Clinical Scenario You are working in a community clinic as a…
Question Clinical Scenario You are working in a community clinic as a… Clinical ScenarioYou are working in a community clinic as a registered nurse. Your next patient is Ms Florence ‘Flo’ Ljukuta and Lionel’s husband. Flo is 70 years old, and Lionel is 84 years old. Flo is the primary carer for her husband, who has physical disabilities due to a stroke and was recently diagnosed with dementia. Flo would typically attend the clinic regularly, but you notice in her records she has not presented in nearly 12 months. The last entry on the eHealth record is a hospital visit due to a fall last year.When Flo and Lionel arrive, you notice that Flo is limping, and they both appear underweight. You also see Flo and Lionel looking untidy, wearing clothes that appear to be dirty, which is very unusual for them. You read Flo and Lionel’s medical files and identify no services currently linked to them, and Flo is looking after a lot of family in her house.When you ask Flo, what has brought her in, Flo tells you she has a wound on her right foot, which she has been dressing at home for three months, but it is not getting better. Flo tells you she hasn’t seen a doctor about her foot earlier because it was only a tiny wound and she didn’t want to trouble anyone. Flo also stated that because she doesn’t drive, she finds it challenging to catch public transport with Lionel. She can’t leave him at home because he sometimes becomes agitated, plus the children are so busy looking after the little ones she doesn’t want to bother them.Patient profile Presenting complaint History of complaint: Florence ‘Flo’ Ljukuta, 70-year-old female from Alice Springs, Diabetic foot woundPhx: Hypertension, Type 2 diabetes, Angina, Hypercholesteremia, Asthma, Osteoarthritis. Complete hysterectomy 30years ago for treatment of endometrial cancer.Allergies: Nil Known AllergiesAssessment data: Small wound appeared over 3months ago; I am unsure what caused it. I was applying pawpaw ointment and dry dressing every few days. Medications : Aspirin 100mg manePerindopril 2mg maneMetformin XR 2g maneGTN 600mcg tablets S/L prnOsteo paracetamol 1330mg TDSCodeine 60mg QLD as required for acute painAtorvastatin 40mg maneSalbutamol inhaler 2-4 puffs PRN Ethnicity/language: Aboriginal. Speaks Waramungu, Walpiri, Eastern and Western Arrentre, EnglishAlcohol uses Tobacco use: Few wines or beers with family and friends 3-4 times per week. Smoker 1⁄2 packet per day/ whole family smokes. Regular exposure to the campfire and passive smokeDrug use: NilWork environment: Retired 10 years. Previously a manager of a community health clinic.Education: VET level certificateEconomic status: Family land and house in the remote community but staying in town to be with children and support needs for husbandReligion/spirituality: Baptised Catholic by missionaries when youngADLs: IndependentIADLs: Does not drive anymore due to decreased vision (diabetic retinopathy). They are starting to develop cataracts. I had glasses a few years ago, but they don’t help much now.Cognitive function: No concerns identifiedDiet: Diabetic diet when ableSleep: 5-6 hours a night, broken sleep. He gets up several times to assist Lionel with toileting. He falls asleep in the chair whilst watching TV most evenings.Health checkups: The last checkup was 11months agoVital signs : Temp 36.8oC, HR 84bpm regular, Resp 24, SpO2 93% RA, BP 145/80, BGL 11.0 mmols/L, Pain 6 out of 10 Stress: Currently eldest daughter is receiving treatment for breast cancer. States she is doing very well. Teenage boys have been a little naughty – two are heading to boarding school soon. The eldest son works in the mines ‘FIFO’, which helps financially. Neurovascular: Bilateral feet appear standard colour, cool to touch, cap refill >3sec, Pedal pulse diminished bilaterally, Numb sensation, Weak strength but a full range of movement. Skin to heels very dry and cracked. Question 2: Medication management (recommend 750words)The older person is vulnerable to adverse drug events. Examining Flo’s medication history, answer the following questions.Identify and describe three (3) factors in the case study which increase the risk of an adverse drug eventChoose TWO (2) medications and describe:what is the indication for each prescription?any potential complications that Flo may experience while taking this medicationTo minimise adverse drug events, you would implement two (2) nursing actions or health promotions. Health Science Science Nursing NUR MISC Share QuestionEmailCopy link Comments (0)
