QuestionCase Study 5 – EdithEdith, an 89-year-old widow, had recently been admitted to the dementia unit of a residential aged-care facility. Edith has been admitted because she was found wandering aimlessly around her 1,000 hectare property west of Bourke, with no idea of who or where she was. It was obvious from her disheveled appearance that Edith had been outside for a number of days, and that she was no longer able to look after herself.Her past history was obtained from the members of her local community. Edith had been born, raised, and married in this community, and had lived there all her life. She had been the only girl in a family of 14 children. Her father had been a farmer and her mother had died following childbirth when Edith was nine years old. Because she was the only female, she was expected to take on her mother’s role and look after the family. She had received no formal education and was illiterate.Edith had married George, a cattle farmer, when she was 17 years of age. She had given birth to six children, who had all predeceased her. Throughout her adult life she had worked to subsidise the farm. During the day she had worked at the local shop, and in the evenings she had served behind the bar at the local pub. George had died when Edith was 56 years old.On admission to the Fitzroy Falls Aged-Care Facility, Edith’s medical diagnoses were listed as:Korsakoff’s syndrome;Congestive cardiac failure;Osteoarthritis;Traumatic amputation of the first three fingers of her right hand (three years previously);Total deafness in the right ear, and limited hearing in the left ear;Infected sores on both of her lower legs;Dehydration and malnutrition; andIncontinence of urineAfter examination and assessment the following data were identified;Weight 46kgs; height 174cms;Mucous membrane pale; skin turgor markedly decreased;27 suppurating lesions on the lower legs (infected insect bites);Hearing severely impaired; no hearing aid;Vision not impaired when wearing spectacles;Incontinent of urine only early in the morning;Constant pain in knees, elbows, fingers, and back;Unable to button clothes or hold cutlery;Refused all food and frequently stated: “I’m not eating that muck”;When offered fluids, stated: “I want a real drink”; andContinually wandered and tried to abscond, stating that she ‘needed to get home to feed the cattle and dogs’.To develop the care plan for Edith you need to analyse the collected data and place a priority rating on each issue requiring intervention.The most important issue should be placed first in the care plan, followed by the next most important, then the third, fourth, fifth and so on until all issues are placed in descending order of importance If each issue is placed on a separate page, the order of priority can readily be changed to reflect revised assessments.Using the information you develop here use a blank proforma from the Care plans from the Fitzroy Falls Aged Care Facility, next page, and fill in the details – keep this care plan as part of your ongoing assessment. Table 1: Care PlanName: Date of birth:Address: Contact no:Doctor: Doctor’s contact no:Medicare no: Pension no: CommunicationPreferred name: Care needs: Goal: Vision HearingAids glasses magnifying glassesClean and fit glasses dailyAble to clean own glasses Aids hearing aids ( right left )Adjust volume dailyCheck batteries and clean aids daily Place objects in range of visionRead aloud – letters/documentsAssist to writeAssist to use telephone Gain attention before speakingSpeak loudly, clearly and directlyAllow extra time for responseGive step-by-step instructionsUse repetition when difficulty persistsOther OtherEye care required Ear care required Speech and language Comprehension issues (For example: inappropriate responses) Language/s spoken English Short term memory lossOrientate to correct time Speech disorder/s Translate for care recipientTake time to listenInitiate conversationUse language cardsUse picture cards Other Mobility Care needs: Goal: Ambulation (walking) Transfers ambulant (able to walk)non-ambulant (unable to walk) independent weight bearing (able to stand) non-weight bearing (unable to stand)1-staff assist 2-staff assisthip replacement knee replacementamputee ( left right ) Aids walking stick walking framewheelchair quad stickwheeled walker Aids bed rail slide sheet gait belthoist standing hoistHoist sling type and position of loop Other Other Provide directionSupervise movementEncourage to maintain mobility Other Toileting and continenceCare needs: Goal: ContinenceBladder control continent incontinent catheter (occasionally frequently total incontinence )Bladder management Toilet (times )Other Bowel control continent incontinent constipation colostomy ( occasionally frequently total incontinence )Bowel management high fibre diet encourage fluid intake aperients bowel chartContinence aids Day Night ToiletingToileting aids commode urinal uridome kylie bed panover-toilet frame Other Toileting regime independent supervise some assistance/prompt fully assistAdjust clothing Position on toilet Encourage self care Clean perianal areaOtherShowering, dressing and groomingCare needs: Goal: Shower and washing independent supervise some assistance/prompt fully assistshower bath bed sponge flannel washFrequency Preferred time Adjust water temperature Encourage to optimise self careOtherTransfer walk to shower wheelchair OtherShowering aids shower chair Other Toiletries normal soap deodorant aqueous cream moisturiser ( am pm )OtherHair care wash in shower wash in bath Preferred days GroomingHair care independent supervise some assistance/prompt fully assistHairdresser Facial hair wet shave dry shave FrequencyHair removal FrequencyNail/foot care independent supervise some assistance/prompt fully assistPodiatry visits Teeth none some ( upper lower ) allCleaning routine Dentures none partial full ( upper lower ) Night in outCleaning routineDressing and undressing independent supervise some assistance/prompt fully assistcallipers splints OtherCultural dressing Dressing assistance bra singlet buttons belt zipsstockings socks jewellery make-up shoesAssist with selecting clothing Other Pressure area and skin careCare needs: NilGoal: (expected outcome) Norton Scale Score [ x ] low risk [ ] medium risk [ ] high riskPressure relief aids bed cradle sheepskin cushion bedrail/protectors OtherPressure area regime Reposition in bed Reposition in chair Frequencyspecial mattress (type ) personal chairOther/specific ordersSkin care emollient cream to dry skin areas ( daily twice daily ) Eating and drinkingCare needs: Goal: Eating independent supervise some assistance/prompt fully assistright-handed left-handedPreferred place to eat dining room bedroom Other KitchenType of diet normal soft modified soft (minced) pureeSpecial diet high fibre diabetic enteral feeding (PEG/NGT)Special instructions Aids modified crockery modified cutlery bowl lipped platebuilt up cutlery clothing protector OtherDrinking independent supervise some assistance/prompt fully assistright-handed left-handed Aids modified cup clothing protectorThickened fluids level 1 level 2 level 3Type of thickener to be used Sleep and settling routinesCare needs: Goal: Usual time to rise Usual time to bed Rest time ( am pm )Preferred sleeping position Pillows required Sleep Aids massage music hot packs OtherRoom light on door open door closed bedrail/protectors OtherNight-time patterns Other preferences (For example: hot drinks or snacks) Night checks every hour every 2 hours OtherMedicationsCurrent medications eye drops ear drops Other See list of medications independent supervise some assistance/prompt fully assistpre-packed measure self-administerBlood sugar level testing independent supervise some assistance/prompt fully assistFrequencySpecialised care plansRefer to specialised care plans for [x ] Medications [ ] Pain management [ ] Wound care [ ] Therapy [ ] Restraint managementWHS Completed injury risk assessment forms Home environment Yes NoClient assessment Yes No Social and human needs/activitiesCare needs:Goal: (expected outcome) Frequency of visit/contact by family/friends Religion beliefs/practices Pastoral requirements Attends place of worship (day/s )Cultural needs Hobbies/interests Employment history Pets Name/s Type/s client manages pet requires prompt and assistance in pet care fully assist pet careSocial group/s Preferred activity/games Community care social outings (Frequency: )RequirementsTaxi vouchers Yes NoDomestic needs/activities independent supervise some assistance/prompt fully assist Frequency ( daily every 2nd day weekly fortnightly Other ) Requirements ShoppingWashing clothesCleaningCookingTransportGardeningOther Emotional support BehaviourCare needs: Goal: Additional comments (For example: special needs, restraint, routines, pain, palliative care, pacemaker) Terminal care recorded Yes NoDate care plan evaluated (document in progress notes) Signature Fitzroy Falls Aged Care Facility use onlyEntered in progress notes DateSigned Print Name Position title Review date Health ScienceScienceNursingCHC 33015Share Question
QuestionCase Study 5 – EdithEdith, an 89-year-old widow, had recently been admitted to the dementia unit of a residential aged-care facility. Edith has been admitted because she was found wandering aimlessly around her 1,000 hectare property west of Bourke, with no idea of who or where she was. It was obvious from her disheveled appearance that Edith had been outside for a number of days, and that she was no longer able to look after herself.Her past history was obtained from the members of her local community. Edith had been born, raised, and married in this community, and had lived there all her life. She had been the only girl in a family of 14 children. Her father had been a farmer and her mother had died following childbirth when Edith was nine years old. Because she was the only female, she was expected to take on her mother’s role and look after the family. She had received no formal education and was illiterate.Edith had married George, a cattle farmer, when she was 17 years of age. She had given birth to six children, who had all predeceased her. Throughout her adult life she had worked to subsidise the farm. During the day she had worked at the local shop, and in the evenings she had served behind the bar at the local pub. George had died when Edith was 56 years old.On admission to the Fitzroy Falls Aged-Care Facility, Edith’s medical diagnoses were listed as:Korsakoff’s syndrome;Congestive cardiac failure;Osteoarthritis;Traumatic amputation of the first three fingers of her right hand (three years previously);Total deafness in the right ear, and limited hearing in the left ear;Infected sores on both of her lower legs;Dehydration and malnutrition; andIncontinence of urineAfter examination and assessment the following data were identified;Weight 46kgs; height 174cms;Mucous membrane pale; skin turgor markedly decreased;27 suppurating lesions on the lower legs (infected insect bites);Hearing severely impaired; no hearing aid;Vision not impaired when wearing spectacles;Incontinent of urine only early in the morning;Constant pain in knees, elbows, fingers, and back;Unable to button clothes or hold cutlery;Refused all food and frequently stated: “I’m not eating that muck”;When offered fluids, stated: “I want a real drink”; andContinually wandered and tried to abscond, stating that she ‘needed to get home to feed the cattle and dogs’.To develop the care plan for Edith you need to analyse the collected data and place a priority rating on each issue requiring intervention.The most important issue should be placed first in the care plan, followed by the next most important, then the third, fourth, fifth and so on until all issues are placed in descending order of importance If each issue is placed on a separate page, the order of priority can readily be changed to reflect revised assessments.Using the information you develop here use a blank proforma from the Care plans from the Fitzroy Falls Aged Care Facility, next page, and fill in the details – keep this care plan as part of your ongoing assessment. Table 1: Care PlanName: Date of birth:Address: Contact no:Doctor: Doctor’s contact no:Medicare no: Pension no: CommunicationPreferred name: Care needs: Goal: Vision HearingAids glasses magnifying glassesClean and fit glasses dailyAble to clean own glasses Aids hearing aids ( right left )Adjust volume dailyCheck batteries and clean aids daily Place objects in range of visionRead aloud – letters/documentsAssist to writeAssist to use telephone Gain attention before speakingSpeak loudly, clearly and directlyAllow extra time for responseGive step-by-step instructionsUse repetition when difficulty persistsOther OtherEye care required Ear care required Speech and language Comprehension issues (For example: inappropriate responses) Language/s spoken English Short term memory lossOrientate to correct time Speech disorder/s Translate for care recipientTake time to listenInitiate conversationUse language cardsUse picture cards Other Mobility Care needs: Goal: Ambulation (walking) Transfers ambulant (able to walk)non-ambulant (unable to walk) independent weight bearing (able to stand) non-weight bearing (unable to stand)1-staff assist 2-staff assisthip replacement knee replacementamputee ( left right ) Aids walking stick walking framewheelchair quad stickwheeled walker Aids bed rail slide sheet gait belthoist standing hoistHoist sling type and position of loop Other Other Provide directionSupervise movementEncourage to maintain mobility Other Toileting and continenceCare needs: Goal: ContinenceBladder control continent incontinent catheter (occasionally frequently total incontinence )Bladder management Toilet (times )Other Bowel control continent incontinent constipation colostomy ( occasionally frequently total incontinence )Bowel management high fibre diet encourage fluid intake aperients bowel chartContinence aids Day Night ToiletingToileting aids commode urinal uridome kylie bed panover-toilet frame Other Toileting regime independent supervise some assistance/prompt fully assistAdjust clothing Position on toilet Encourage self care Clean perianal areaOtherShowering, dressing and groomingCare needs: Goal: Shower and washing independent supervise some assistance/prompt fully assistshower bath bed sponge flannel washFrequency Preferred time Adjust water temperature Encourage to optimise self careOtherTransfer walk to shower wheelchair OtherShowering aids shower chair Other Toiletries normal soap deodorant aqueous cream moisturiser ( am pm )OtherHair care wash in shower wash in bath Preferred days GroomingHair care independent supervise some assistance/prompt fully assistHairdresser Facial hair wet shave dry shave FrequencyHair removal FrequencyNail/foot care independent supervise some assistance/prompt fully assistPodiatry visits Teeth none some ( upper lower ) allCleaning routine Dentures none partial full ( upper lower ) Night in outCleaning routineDressing and undressing independent supervise some assistance/prompt fully assistcallipers splints OtherCultural dressing Dressing assistance bra singlet buttons belt zipsstockings socks jewellery make-up shoesAssist with selecting clothing Other Pressure area and skin careCare needs: NilGoal: (expected outcome) Norton Scale Score [ x ] low risk [ ] medium risk [ ] high riskPressure relief aids bed cradle sheepskin cushion bedrail/protectors OtherPressure area regime Reposition in bed Reposition in chair Frequencyspecial mattress (type ) personal chairOther/specific ordersSkin care emollient cream to dry skin areas ( daily twice daily ) Eating and drinkingCare needs: Goal: Eating independent supervise some assistance/prompt fully assistright-handed left-handedPreferred place to eat dining room bedroom Other KitchenType of diet normal soft modified soft (minced) pureeSpecial diet high fibre diabetic enteral feeding (PEG/NGT)Special instructions Aids modified crockery modified cutlery bowl lipped platebuilt up cutlery clothing protector OtherDrinking independent supervise some assistance/prompt fully assistright-handed left-handed Aids modified cup clothing protectorThickened fluids level 1 level 2 level 3Type of thickener to be used Sleep and settling routinesCare needs: Goal: Usual time to rise Usual time to bed Rest time ( am pm )Preferred sleeping position Pillows required Sleep Aids massage music hot packs OtherRoom light on door open door closed bedrail/protectors OtherNight-time patterns Other preferences (For example: hot drinks or snacks) Night checks every hour every 2 hours OtherMedicationsCurrent medications eye drops ear drops Other See list of medications independent supervise some assistance/prompt fully assistpre-packed measure self-administerBlood sugar level testing independent supervise some assistance/prompt fully assistFrequencySpecialised care plansRefer to specialised care plans for [x ] Medications [ ] Pain management [ ] Wound care [ ] Therapy [ ] Restraint managementWHS Completed injury risk assessment forms Home environment Yes NoClient assessment Yes No Social and human needs/activitiesCare needs:Goal: (expected outcome) Frequency of visit/contact by family/friends Religion beliefs/practices Pastoral requirements Attends place of worship (day/s )Cultural needs Hobbies/interests Employment history Pets Name/s Type/s client manages pet requires prompt and assistance in pet care fully assist pet careSocial group/s Preferred activity/games Community care social outings (Frequency: )RequirementsTaxi vouchers Yes NoDomestic needs/activities independent supervise some assistance/prompt fully assist Frequency ( daily every 2nd day weekly fortnightly Other ) Requirements ShoppingWashing clothesCleaningCookingTransportGardeningOther Emotional support BehaviourCare needs: Goal: Additional comments (For example: special needs, restraint, routines, pain, palliative care, pacemaker) Terminal care recorded Yes NoDate care plan evaluated (document in progress notes) Signature Fitzroy Falls Aged Care Facility use onlyEntered in progress notes DateSigned Print Name Position title Review date Health ScienceScienceNursingCHC 33015Share Question
