Question:

Mrs Walker is a 72-year old woman who lives alone.

Mrs Walker was recently diagnosed with Alzheimer’s disease (4 months ago) and has suffered from mental and physical decline over the last 8-weeks. She regularly paces up and back, despite her poor balance and appearances of being pale and tired.

Mrs Walker has been declared incapable by her psychogeriatrician, and the Enduring Power of Authority has been adopted.

Mrs Walker’s family and health team have all confirmed that she is dangerous to herself and others. They have decided to place her in a secure residential facility.

Mrs Walker is in distress and had to be physically escorted to the residential facility.

Mrs Walker has severe contractured her right hand from burns she received in the kitchen 11 months ago. The hand is useless because of Mrs Walker’s non-compliance to physiotherapy.

Mrs Walker weighed in at 62kg a year ago. She is now 34.5kg.

Her family advises her that she is refusing food, and that they often find Mrs Walker’s dentures hidden in odd places throughout their home.

Part A

1a. You are Mrs Walker’s nursing assistant and will need to do a health evaluation.

Discuss any sources you might use to locate information about Mrs Walkers medical history.

1b. In detail, describe the interview stage in a health exam.

1c. Discuss why older persons should be assessed and name at most two tools you would recommend for Mrs Walker.2a).

You are worried about Mrs Walker, who is extremely anxious and emotional.

You’ve tried several communication channels, but Mrs Walker isn’t engaging. Her family is also distressed.

Identify the person to whom you would discuss your concerns. Also identify the information that you would need to relay.2b).

Please identify and explain briefly the Standard of the Enrolled Nursing which concerns decision making and the provision of care.

3a. Define restraint. Describe who ultimately authorizes its use.

3b. Discuss the restraint that Mrs Walker is subject to and what your obligations are once it’s in place.

4a. You cannot weigh Mrs Walker because she isn’t following your instructions.

Discuss at the very least 4 reasons why Mrs Walker is losing weight.

(Please note: It is not acceptable for Mrs Walkers to compile a list without giving reasons.

4b. Discuss how Mrs Walker’s physical disability might be contributing to her weight reduction.

4c. Discuss Mrs Walker’s weight loss with a specialist.

5 You manage to get Mrs Walker down to drink with the help your daughter.

You decide to take advantage of the opportunity to do an oral assessment.

a) List at least 4 examples of how bad oral care can affect older people’s health.

b. Create a list listing the things you will examine during Mrs Walker’s dental health assessment

c. Mrs Walker’s dentures, which look too large and are stained and chipped, is checked.

The daughter asks what the best way is to care for dentures.

Talk about what you’ll tell Mrs Walker.

6 Mrs Walker is unstable on her feet. Discuss what type of assessment Mrs Walker might be referred for and who might carry it out.

7a. As you discuss the diagnosis of Alzheimer’s disease with Mrs Walker’s young son, he informs you that he does not understand the meaning of dementia and asks you whether there is a cure.

Include a definition of dementia that includes a specific reference to Alzheimer’s.

7b. Mr Walker asks you whether your mother will die soon. Talk about the difference between palliative or end-oflife care

8a. Mrs Walker, after two weeks in the facility, has stopped engaging in any activities. She continues to pace the corridor but with less anxiety.

The activity officer will discuss your concerns and suggest possible therapies for Mrs Walker.

8b. Discuss the need to make Mrs Walker feel secure in her surroundings.

Part B

The following questions are short and easy to answer

Why was 2010 the Carer’s Recognition Act implemented?

Do you have 3 ethical or legal concerns that are not included in the Carers recognition Act 2010’s 10 key principles?

What are the best organisational policies, procedures and processes to be aware of when caring for a loved one who is deceased?

What standard precautions must you take to care for a body that has died?

As a nurse, you have the responsibility of comforting grieving families and caregivers.

You can accomplish this in two ways as an Enrolled Nurse.

Answer to Question: HLTENN013 Implement And Monitor Care Of The Older Person

Part A1a).

You can retrieve the past medical history for Mrs. Walker by consulting the hospital in which she was given her dementia diagnosis.

You should contact Mrs. Walker’s relatives as they can help you with information like her symptoms, diagnosis, treatment, medications and any allergies.1b).

The nurses will collect the data and record it during the health assessment interview.

The interview is conducted in both verbal and written communication, with open and closed-ended question.

A health assessment interview is essential as it provides important information such as biographical data, reasons for seeking medical care, current health condition, and family health history.

Interviews require communication skills to make patients feel at ease.

This allows for the disclosure of family history regarding any type or illness (Kring, et al. 2013,).1c).

The assessment tool is vital for older people. It allows them to assess their health and identify potential issues.

This tool is used to improve the quality life and overall health for the older population.

Since Mrs. Walker is a patient with dementia, it is essential to identify her risk factors and general factors that can influence her psychosocial, physical, and social well-being.

Two specific tools to help her assess her functional status are the Nutritional Questionnaire, which measures the patient’s eating behaviour, nutrition, and Katz Index of Independence for Activities of Daily Living (ADL).2a).

The immediate person that Mrs. Walker can contact to discuss her concerns about anxiety and emotions is the member or team of healthcare who is providing residential home care.

This person should be the home caregiver who is responsible for taking care of Mrs. Walker and can be trusted.

You can use the Health Questionnaire as part of your health assessment tool to ask open-ended and closed-ended question to the home caregiver. These questions will include information regarding her health and current status.2b).

Australian Nursing and Midwifery Council, (ANMC), states that they are required to use reflective and critical thinking skills to aid in decision-making.

Enrolled nurses must work with registered nurses and collaborate in the Domain of Critical Thinking and Analysis 5 Competency Unit 5.

They should provide relevant and accurate information to support decision-making and care provision (Dalton Gee & Levett Jones (2015)).3a).

A restraint is any type of physical or mechanical device attached to a resident’s body that restricts freedom of movement and access.

It is a practice that renders individuals helpless and places them in captivity using straps or ropes.

There are two types of restraints that control or restrict behavior and movement, namely physical and chemical.

However, restraint is not allowed in law. In an emergency, however, it may be authorized by the police or Medical director (Muskett, 2014).3b).

Mrs. Walker is elderly, weak, overweight, and has dementia. This puts her at risk of falling and wandering.

She is restrained by a locked door, bed rails, wheelchair, and use of bed rails. These are all useful in keeping her from wandering off and falling.4a).

Due to dementia, weight loss can be caused by the inability to eat the food because of difficulty swallowing.

A person with dementia may not like certain foods due to their taste or consistency. They are also unable to eat cachexia, which is a condition that causes them to lose weight.

Poor oral hygiene such as poorly fitting dentures, poor teeth or moth bites can also contribute to it.

Mrs. Walker could also be suffering from anxiety, depression, or emotional distress.

Due to her dementia, she has a tendency to become cachexia, which is caused by her inability to absorb nutrients and causes weight loss. (Saha et. al., 2016,4b).

A medical condition such as dementia, which can lead to weight loss, or physical disability, can cause weight loss.

She is losing appetite due to her reduced muscle mass.

She has difficulty swallowing because of poor food consistency and a lack of willingness to eat.

Like Mrs. Walker, physical disability can also cause anxiety and depression.4c).

Mrs. Walker’s weight loss was made possible by the assistance of specialist health professionals, including a dietician and nurse. These specialists would assist her in gaining weight through proper diet and weight control.

To choose the patient-centered diet and weight management strategy, the doctor should be consulted about her medical history.

A dietician will recommend the right diet for weight gain based on her medical condition and age. A nurse would offer education and support.5a).

Poor oral hygiene can lead directly to poor health.

Bad oral hygiene can lead them to various health problems.

These bacteria can also be transmitted to the bloodstream. They can infect other areas of your body and cause inflammation.

When people get older, they don’t brush their teeth properly. A condition called systemic inflammation also occurs when the gums become inflamed or bleeding.

Oral bacteria may also be a cause of blood clots (Gil Montoya, et al. 2015).5b).

It is important to examine Mrs. Walker’s past including her medical, personal and dental histories, as well as any other pertinent information, during the oral assessment.

Also, Mrs. Walker’s level of anxiety regarding dental treatment and oral mucosa is assessed.

Also, the risk assessment of periodontal disease or oral mucosal illness is essential.

For tooth surface abnormalities such as loss, damage, or occlusion, an oral assessment is necessary.

It is also necessary to conduct a clinical examination of your head, neck, tongue, gum, and throat.

It is also necessary to check for pain, food restrictions, dentures, ongoing medication for pain or discomfort (Rahman, et al. 2016).5c).

Your dentures must be properly cleaned on a regular schedule and free from food particles.

It should also be free of any stains or damage to dentures.

After denture removal the mouth should be cleaned thoroughly.

Dentures can be large, chipped or stained.

Dentures should be treated with care.

It should be stored in denture soak solution.

You should rinse your dentures after handling them.

After eating, dentures should always be removed and washed.

Avoid using hot water, discolouring, bleaching, toothpastes or whitening toothpastes on dentures.

Regular visits to the dentist will help prevent dentures from becoming loose or uncomfortable (Ryu, et al. (2015)).6).

Mrs. Walker should have balance and gait assessments done as this could result in falls or decreased functioning when performing ADLs (Bauer et.al., 2016).

It will help her assess her balance, unsteadiness and physical ability as well as determine the extent of impairment.

This can be done either by a physiotherapist, or an orthopedic.7a).

The medical condition of dementia is when a person’s mental capacity declines and that affects their daily activities.

The condition affects thinking skills and memory. This can lead to difficulty performing daily activities.

Significant impairments are seen in communication, memory language, attention, focus, judgment, reasoning and memory.

The memory loss in patients with dementia is short-term. It starts slowly and gets worse over time.

Alzheimer, a form of dementia, can cause issues in the brain, memory, and behavior.

These symptoms can develop slowly and then get worse with age.

It is not an ordinary occurrence of aging. However, age can act as a risk factor to Alzheimer’s Disease (Alzheimer’s (2015)).7b).

Mrs. Walker has no sign of dying and is being kept in residential care. This is because she is unable physically and mentally to carry out her daily activities.

This is palliative, and not end-oflife care.

This is a way that can improve their quality of life, protect them from harm, and preserve their ability to think and remember.

Because she is suffering from pain and discomfort, palliative medicine is essential.

End-oflife care is offered to patients with life-threatening and life-limiting illnesses.

This is to ensure that they are comfortable and receive the necessary care.8a).

Mrs. Walker experiences anxiety after being in the residential care home.

Non-pharmacological therapy can be used to provide psychosocial interventions. These include training her in skills and orienting her.

These interventions could also be helpful as she would be engaged with activities to distract her thoughts and maintain cognitive stability.

These activities, which are part of psychosocial treatments, would also help her to balance emotions, thoughts and behaviour.8b).

A physical environment assessment is essential for dementia patients as it affects their mental and bodily well-being.

Alzheimer patients tend to be aggressive when they see changes in the environment. It is important to ensure safety as they are susceptible to falling and wandering.

Also, they become irritable in a noisy environment and are unable adjust to a new environment.

To feel emotionally secure and safe, she must have a secure and secure environment.

To reduce the chances of her falling, there should be ample light in the room. Also, Mrs. Walker needs to keep her safe and secure.

Part B

Australia has 2.7 million carers who provide support for people who are aged, disabled or sick.

Carers recognition Act 2010 was established to raise awareness about the role of carers and provide daily care and support to those with disabilities, mental health conditions and other medical conditions.

These guidelines were developed to assist funded providers of Commonwealth Government and Australian Public Service Agencies in ensuring that role carers are able to meet the responsibilities set forth in this Act.

This Act acknowledges the important economic and social contribution made by the care recognition legislation. It also supplements the Act’s responsibilities.

It defines carer and their role in supporting people who live at home but are still connected to the outside. (McMillan. et. al., 2017).

Three legal considerations are included in the Carers Recognition Act 2010. They are that it doesn’t create legal enforcement nor obligations under this Act.

The Act does NOT create any legal obligations or rights that could be legally enforced in any proceeding.

It does not affect any type of decision if it is not in compliance with the Act.

An Act may not prohibit an associated provider of public service or a state agency from exercising its powers or functions if it is required by law.

When caring for a deceased client, there are two things that must be done: the declaration of death and informing MRP about the patent deaths by the Registered Nurse or Licensed Practice Nurse.

The family doctor is informed, and in the event of an unnatural death, it’s reported to the coroner.

For registration, a Notice of death form must be completed.

Nurses have an important duty after death care. They must ensure that the body is treated with dignity and respect.

It also takes into consideration the local policies concerning the care and burial of the deceased, including the information required to inform the post-mortem team and the care for the property and valuables of the patient.

You must take the best care of the dead body.

The body must first be washed thoroughly. Any mechanical or jewellery should also be taken out.

It is protected from any blood or fluid contact by nurses.

The deceased body should be wrapped in a shroud or cloth with appropriate labeling.

A registered nurse can offer comfort and support to grieving families by building a relationship with them and giving them moral support.

They can optimize their interaction with family members by being sensitive and empathic to their concerns.

They can help the grieving family feel more at ease by listening to them and understanding their pain.

They can also offer ongoing support via information about bereavement group and understanding communication.

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