Case senario: Shaym Thompson Shaym Thompson is a 64-year-old male

Case senario: Shaym Thompson Shaym Thompson is a 64-year-old male living alone, presenting with multiple chronic health conditions. He has difficulty walking and balancing, primarily due to his health complications, which include Type 2 diabetes mellitus (T2DM) with associated peripheral vascular disease, hypertension, and a history of obesity. His most immediate concern is a chronic diabetic ulcer on his right foot, specifically an infected wound that has progressed to osteomyelitis, requiring the scheduled amputation of a toe. This surgery is set for Monday, after which Shaym will need a hospital stay for 3 to 4 days for recovery. Medical History and Condition Shaym’s medical history is complex. He has T2DM with complications, including neuropathy that has contributed to a non-healing diabetic ulcer on his right sole. The wound is deep (2 cm long, 3 cm wide), sloughy, and foul-smelling due to a severe infection. The infection has spread to the bone, leading to osteomyelitis, which requires immediate surgical intervention to prevent further complications such as the potential need for leg amputation. Shaym’s overall physical health is further complicated by obesity, weighing 115 kg, which has a direct impact on his mobility and the healing process. He also suffers from rheumatoid arthritis and plaque psoriasis, for which he takes medications such as sulfasalazine and ixekizumab. Additionally, he is on insulin (Novomix 30) and metformin to manage his diabetes, atorvastatin for cholesterol control, and perindopril erbumine to manage hypertension. Due to his complex health conditions, Shaym requires regular medical monitoring and an obesity management plan. Impact on Health and Wellbeing Shaym’s health has been deteriorating due to his chronic conditions, which affect his physical, emotional, and social wellbeing. The loss of feeling in his legs and feet, along with pain from his diabetic ulcer, significantly impacts his ability to engage in physical activity or self-care. He faces housing instability at times, which further exacerbates his health challenges. Shaym is isolated, living alone without consistent social support, adding to his sense of vulnerability. He has expressed a positive outlook towards the upcoming surgery, hoping it will help prevent the further spread of infection. However, concerns remain regarding his recovery and post-surgery care, especially considering his limited mobility and ongoing need for wound care. Social Determinants of Health Shaym’s lifestyle and social factors play a significant role in his health management. He does not engage in regular physical activity due to his mobility issues and chronic pain. The National Disability Insurance Scheme (NDIS) will provide him with specialized footwear to assist with mobility post-surgery, and a referral to a social worker has been made to help address his broader social and healthcare needs. Shaym has a history of struggling with housing stability, which complicates his ability to maintain a consistent routine for medication management, exercise, and wound care. Plan of Care The immediate priority for Shaym’s care involves the surgical removal of his infected toe, followed by a short hospital stay to monitor recovery. Post-operative care will include close monitoring for signs of further infection, wound healing, and pain management. Community nurses will perform home visits to assist with wound care and monitor his recovery progress. Additional healthcare support includes follow-up appointments with a dietitian to manage his obesity, with a focus on improving his overall health and preventing further complications from diabetes. Given Shaym’s complex needs, a person-centered approach will be adopted, focusing on his physical, social, and cultural safety. This includes ensuring Shaym has access to the necessary healthcare services and social support while respecting his autonomy and personal preferences in managing his health conditions. Social workers will be involved to assess and address his housing needs, and efforts will be made to ensure Shaym has adequate support in his home environment during his recovery. An introduction to and description of the person (ensuring privacy principles are maintained), including an outline of their health condition and explanation of how this affects the person’s health and well-being. A discussion of nursing and risk assessments, medications and specific treatments required.   A plan of care that outlines priorities of care (problem/issue to be addressed with relevant nursing diagnosis statement) that are relevant to the patients’ situation; the intended goals; relevant interventions needed- Interventions are comprehensive, safe, supported by evidence, and relevant to the patient’s needs and condition, and rationales for interventions. A minimum of three priorities of care should be given.- Person centred principles clearly presented, comprehensively explored, and incorporated in plan of care, demonstrating a physically, socially, and culturally safe approach to patient care. Priorities of care and goals are relevant and appropriate to patient condition and circumstances This will also include reference to nursing assessments, clinical data, and treatment plan/s. Using a person-centred nursing framework, ensure that the plan of care is appropriate for the person, (including their family, culture, and social environment), with consideration given to their current as well as future health needs and requirements.

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