Question

Mr. Bennet is 60 years old. He teaches grade 5 and loves working with his students. He was diagnosed with MS at 30 years old, after many years of having symptoms. He has primary progressive MS. He enjoys teaching and hopes he will be able to continue to work in his chosen career until retirement. He is also married and has 4 young grandchildren. He is a hands-on Grandpa. He enjoys reading to his grandchildren and helping them with their homework.

Mr. Bennet has started to notice that he has some cognitive changes that are starting to occur more often. It is getting harder to pick the right word when he is talking in front of the class. This is made worse by the fatigue that hits him often halfway through the school day. He is finding that his concentration isn’t as good as it was and sometimes it is hard to stay on track during his lessons. At night he is starting to notice that his muscles are very rigid (tight like cement) and this makes it very hard to get to sleep. He no longer sleeps with his wife at night because his stiffness makes him very restless, which keeps his wife up. He is having a hard time dealing with this and the associated pain that his tight muscles are causing. His doctor explained this symptom as spasticity which is very common in people with MS. He lives in a 2-story house that he and his wife bought when they were young. The house is paid for and he has been dealing with foot drop (he drags one foot) since he had his last exacerbation (flare up) from MS. He is doing better at lifting his foot, but you can still tell there is a slight dragging of his left foot and occasionally has falls. His wife has talked about getting a chair lift (a lift that he sits down on to carry him up the stairs) installed to help Mr. Bennet on those days when he is very fatigued and he is unable to walk properly. His doctor has also talked to Mr. Bennet about getting a power wheelchair to help conserve his energy for the work that he loves so much and start doing some stretching. He has been on baclofen for the muscle spasticity for a few years and finds that the tightness is getting worse. He is also dealing with congestive heart failure, taking methyldopa for his blood pressure as well as warfarin and requires help putting on his compression stockings. His finger tips have pins and needles (paresthesia) which is making it hard for him to use his hands and he just doesn’t have the strength to get them on. He is starting to need assistance with dressing most days and his wife is dealing with her own medical problems. Mr. Bennet expressed that he is having a hard time dealing with all the changes and feels like he is a burden right now.

His goals of care are to remain as independent as possible, continue to teach, to get some cognitive therapy to help with the cognitive decline. He also requires PSWs to help him with bathing because he is quite unsteady in the shower, and the combination of baclofen as well as heat causes him to be very fatigued halfway through his shower. He has been falling in the shower and his doctor as well as his wife feels he needs some extra help. He also requires stretching exercises to decrease his muscle tightness.

1) After reading the above scenario, how could the PSW (you) physically and emotionally help Mr. Bennet? (3 marks)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2) What is the information you would need before starting his care? Think of the things that would be important to know before starting care with him. (2 marks) ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3) What would you expect to see in his care plan? (2 marks) ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4) In the following problem, explain briefly the feelings expressed by Mr. Bennet and the actions that you as the PSW would take. (2 marks each)

Situation 1: Recently his physiotherapist (PT) left some exercises for him to complete daily. The PT has trained the PSWs on the stretches Mr. Bennett needs to complete. Mr. Bennet gets very upset about halfway through his exercises when you help with his stretches. He has told you that the stretches are hard for him to do and cause him pain.

a) What are some of the emotions that Mr. Bennet is feeling right now? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) What would the PSW’s actions be to help Mr. Bennet? (Physical and Emotional) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Situation #2: You haven’t seen Mr. Bennet in about a month. Your supervisor mentioned that he has been having a hard time with his health lately. He is recovering from another exacerbation and he requires a lot more help now. He is needing a sit to stand lift now to get up from bed and use the toilet. When you see Mr. Bennet he says to you “That he doesn’t want to keep living if this is what he has to look forward to. He says “He feels like he is a burden to his family.”

a) What is Mr. Bennet’s feelings right now? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) What is the PSW’s actions now? (Physical and emotional) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Situation # 3: Mr. Bennet is recovering from his last exacerbation and you notice that while his

abilities have improved his cognitive abilities are getting worse. He is having a harder time talking, his

pain has increased and he requires more sleep when you see him. He tells you that when his pain is

this high he has to pace his activities. His pain management doesn’t seem to be enough. His face is

grimacing each time you touch him to help him get dressed or put his compression stockings on. He

isn’t leaving his house much right now because he has told you his pain is making him feel physically

ill.

a) How is Mr. Bennet feeling right now? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) What would the PSW’s actions? (Physical and emotional) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Using all of the above information, describe the above factors that might affect Mr. Bennet from being able to be independent and allowing him to return to work for his last 5 years before retirement. Use all of the information you have in the scenario and the situations to form your answers. MS is an autoimmune disease that attacks the myelin on the axons (nerve cells) in the brain. It is a progressive disease that gets worse over time. Each individual will experience the disease differently. (6 marks)

a) Age ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Individual characteristics ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) Environment ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Describe 5 ways that the PSW can help improve his motivation and quality of life during his daily activities. (5 marks)

a) ____________________________________________________________________________________________________________________________________________________________

b) ____________________________________________________________________________________________________________________________________________________________

c) ____________________________________________________________________________________________________________________________________________________________

d) ____________________________________________________________________________________________________________________________________________________________

e) ____________________________________________________________________________________________________________________________________________________________

Answer 1

1) PSW could physically and emotionally help Mr. Bennet. He could provide him physical support in Mr. Bennet's daily activities like feeding, bathing, toileting, dressing, etc. Moreover, PSW could also provide him emotional support and comfort, relieve loneliness, and promote his self respect and independence.

2) As a PSW, the information required before starting Mr. Bennet's care are :-

• Nature and type of Mr. Bennet's disease.
• Personality of Mr. Bennet.
• Difficulties faced by Mr. Bennet by the disease.
• His mental state.
• Types of medicines taken by him.
• His family background.

3) I would expect to see some positive impact on his health during his care plan. I would expect him to be cooperative and comfortable with me during the care plan.

4)

Situation 1

a) Right now, Mr. Bennet is feeling upset and suffers from pain during the exercise. He is feeling uncomfortable and anxious.

b) As a PSW, i would try to help him to carry out his exercise effectively with negligible amount of pain. I would encourage him and try to make him comfortable.

Situation 2

a) Right now, Mr. Bennet is feeling very anxious, sad and hopeless. He has negative thoughts in his mind. He requires more help now.

b) As a PSW, i would try to encourage him, remove his loneliness and give him some hope. I would help him in getting up from bed and toileting along with other daily activities.

Situation 3

a) Right now, Mr. Bennet is feeling uneasiness and more pain. He feels uncomfortable due to increase pain when PSW tries to help him in dressing.

b) As a PSW, i would try to encourage him and try to make him feel relaxed. I would try to help him in his daily routine activities.

5)

5 ways that the PSW can help to improve Mr Bennet's motivation and quality of life during his daily activities are :-

• Encourage and promote Mr. Bennet's self respect and independence.
• Help in daily routine activities like dressing, feeding, bathing, toileting, etc.
• Implementing care plan interventions.
• Providing companionship and social engagement.
• Help in locomotion and movement.

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