HLTENN045 - Implement and monitor care of the older person

Assignment Task 

PART A

Mrs Walker is a 72-year-old lady who lives alone and until recently was in her own home with a care package.

Mrs Walker has a diagnosis of Alzheimer’s dementia (4 months) and has deteriorated both physically and mentally over the last 8 weeks, she habitually paces up and down even though she has very poor balance and appears very pale and tired.

Mrs Walker has been deemed to have ‘lost capacity’ by her Psychogeriatrician and the Enduring Power of Attorney has been enacted.

Mrs Walker’s family and the health team caring for her have all agreed that she is a danger to herself and others, a decision has been made to place her in a residential facility within a secure environment.

Mrs Walker has had to be physically escorted into the residential facility and is very distressed.

Mrs Walker has a severe contracture of her right hand caused by burns received in her kitchen 11 months ago, and her noncompliance with physiotherapy has rendered that hand unusable.

Mrs Walker weighed 62kgs a year ago, today she weighs 34.5kgs. Her family advise you that she is refusing to eat and that they often find Mrs Walker’s ill-fitting dentures in bizarre places around the house, they tell you that Mrs Walker is still drinking plenty.

• You are the nurse receiving Mrs Walker and as such, you will need to complete a health assessment. Discuss four (4) sources that you might access to retrieve information about Mrs. Walkers past medical history. (50 words)

• In detail, describe what the interview stage of a health assessment is. (50 words)

• Discuss why assessment tools specific to the older person are important and name three you would consider using for Mrs Walker. (50 words)

• You are concerned about Mrs Walker who seems very anxious and emotional. You have tried various types of communication; however, Mrs Walker is not engaging, and her family are Identify the person you would immediately discuss your concerns with, stating what communication techniques you may have tried, what name a relevant assessment tool you could use. (50 words)

• Identify and provide a brief explanation of the Standard for the Enrolled Nurse which relates to decision making and provision of care.

• Define what a physical, chemical, and psychological restraint is and describe who is ultimately responsible for authorising their use. (75 words)

• Mrs Walker has a mechanical restraint in place due to being in a locked environment, what are your obligations now it is in place? (50 words)

• You are unable to weigh Mrs Walker as she is not compliant. Discuss in detail at least four (4) possible reasons relating to dementia, for Mrs Walkers weight loss.(Please note that it is not acceptable to produce a list without detailing giving reasons) (100 words)

• Discuss how Mrs Walker’s physical disability may be a contributing factor to her weight loss.(50 words)

• Discuss the three (3) health professionals Mrs Walker may be referred to for her weight loss.(50 words) With her daughter’s help, you are finally able to get Mrs Walker to sit down and have a drink. You decide to try and take the opportunity to complete an oral assessment.Create a detailed list with four (4) examples of how poor oral care can contribute to poor general health in the older person. Include in your answer signs and symptoms that may be evident when performing an oral assessment. (100 words)

• You check Mrs Walker’s dentures which are chipped and stained and look too big. The daughter asks you the best way to care for dentures. Discuss in detail what you will tell Mrs Walker’s daughter. (150 words)

• Mrs Walker is unsteady on her feet. Discuss what type of relevant assessment you might refer Mrs Walker for and who might undertake this. Given one example of this type of assessment.(50 words)

• You are discussing the diagnosis of Alzheimer’s disease with Mrs Walker’s son; he tells you he doesn’t understand what dementia means and asks you if there is a cure.Provide a definition of dementia with reference to what Alzheimer’s disease is (150words)

• Mrs Walker is becoming aggressive and distressed, provide three (3) examples of what could cause these changes and how you as the nurse can assist?

• Mr Walker asks you if his mother will die soon, discuss the difference between palliative and end of life care (150 words)

• After 2 weeks of residing in the facility, Mrs Walker has not engaged in any activities and continues to pace the corridor, although not with the same level of anxiety. You discuss your concerns with the activity officer. What are three (3) types of therapies they may suggest for Mrs Walker? (150 words)

• Discuss the need for the Mrs Walker to feel as though her environment is both physically and emotionally safe (150 words)

• Explain each of the following:

  Mini mental

• Psychogeriatric assessment scale

• When you go in to wake Mrs Walker her sheets are wet and you realise she was incontinent overnight. Documentation shows this has been occurring more frequently and appears to be becoming a chronic issue
• Define urinary incontinence and explain three (3) different types in your answer. (75 words)

• Provide two (2) methods to assess a client for incontinence

• Provide two (2) nursing interventions that can be undertaken to identify possible causes and ways to improve Mrs Walker’s urinary incontinence. (Note: the answers do no relate to providing incontinence aids)

• Mrs Walker requires a wash. Explain the benefit of showering/bathing and what aspects the nurse can directly observe while assisting Mrs Walker in this. (50 words)

• Whilst you are showering Mrs Walker you notice a reddened area on her toes and a skin tear on her left arm.
• Describe one (1) assessment tool you would use to assess Mrs Walker’s pressure injury risk including how often it should be used. (50 words)
• Your physical assessment of Mrs Walker should include a review of her skin. Describe four (4) aspects that you would note and why. (100 words)

• Mrs Walker has been found wondering the halls of the facility at 2am. She has been incontinent and removed her pad and her clothes are wet. She is confused and has a large laceration on her right arm.

• Within your scope as a student, what are your actions and priorities of care, keeping in mind her safety is important

• PART B

  Complete the following short answer questions

• Explain the Carer’s Recognition Act 2010.

• What is the role of the Aged Care regulator
• Provide a brief description of each of the following:
  Advanced care directives 
• Aged Care Funding Instrument (ACFI)
• Aged Care Act
•  Aged Care Quality Standards
• Aged care quality & safety commission 

• Pain can be unrecognised and poorly managed which will impact an individuals’ quality of life. Using the following headings list two (2) barriers under each, that may prevent the client from informing you of pain.a) Social and/ or cultural diversity which may include the older persons’ attitude

• Cognitive and communication impairments

• Polypharmacy is a concern with the older client. What is polypharmacy and why is it prevalent in the older age group?

• Discuss four (4) age-related health impacts of polypharmacy (50 words)

• Why would the older client use primary health? Include in your answer one health care service, one counselling service and one support service that may be used by the older client or their carers/family.

• Considering the various theories of ageing, choose one and describe how you would use it in your practice as an EN. (100 words)

  The theories to select from include: biological theory, psychosocial theory, disengagement theory, social exchange theory, ‘wear and tear’ theory and activity theory.

• Explain the term ‘ageism’ and include one example of a stereotype commonly used

• From the list below explain how one (1) of these pathophysiological disorders could impact on Activities of Daily Living (ADL’s). (50 words)

• • Osteoarthritis,
  • Late-stage macular degeneration,
  • Loss of hearing,
  • Cerebrovascular accident (CVA

• Describe the normal changes of the ageing sexual response in both men and women.(50 words each)

• Describe five (5) ways elder abuse can present. Also include in your answer, five (5) signs that may indicate someone is being abused.

• You are caring for an elderly client who wears a hearing aid.How do you assess whether the hearing aid is working? Your answer should include cultural considerations.

• Choose one of the following sensory deficits: hearing, sight, tasting/ smell, and touch. What communication considerations do you need to think about with a client who has a sensory deficit?
• Provide two (2) examples of complementary therapies and provide two (2) areas of care they may assist with.
• Part of your role is to provide support and comfort for the grieving family or carer. Within your scope as an Enrolled Nurse, briefly explain two (2) ways you can achieve this.
• What organisational policies and procedures do you need to pay attention to when caring for a deceased client?

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