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Assessment 2. Guided Essay Weight 60%

Supporting people with chronic conditions to live well at home 

Case Study: Mr and Mrs Walters

 

OVERVIEW

Name: Ellen Walters
Age: 67
Address: Street Rd, Flagstaff hill SA
Height: 160 cms
Weight: 55kgs (was 65kgs at beginning of hospitalisation in Feb 2022)

Mrs Walters (Ellen) was diagnosed with mild cognitive decline, vascular dementia 18mths ago.

Initial cognitive score on the mini-mental was 21/30. Most recent mini-mental score (Feb 2022) 15/30.

Recently discharged from 3 weeks of rehabilitation following a (R side) Stroke (June 2022) – with residual left arm and leg weakness.

Brain imaging, post Stroke, showed generalised atrophy along with evidence of the stroke affecting the right frontal lobe. Primarily affecting memory, attention, and executive function (planning, problem solving, mental flexibility and abstract reasoning).

PMHx

Hypertension

Hypercholesterolaemia

Osteoarthritis

R sided Stroke (Feb 2022)

Persistent Urinary tract Infections – since the stroke

MEDICATION

PO Atorvastatin 10mg daily

PO Captopril 25mg BD

Apixaban 2.5mg BD

Macrogol (Movicol),1g sachet 1 daily

Melatonin (Circadin) 2mg 1 at night prn

1

You are the RN in the GP practice – the GP has said that Michael and Ellen have come to the practice – as Michael feels he needs more support at home for Ellen – but he does not know where to start.
The information that follows comes mostly from Michael and the discharge documentation from the rehabilitation unit. You have access to the patient notes held by the GP practice

BACKGROUND

When Ellen was hospitalised, Michael reported that prior to the stroke Ellen was becoming increasingly vague and was displaying short term memory deficits. Ellen had a lack of insight with regards to her physical and memory abilities and would often leave the house during the day – when Michael was at work he had received phone calls from Ellen stating she taken the bus to the main shopping centre but was not sure not sure how to get home.

Michael is semi-retired and works 2 days a week – during COVID restrictions he started to work from home and does not plan to return to the office. Michael feels that he needs to stay at home as he is concerned about Ellen’s lack of insight and her safety related to mobility (they have stairs in their house) and cooking. Michael is reluctant to ‘restrict ‘Ellen as she becomes upset if she feels people are treating her as a ‘child’.

Michael takes Ellen in for regular check-ups with the GP, as Ellen deteriorates, Michael has noticed the GP is talking more to him about Ellen’s condition than to Ellen directly. Something which Ellen can often notice – and this also upsets her. Michael worries that Ellen has not completely realised the extent of her own health situation.

Ellen is a non-smoker and does not drink alcohol. She has no allergies.

MOBILITY

Ellen walks with an heirloom walking stick and has as uneven gait, she was discharged with a 4-prong stick but does not want to use it as it as it ‘looks ugly’.
Her right hand and arm can become swollen if ‘dependent’ – Ellen also does not like to wear any supportive devices and finds the compression garment for her arm too restrictive, as a result her arm is often swollen and sore.

2

HYGIENE

The bathroom has been modified with rails and the shower is sperate from the bath. A shower chair was supplied on discharge – but Ellen does not like to use it – she gets upset if she feels Michael is ‘supervising’ her in the shower as she wants to attend to her own hygiene. Michael usually waits outside the bathroom door until Ellen is finished and comes in to assist with dressing – he has noticed that Ellen has had difficulty washing her hair and her genital area and he has occasionally noticed an unpleasant odour on her clothes and most of the time when he is attending to the washing. He has also noticed urine on her underclothing- but he has not felt comfortable discussing it with her as when he has previously tried to discuss this Ellen became very upset.

NUTRITION/EATING

Michael has taken over all the cooking from Ellen. He can make basic meals such as spaghetti bolognaise, steak and salad, but struggles to find variety, the meals are high in carbohydrates – which has not been good for his weight. This diet does not seem to make a difference to Ellen, who seems to have lost interest in eating.
Ellen did most of the cooking throughout their marriage and does offer advice, but this tends to make Michael flustered as he does not feel he is doing a good enough job.

LEISURE/SOCIAL LIFE

Ellen used to be quite active in her garden before her physical condition deteriorated and used to make preserves and chutneys with the fruit they grew. Ellen is also a devout Catholic and since her most recent admission to hospital she has received a monthly visit from her local priest. Her husband is not religious but knows how important Ellen’s faith is to her.

Ellen is a member of a local gardening club and often helped at a local community garden however she seems to have lost interest in this as well- as she is concerned about what other people will think about her and concerned that she won’t be able to do some of the activities she has done before.

3

FAMILY

Ellen and Michael have three adult children, Maria (35), Sarah (33) and Simon (29). Maria lives in the United Kingdom with her partner and her two children. Due to recent COVID restrictions they have not seen her for more than 2years.

Sarah lives same suburb as Ellen and Michael and is a single mother with three children. Sarah separated from her husband 3 years ago – the children have no contact with their father. She tries to help Michael with Ellen’s care as much as she can, but her time is limited.

Simon works in the mines at Mt Isa as a fly-in-fly-out (FIFO) mining consultant. He is based in Townsville but again the COVID restrictions have limited visiting opportunities – Simon has a visit planned for his next break.

MICHAEL

Michael had a mild heart attack at 62. He takes Atorvastatin (80mg) at night, Metoprolol (100mg) twice a day and Aspirin (100mg) in the morning. Since taking over the cooking from Ellen, Michael has admitted he isn’t eating as well as he should be and admits to drinking several beers on a weekend.

Michael has taken on most of the household work; however, he has arthritis in his hips and finds the burden of housework, maintenance, and his home business quite demanding. Lately he reports he has started to experience some chest pain and he wonders how much longer he is going to be able to look after Ellen.

FINANCIAL

Ellen used to work as an administration officer but retired at after her initial dementia diagnosis.
Michael is an electrician and owns his own business: he has two employees. Since Ellen’s condition has worsened he has considered selling his business to one of his employees to free up some cash and make more time to care for Ellen. Michael knows that as Ellen gets worse there may be more health bills in the future.

Though he knows his business is in reasonable financial health, he isn’t sure it is enough, and he worries where the extra money will come from. They have not quite paid off their mortgage and have started to draw on Ellen’s modest superannuation fund. Ellen and Michael also contribute to the rent of their daughter Sarah, who can only work part time.

4

HOME ENVIRONMENT

Michael and Ellen live in a four-bedroom two storey house with an internal staircase. The carpeted bedrooms and tiled bathroom are on the top floor, with the kitchen, living, dining, office, and laundry on the ground floor.
Outside there is a concrete walkway up to the front door that has settled unevenly over the years.

There are no home modifications at present. The bathroom has a bathtub and stand-up separate shower.
The house sits on a quarter acre block with a mature garden. Michael tries to keep the grass down but it’s getting harder to find the time maintain the garden. Snakes are a common occurrence in the area during summer and Michael is concerned that this is a dangerous situation – given Ellen likes to work in the garden and the grandchildren visit regularly.

SCIENCE
HEALTH SCIENCE
NURSING
NURS 3003

 

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