Patient scenario

Patient scenario
Patient Demographics:

Mr Lennard (Lenny) De Caprio URN: A345678
DOB 11/11/1940 Medicare No. 3427 8652 1
Tel: (08) 9458 6781 GP: Dr White, Swan GP Practice Tel: 08 93245617
Seaview Respite Care Hester Road Swan Valley WA 6000 Ward: Blue Ward [Tel ext. no: 6027] Past Medical History:

Osteo Arthritis (OA) 25yrs mainly in left hip and left knee has become increasingly painful in the past 2 years – surgery is not an option.
COPD – 10 years stopped (smoking in 2009)
Prostatic Hyperplasia (non-malignant) with urge Incontinence
Cataracts in both eyes – awaiting surgery
Constipation
Medications:
Bisolvon Ventolin Panadol Osteo Aspirin Movicol

Allergies: No Known Allergies
Nursing Care Plan:
? Lenny has reduced mobility;
? Requires 2 person assistance with transferring and showering
? Uses a Zimmer Frame to walk
? Wears dentures and a hearing aid.
? Generally is continent of urine when he can find a toilet but wears a small size incontinence pad for ‘accidents’
Social History:

Mr Lennard (Lenny) De Caprio is a 77 year old gentleman, who has been admitted to aged care facility for respite care.
Reduced mobility – requires 2 person assistance with transferring and showering – uses a Zimmer Frame to walk.
Wears dentures and a hearing aid.
Generally continent of urine when he can find a toilet but wears a small size incontinence pad for ‘accidents’.
Kate Lenny’s wife has been caring for Lenny at their home since he has been unable to get around due to increasing OA pain
He gets lonely and does forget when family has visited. He is often confused about what day it is and frequently asks when he is going home.
6 children all living in other states of Australia
Lenny was a brick-layer all his life and was still working 5 years ago on small jobs, he gets very frustrated with his pain and limited mobility.

Reason For Admission: Respite care and assessment for? Dementia.

1. What are the potential impacts of dual or multiple diagnoses (Co-Morbidities) on identification and prioritisation of the older person’s needs?
2. List Lenny’s chronic age-related health problems, give brief reason why.
3. a) Explain urge incontinence. b) Explain continence care.
4. What functional assessment tools would you use for assessing Lenny? (8)
5. a).Outline the nature of dementia as a progressive neurological condition.
b).Identify two nursing interventions that can be used with people with dementia. (11)
6. List at least two support services and resources in the aged care environment.
Kate 78 yrs old (Lenny’s wife) has recently been diagnosed with Diabetes Type II, she has expressed her concerns about not being given any information about her new diagnosis she believes it is because she is old.
7. What primary health care and services can be offered Kate i.e. for the older person? (12)
8. List the stereotypes and influences on ageing. (13)
Lenny has become increasingly confused, he has been diagnosed with Vascular Dementia, he has progressively demonstrated short term memory loss and is starting to wander without assistance and the use of a Zimmer frame with other challenging behaviours e.g. continuously calling out aloud.
9. What are the limitations and legal ramifications of physical, chemical and psychological restraint?
10. List the legal and ethical issues and considerations, and assessment tools relevant to the older person.
11. Describe two physical triggers for challenging behaviour? (14)
12. Describe two strategies used to respond to challenging behaviour? (13)
13. Why is it important to have a safe, physical, social and emotional environment for all older people, and particularly for people with dementia? (17)