Case Study: Patient Needs Assessments

Introduction

As part of the FETAC Level 5 Major Award in Healthcare Support the author was asked to do this assignment on Care Skills covering all aspects of caring for a confused person. The model of nursing assessment -Logan, Tierney and Roper will be used to assess the client’s needs.

• Physical
• Intellectual
• Emotional
• Social/Spiritual

Methodology will include class and tutor notes along with independent research conducted on the Internet and information from Creative Training’s Module learner book.

The client used for this assignment is Peggy, living in her own home with mild stage of Alzheimer’s disease. The client’s name has been changed to maintain confidentiality.

Peggy is a very outgoing person who enjoys horse racing, bingo and Irish music. Peggy is a roman catholic and attends mass every Sunday morning.

Alzheimer’s Disease (AD)

‘Alzheimer’s is a type of dementia that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks’(Alz.org, 2014)

AD starts off gradual but gets worse and worse overtime it is classed as having 3 Stages

Mild – Moderate – Severe

Peggy is in the mild/early stages of Alzheimer’s which means it is possible for her to continue to do lots of things under supervision bearing in mind this will change over time.

Mild stage AD

Gets confused in new places

Finds it hard to make decisions when rushed

Poor judgement

Repeats things a lot

Forgets things easily

Lack of interest in activities

Mood changes

Gets frustrated and angry easier

(Alzheimer Society of Ireland, 2014)

Question 1 Development of a client profile and assessment of individual client needs.

Client Profile

Peggy is a 75 year old female with mild stages of Alzheimer disease living in her own home because of AD she is very confused. Family has assigned a Nurse and a Healthcare Assistant to help with her needs as well as rostering set days and nights that they will partake in her care alongside a multidisciplinary team (Patient, family, GP, nurse and a healthcare assistant). From meetings with Peggy and her family and MDT – it has been decided that she needs a holistic, person-centred approach for her care plan.

INDIVIDUAL CLIENT NEEDS ASSESSMENT

A holistic approach to care is always advised for Alzheimer’s patients after a thorough PIES analysis – for Peggy it shows:

Physically

Assessment of clients home – safety measures that need to be put in place

M.U.S.T analysis is performed – diet adjustments made and food intake monitored

Regular exercise and activities with the client completed

Try to create a regular sleep pattern

Ensure client has the correct non slip footwear when leaving the house

Intellectually

Assessing client at home – seeing what they can do for themselves and encourage the client to do as much as they can to ensure not to in still helplessness.

Try to find topics to talk about that interest the client and create a reminiscence book or other photo book with them.

Puzzles and other problem solving activities can be played when the client is confused – it can help to focus the mind.

Emotionally

Talking to the client – regardless of the topic

Ensure they feel safe and secure and gain their trust

Assign small tasks for them around the house and ask them to assist you in doing chores – such as folding tea towels or sorting socks – helps to make them feel useful and wanted

Allow the client to lead in decision making regardless of the task – such as picking out clothing, hair style, makeup etc

Note any personality changes as this can be a sign of the disease progressing

Socially/Spiritually

Encourage family members to visit regularly

Try to get the client to attend day care centres and research any activities they are interested in to see if they would like to attend – such as bingo or card games, horse racing meetings etc

The client is very religious – determine whether she would like to attend mass and if so on what day.

Prayers may be said throughout the day in the home – such as the rosary

(Sorrentino, 2008)

Question 2

Determine the level of assistance required to complete activities of daily living

Feeding – Can feed herself – food and fluids documented (intake and out-take chart)

Toileting – Manages toileting – any changes monitored as can change if AD progress’s

Selecting appropriate clothing (attire) shoes slippers etc – assistance needed

Grooming – help with hair curling

Continence maintenance – Monitored as can change if AD progress’s

Putting on clothes – can get confused needs some assistance clothes laid out in order helps

Showering – some assistance needed

Walking – mobility good Morse fall scale 0

Finance management – needs assistance gets a little confused with counting money (old money)

Transport – individual not allowed drive roster done out to bring individual places by family and close friends

Shopping – supervision needed as gets confused unless guidance given in shop and gets lost easily

Meal preparation –supervision needed

Telephone and other communication devices – Assistance needed

Medications management – supervised and documented by nurse at all times

Housework and basic home maintenance –assistance with housework – home maintenance directed by Peggy done by family

Sleeping and resting – very confused when she wakes up especially during the night one of the team stays over and night light left on during night

Question 3

Maintaining a safe environment

Medications in a locked safe place as Peggy sometimes forgets she has taken her medication nurse allotted to give out medication when needed.

Lighters in a safe place

Supervised smoking

No lock on bathroom door

Good housekeeping no clutter or loose cables minimising slips trips and falls

Handrails in bathroom

Non slip mat in bath

Radiator covers to prevents burns

Supervise individual when cooking to minimise burns/scalds

Question 4

Promote client involvement in social events and therapies

Telly bingo with family and friends

Individual loves horse racing days out to local racecourse with family

Day care centre Portlaoise where Peggy has attended for a number of years offers one day a week sessions with loads of different things to do ie hairdresser on site, make and do, chiropodist on site.

Old folks Christmas party annually

Creating a reminisance book of past photos of family and friends gatherings and events

When weather is good peggy likes to help out with gardening(weeding and potting plants)

Peggy’s cd collection is played for her daily as it always brings a smile to her face

Question 5

Mobility including falls and pressure area care

Individual mobility good at moment but watched closely as can deteriorate in Alzheimer’s patients as disease progress’s

Morse Falls Scale result 0 at present.

To minimize pressure sores

Good nutritious diet using the food pyramid

If individual mobility deteriorates check all pressure areas every day for redness

(Search.yahoo.com, 2014)

Use of air mattress to help prevent pressure area sores

Gel cushions in chair

If client becomes bed bound to be turned every 4 hours

Constantly checking pressure areas

Preventing falls

Risk assessment done on house to minimize falls

Individual supervised

Good housekeeping to prevent slips trips and falls

Floors not polished

Non slip floors in bathroom

Spills cleaned up as they happen

If any falls occur they are documented and individual checked out by nurse /GP(Morse fall scale form updated

Question 6

Effective verbal and written communication with client and Health care team

Client

Speaking

Always use their name when talking to them and say who you are

Get down to eye level with client and keep good eye contact as this helps them focus

Speak clearly and one idea at a time as to not confuse them more

Do not speak to them like a child

Short sentences

Listening

Listen carefully to client without interrupting

Listen for clues when client is trying to tell you something

Don’t rush client when they are trying to say something

Body movements

Use body movements tactfully to try explain things to them by pointing to things or acting out what you are going to do with them

Tips

Include patient in conversation and decision making(may change overtime)

Don’t treat client as a child

Try keep their sense of humour going by having a laugh with them

Always hold their hand if they are feeling sad as the touch connects them to you emotionally without invading their personal space

Make sure their glasses and hearing aids are working for them correctly as this will play havoc with communication

(Alzheimer Society of Ireland, 2014)

Healthcare Team

Handovers done on person change over

All healthcare team have been told of all changes to care plan promptly

24 hour diary kept and handed over at handover

Appointments for Peggy kept in diary

Question 7

Assist clients with activities of daily living

Give a choice with clothes Peggy would like to wear

Assist with shower but let Peggy do as much as she is able keeping her dignity by covering parts of her that are washed as you go

Assist with meal preparations and cooking

Nurse assists Peggy with medication

Assist with housework and laundry

Assist with shopping

Curl clients hair the way they like it promoting positive self image

When assisting with activities of daily living let client do what they are able to handle and it gives them a sense of independence and self worth

(Alzheimer Society of Ireland, 2014)

Question 8

Promote the rights of the clients to dignity, privacy, independence and positive self image

Dignity

Making sure client is dressed appropriately

If client is getting washed make sure no one walks in on them

Privacy

Always knock on clients bedroom door and wait for a response before entering

Privacy and confidentiality contained at all times

Personal information not disclosed to public

When family call over give them some space and time alone with client

Always inform client of what the agenda is for the day and let them make their own decisions

Independence

Let client do as much as they can even if it means it is time consuming

Let client help out with light house work if they are willing

Positive self image

Hair curled the way they like it

Let them pick out their clothes

Compliment them when they look nice

Let them use their soaps, shampoos etc that they like ie imperial leather is a personal choice for peggy

If they like their nails painted help them do them

Always make sure they have their false teeth in during the day

Reference List

BOOKS

Sorrentino, S. (2008). Mosby’s textbook for nursing assistants. St. Louis, Mo.: Mosby/Elsevier.

E-BOOKS

WEBSITES

Search.yahoo.com, (2014). food pyramid – Yahoo Search Results. [online] Available at: https://search.yahoo.com/search?fr=mcafee&type=B211IE662D20140712&p=food+pyramid [Accessed 27 Nov. 2014].

Search.yahoo.com, (2014). pressure areas – Yahoo Search Results. [online] Available at: https://search.yahoo.com/search?fr=mcafee&type=B211IE662D20140712&p=pressure+areas [Accessed 27 Nov. 2014].

Alz.org, (2014). Alzheimer’s Disease & Dementia | Alzheimer’s Association. [online] Available at: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp [Accessed 14 Dec. 2014].

Alzheimer Society of Ireland, (2014). About Dementia – Alzheimer Society of Ireland. [online] Available at: http://www.alzheimer.ie/about-dementia.aspx [Accessed 14 Dec. 2014].