledges the valuable economic and social contribution of the care recognition legislation and complements to meet the responsibilities of the Act. It encompasses the definition of carer and its role in supporting the individuals, their family members and friends who live at home and stay connected to the outside social world (McMillan et al., 2017).
   
   
2. The three legal considerations in the Carers Recognition Act 2010 is that it does not create legal enforcement or obligations under this Act.
   
   
3. The Act does not create any duties or rights that are legally enforceable in nay proceedings or judicial entitlement.  
   
   
4. The validity of any kind of decision is not affected is one fails to comply with the Act and is not reviewed or challenged regarding any decisions on any grounds.

• If an associated provider or a public service agency is required by law of a Territory or State or of the Commonwealth for the consideration of the particular matters or to exercise its powers or functions, there is nothing in the Act that require the associated provider or agency that acts inconsistently with the law (Lawn & McMahon, 2015).

3. The policy considerations in the care of a deceased client are the pronouncement of death and informing the Most Responsible Physician (MRP) about the patent death by the Registered Nurse, or a Licensed Practical Nurse. Moreover, the family physician is also informed and in case of an unnatural death, it is reported to the coroner and in cases where the reasonable cause of death cannot be established. A Notice of Death form is completed and provided for Registration. After death care is an important duty of the nurses where the body of the deceased person is maintained with respect and dignity. It takes into account the local policies on the care of deceased person, informing to post mortem ad caring for the valuables and property of the patient.
   
   
4. While caring for the deceased body, utmost precautions are taken for the handling n disposal of the deceased body. The body should be washed properly, limbs are straightened and any kind of mechanical equipment and jewellery is removed. In case of wound, it is covered with a waterproof dressing and nurses take precautions to protect themselves from the blood and patient’s body fluid contact during, moving, handling and disposing of the body. The deceased body should be dressed in shroud or clothes with proper labeling and wrapping in a sheet (Moriarty et al., 2015).
   
   
5. Enrolled nurse can support and comfort the grieving family by bonding themselves with the family and providing them moral support. This can be done by optimizing their interaction with the family through empathetic communication and sensitive to the family concerns. They can also enhance their comfort to the grieving family by understanding their needs and acknowledging their devastating loss. They can also provide continued moral support through resource information about bereavement groups and understandable communication and caring for the grieving family (Ruth Jacob et al., 2013).

References

Alzheimer’s, A. (2015). 2015 Alzheimer's disease facts and figures. Alzheimer's & dementia: the journal of the Alzheimer's Association, 11(3), 332.

Bauer, C. M., Gröger, I., Rupprecht, R., Marcar, V. L., & Gaßmann, K. G. (2016). Prediction of future falls in a community dwelling older adult population using instrumented balance and gait analysis. Zeitschrift für Gerontologie und Geriatrie, 49(3), 232-236.

Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based education to'flip'the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing, The, 33(2), 29.

Giebel, C. M., Sutcliffe, C., & Challis, D. (2015). Activities of daily living and quality of life across different stages of dementia: a UK study. Aging & mental health, 19(1), 63-71.

Gil Montoya, J. A., Ferreira de Mello, A. L., Barrios, L., González Moles, M. Á., & Bravo Pérez, M. (2015). Oral health in the elderly patient and its impact on general well-being: a nonsystematic review.

Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P. (2013). The clinical assessment interview for negative symptoms (CAINS): final development and validation. American Journal of Psychiatry, 170(2), 165-172.

Larsen, A. L., McArdle, J. J., Robertson, T., & Dunton, G. (2015). Four dietary items of the School Physical Activity and nutrition (SPAN) questionnaire form a robust latent variable measuring healthy eating patterns. Journal of nutrition education and behavior, 47(3), 253-258.

Lawn, S., & McMahon, J. (2015). Experiences of family carers of people diagnosed with borderline personality disorder. Journal of psychiatric and mental health nursing, 22(4), 234-243.

McMillan, S. S., Wheeler, A. J., Sav, A., King, M. A., & Kelly, F. (2017). Caring for carers in community pharmacy. Research in Social and Administrative Pharmacy, 13(1), 254-256.

Moriarty, J., Maguire, A., O’Reilly, D., & McCann, M. (2015). Bereavement after informal caregiving: assessing mental health burden using linked population data. American journal of public health, 105(8), 1630-1637.

Muskett, C. (2014). Trauma?informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23(1), 51-59.

Rahman, A., Hasan, R. M., Agarwala, R., Martin, C., Day, A. G., & Heyland, D. K. (2016). Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool. Clinical Nutrition, 35(1), 158-162.

Ruth Jacob, E., Barnett, A., Sellick, K., & McKenna, L. (2013). Scope of practice for Australian enrolled nurses: Evolution and practice issues. Contemporary nurse, 45(2), 155-163.

Ryu, M., Izumi, S., Ueda, T., Oda, S., & Sakurai, K. (2015). Association between frequency of oral and denture cleaning and personality in edentulous older adults. Geriatrics & gerontology international, 15(12), 1258-1263.

Saha, S., Hatch, D. J., Hayden, K. M., Steffens, D. C., & Potter, G. G. (2016). Appetite and weight loss symptoms in late-life depression predict dementia outcomes. The American Journal of Geriatric Psychiatry, 24(10), 870-878.

Williams, E. D., Eastwood, S. V., Tillin, T., Hughes, A. D., & Chaturvedi, N. (2014). The effects of weight and physical activity change over 20 years on later-life objective and self-reported disability. International journal of epidemiology, 43(3), 856-865.