Question

Case Study: Name: Ms. Jenny Long DOB: 09/02/1951 New resident of Dementia Specific Unit, Westside Aged Care Facility Single, Under the Australian Guardianship and Administration Council protection Medical Background- Ischemic heart disease (IHD) since 2005, takes Nitro-glycerine patch, daily In 2011 - diagnosed with severe dementia - able to understand simple instructions only, confused and disorientated Osteoarthritis of both knees 20 yrs. Voltaren Gel to both knees BD Muscular weakness of both upper extremities Chronic constipation, takes Laxatives PRN No allergies to medication or food Increased appetite– usually eats full portion of offered meals x 3 times daily and, also, goes into other residents’ rooms and eats their food as bananas, biscuits or lollies Weight gain 10 kg over the last 5 months, current weight 106kg (BMI of 30) Diabetes mellitus (type 2) since 2000 – on a diabetic diet She feels very fatigued during activities of daily living Social History No friends Lack of interests, but likes colouring and watching TV High emotional dependence on nursing staff Non-smoker, no use of alcohol or illegal drugs You are an Enrolled Nurse at the Dementia Specific Unit. Using the information in the case notes complete care plan and questions for this client.

make a nursing care plan including : assessment, nursing diagnosis, nursing goals, nursing interventions, evaluation

1)

1. Provide details of how ongoing assessment of the patient/resident is maintained – e.g. observation, monitoring equipment and devices. What is the outcome of this?

2. Describe how you prioritise the patient/resident’s urgent needs with other work activities?

3. Explain how you handle any concerns about the patient/resident’s condition or behaviour. Who did you report these concerns to? Give example of policies in regards to this?

4. List the other team members you consulate and collaborate with in providing care to the patient/resident. Describe the outcomes of this collaboration?

5. Provide an evaluation of how the patient/resident progress towards their nursing goals outlined in the care plan after care was provided. What changes can be made to the nursing care plan after care was provided

Answer 1

Here in the present case, Mrs Jenny Long had a history of severe dementia, type 2 diabetes, diabetes and obesity. As a nurse, we have to provide sufficient and adequate care and as well as the patient is very emotionally attached to the nurses.

Here we can plan nursing care to the patient:

1. Disturbed Thought Process related to irreversible neuronal degeneration /dementia

2. Knowledge Deficit related to the diet plan.

3. Altered bowel elimination related to irregular eating patterns and effects of medication.

1. Disturbed thought process related to irreversible neuronal degeneration/dementia

Nursing Assessment:

- Changes in cognitive and psychosocial function
- Changes in mental status
- Changes in functional abilities
Goals/Expected outcomes:

- Maintain functional ability as long as possible.
- Maintain a safe environment
- Personal care needs to be met
- Dignity maintained

Nursing Interventions:

-Create a quiet, calm environment
- Maximize exposure to daylight
- The nurse should inform patients and family regarding early warning signs
- Memory aids such as calendars may provide benefit
- Drugs must be taken regularly
- Assess for depression
- Counselling as needed to family members

-Assess family members and their ability to cope and accept the diagnosis
- Ongoing monitoring important
- Work in collaboration with the patient's caregiver
- Teach caregiver how to manage care

Evaluation:

The patient is trying to realize the reality and her memory loss and coping with the present situation.

2.  Knowledge Deficit related to the diet plan.

Nursing Assessment:

*Chronic constipation

*Acute weight gain

*Obesity

Goals:

-Maintain a reasonable body weight (weight loss of 10% can significantly improve blood glucose levels)
-Control of blood glucose levels
-Normalization of BP and lipid levels

Nursing Interventions:

-Monitor the glucose level intermittently

-Encourage the patient to do small exercises

-Calorie-controlled diets (50-60% from carbs, 20-30% from fats, 10-20% from protein)
-Carb-counting
-Adequate meal planning

-Administer the medications as prescribed

Evaluation:

The patient achieved a weight loss of 3% in a month with reasonable blood glucose levels.

3. Altered bowel elimination related to irregular eating patterns and effects of medication

Nursing assessment:

*constipation

*weight gain

*Tender abdomen on palpation

*Straining while passing stool

*Hypoactive bowel sounds on auscultation.

Goals:

-Maintaining normal elimination patterns
-Returning to previous levels of function
-Preventing risks associated with specific alterations

Nursing Interventions:

- Encourage adequate fluid intake
-Plan the meal with adequate fibre
-Rule out the actual reason for constipation

-Encourage the physical activity of the patient

Administer laxatives as needed.

Evaluation:

The patients report a strain-free bowel elimination and no tenderness over the abdomen while palpating.

The patient is getting adequate treatment and needs according to the plan, meanwhile, the patient is feeling and looking better than the previous and taking the medications as prescribed.

In case any concerns arise related to the treatment and other needs of the patient we have to inform it to the concerned physician in time.

The concern is informed through the proper channel and take the necessary action as per patient safety act.

All the medical professionals including the doctors, nurses, physical therapist, psychotherapist, counsellors, lab technicians have to collaborate and work as a team for a sufficient outcome.

In case after the care was provided to the patient according to the care plan if the condition is improving or not improving. if needed, we have to improve the care plan according to the patient present needs.