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NUR 2102 Chronic Care Across The Lifespan B

tag 0 Download 5 Pages / 1,168 Words tag 01-02-2021

Question:

Case History:
 
Mrs Perkins is an Aboriginal Elder from the Giabal people at Cecil Plains. She is 77 years old (DOB 4/5/41) and lives with her husband, a daughter, son-in-law and 4 grandchildren. 
 
Mrs Perkins medical history includes: obesity (weight is 95kg), fungal skin infections, hypertension, chronic urinary tract infections (UTI’s), chronic kidney disease (CKD), sleep apnoea, osteoporosis and deteriorating mobility. 
 
She uses Continuous Positive Airway Pressure (CPAP) overnight and has done well at losing 30 kgs over the past year. She is an ex-smoker and follows an exercise routine.
 
Case Study Part A

She currently has an estimated Glomerular Filtration Rate (eGFR) of <15 mL/min/1.73m2 and is in end stage kidney stage disease. In consultation with her Nephrologist and family members she decided to commence on Continuous Ambulatory Peritoneal Dialysis (CAPD). She had surgery three months ago for the insertion of a Tenckhoff catheter. Her initial post-operative period was uneventful, with no reported complications. Her CAPD has been uneventful up to this point. Mrs Perkins was admitted through the emergency department yesterday with a 2 day history of vomiting and diarrhoea. She has been diagnosed with viral gastroenteritis
 
You have arrived on your rostered shift and are receiving bedside handover and you notice that Mrs Perkins is grimacing and unsettled. Her last recorded observations were: Alert and responsive, Temp 38.4, BP 155/78, HR 90bpm, RR22, SaO2 95% on room air, pain 4/10. She is dry retching and has had frequent explosive diarrhoea.
 
You will now prioritise the provision of care for Mrs Perkins throughout your shift. This may include medical history taking, documenting assessment for e.g. vital signs, pain assessment, administration of required medications, progress notes. Planning for discharge needs to be incorporated into this provision of care.
 
Case Study Part B

Mrs Perkins has been discharged home from USQ hospital following her recent admission for viral gastroenteritis. Her family continue to be very supportive, and assist with attending appointments, medication administration and diet. Until recently, Grace had been managing her fluid balance and weighing herself every morning at 6am. On a recent visit from the community nurse, Mrs Perkins discloses that her mother, who was 92 years old, has recently passed away. She reports this is causing her issues with her treatment. Conduct a focused assessment using the comprehensive health assessment documentation. Using the principles of motivational interviewing and selfmanagement, collaboratively develop a care plan including identification of concerns, goal setting using SMART goals, one short term and one long term goal including interventions to achieve the goals.

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