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Case study 

Mr Tony Farnan is a ninety-three (93) years old male who resides at the Greenwood residential aged care facility in metro Victoria. He has lived here for three (3) years and prior to this he used to live alone at home. He had a close friend who used to visit him in the care facility. Once his friend got sick and stopped visiting him, Tony was finding himself becoming increasing socially isolated, anxious and finding it difficult to manage at the care facility.

Mr Farnan was never married and has no children. He used to work as a lawyer and has always taken pride in working independently and efficiently.

 

His past medical history includes:

 

-          Atrial Fibrillation diagnosed 5 years ago and is having a pacemaker

-           TIA (Transient Ischemic Attack) diagnosed 1 year ago

-          Hypothyroidism diagnosed 10 years ago

-          Gout in both knees diagnosed 3 years ago

-          Severe depression diagnosed 4 years ago

 

He has more recently been diagnosed with Alzheimer's dementia and urinary incontinence (urgency incontinence <12 months)

 

He has absconded from the aged care facility twice since admission. Mr Farnan requires one staff to assist with personal care, including dental care (partial upper dentures).

 

Staff encourages him to attend social activities with other residents, however he tends to stay for only short periods and leaves the activity. Tony tends to wander around the facility and often forgets where his room is and requires staff to redirect and reorientate him often, several times a day. Staff have also noted that he is restless and wandering through the night, and spending time asleep during the day due to his night-time wandering. He is often seen distressed and crying at night time. Tony complaints that he has increasing pain in both his knees, however when asked about the pain he does not appear to be able to be to give accurate information to the staff and starts yelling. His answers often seem quite confused and vague.

 

 

He has had four (4) falls in last six (6) month, both resulting in nil injuries.

 

Tony can eat his meals with minimal staff assistance, however more recently the staff has noticed that he is eating less and at times forgets he is even there. He often refuses to attend dining area at mealtimes. He has had a recent weight loss over the last two (2) months of more than three (3) kgs, from 57.6 kgs to 54.6 kgs.

 

He refused to see a dietician on admission.

 

Medications:

 

Aspirin 100mg daily

PRN Panadol 1gm TDS

Voltaren Emulgel daily to right knee

Endone 5mg PRN

Tramadol PRN 10 mg

Atenolol 100 mg mane

Memantine 5mg daily

Thyroxine 25mcg every day before breakfast

 

Current Situation (Morning Handover) 07:00 hrs:

 

You have been assigned to care for Mr Tony Farnan on a morning shift. Here is the handover you receive from the night staff:

 

Mr Farnan, in room 10, has been awake for periods overnight (almost 7 times). Staff checked on him at 01:00 hrs and they noticed he was screaming, and he was found sitting on the edge of his bed. Staff asked him what he was doing, and he replied that he was getting ready for catching the train to go to his home. Staff helped him to use the toilet and they noted that he was incontinent of urine and faeces. He was also noted limping while ambulating. Staff re-applied an incontinence aids, he was administered analgesics by the nurse post pain assessment, and he was assisted back to bed. He seemed quite confused and required reassurance that it was time for bed. He kept asking for going back to his home and cried for 30-45 mins.

 

Staff then noticed him up at 03:00 hrs and he required redirection to his bed. He was very confused and was found putting his day clothes on.  At the time of report, he was having a shower with the night personal carer as he was up and at the nurses' station requesting to go to the shops so he can prepare breakfast for himself. He was quite upset this morning stating that he was looking for his mother, who left him at the facility. 


Question 1. Medical diagnosis - Using the information you have been provided with describe the persons past medical history. Include the impact that this past medical history may/will have on the person.


Question 2. Theory of ageing - Using the information you have been provided with and by doing further research determine which theory of ageing you believe is most appropriate for this person. Provide justification for your response.


Question 3. Physiology of ageing: Using the information you have been provided with, explain the physiology of ageing and how it relates to this person's disease process


Question 4. Primary health services: Identify which primary health services you believe would be appropriate for this person. Justify your response. You must identify at least two (2) primary health services that are appropriate for this person.


Question 5. Strategies and Interventions for dementia/challenging behaviours: Describe at least four (4) strategies or interventions that you may be able to utilise to assist care for an individual with dementia. Ensure that you have linked this back to the person in the case study (what behaviours have you identified in the case study that would need to be managed? and what could be some of the triggers that might contribute to challenging behaviours?). Include physical pain as a trigger and communication strategies in your answer.


Question 6. Oral hygiene: Using the information you have been provided with, identify why this person may be at risk for not having their oral hygiene needs met. Identify two (2) strategies that could be implemented to ensure that this person's oral hygiene needs are met?


Question 7. Pain: Using the information you have been provided with, identify how you would determine if this person was in pain. What may cause this person pain? How would you manage this person's pain?

Question 8. Complementary therapies - using the information provided, identify any two (2) complementary therapies that you think this person may benefit from. Justify your response.


Question 9. Nursing care plan: Using the attached nursing care plan, fill in the blank spaces for Mr Farnan. When developing goals please ensure they are SMART goals. Any actions must be nursing actions. You must have one (1) nursing action for each problem identified. When evaluating outcomes please be sure to include time frames.

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