Mrs. Jane Jones Case Study - Dementia And Depression - Cognitive Behavior - Cholecystectomy - Psychology Assignment Help

Assignment Task

INTRODUCTION: Mrs. Jane Jones case study. Date of birth 5 July 1932. Address 336 Kensington road, Leabrook, Mrs. Jones has two other children who live with their families at Stonyfell and Tailem bend. Her husband passed away in June 2007. After her husband's death starts living with her son who provides her care and support with all daily activities.

SITUATION: Mrs. Jones is alert and orientated but experiences some memory loss and associated confusion which necessitates prompting and reminders with tasks such as social events. She has also experienced a functional decline over the past few years because of her medical conditions. She came into the facility from Queens Elizabeth Hospital and she was in the hospital due to a wound on her buttock (left side) which was 6.5 inches deep and healing with good results. She came into a facility for her wound management and receive care for herself because she cannot look after her self at home. She is a permanent resident.

BACKGROUND: She has Osteoarthritis- left knee, Spine causing severe pain to back, arms and shoulders, Spinal Stenosis, Reduced range of mention and strength to bilateral arm. She also has Osteoporosis, Vitamin D deficiencies, Osteopenia, Fracture to left Radis, chronic obstructive pulmonary disease (COPD), Asthma, breast cancer(L), unstageable wound to left buttock, she also has Bronchiectasis, Undiagnosed diarrhea, Urinary retention.
Surgical PHx: Cholecystectomy
Psychiatric: Dementia and Depression
Implant: Pacemaker
Allergies: Lipitor- increase LFTs
Morphine- cause confusion
Terbutaline- unknown
Social History: Pensioner, lives with son, the husband passed away 2007, non-smoker.

COGNITIVE: she is alert and oriented but gets confused very easily because of her dementia. Her Cornell scale was 15 which she has dementia.

Behavior: she is a well-behaving lady but got agitated while talking to others.
Selfcare: she is double assist because of her functional decline and needs assistance with her routine activities. Her nutrition 3/7 intake charts commenced from 7/11.
Transfer and Mobility: Require assistance with mobility and transfer.
Vision: using glass for clear vision.
Hearing: No hearing impairment.
Communication: got confused while talking need direction and support to remember things.
Elimination: regular pad checks to prevent spoiling around skin. Urinary catheter interested due to urinary retention.
Pain assessment: unoperated hip fracture c/o pain in the lower hip, in arms, gets medicine for a regular basis.
Skin and wound assessment: wound on the buttock, every second-day dressing change.
On her surgery day: she was in theatre, and the doctor noticed some cough and wheezing sound in her chest. The doctor suggested chest x-rays and CT scan to recognize the respiratory tract infection- prominent interstitial markings throughout both lungs similar to previous imaging? She diagnosed with chronic interstitial lung disease as was identified in her CT examination.
* She remained afebrile throughout admission.
* she received chest physiotherapy whilst on the ward.
CARE PLAN OF RESIDENT:
NUTRITION AND PERSONAL HYGIENE: she needs physical assistance with food such as cutting up food in small pieces. The 3/7 intake chart commenced. Place water cup in hand, need double assistance for mobility. Prefer shower and sponge bath both.
Behavior: The resident has verbal disruption, constant physically agitation, has memory loss and confusion.
SLEEP AND REST: Usual sleep hours 8 and mostly remain comfortable.
CATHETER CARE: Catheter and genital area to be washed daily with soap & water under the shower or wash around the insertion point of the catheter with good results.
MOBILITY: She has a high risk of falls and requires a safe environment to prevent physical hazards. Place call bell and side table with reach. Encourage the resident to call if needed.
CONTINENCE MANAGEMENT:
BLADDER: Needs long term IDC because of urinary retention.
BOWEL: Undiagnosed diarrhea, regular pad checks to prevent infection.
WOUND MANAGEMENT: Regular dressing L) buttock to heel wound and daily provided cushion whilst sitting in a chair.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
SIGN AND SYMPTOMS OF DISEASE:
PHARMACOLOGY OF DISEASE:
1. Seretide
2. Spiriva
3. prednisolone
NURSING RECOMMENDATIONS: HEAD TO TOE RECOMMENDATIONS

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