He has a 22-year-old son and an 18-year-old daughter who are in good health. A paternal uncle has hypertension and a maternal uncle has prostate cancer. There is no known family history of diabetes mellitus. On review of systems, he has occasional headaches, experiences shortness of breath when he walks up stairs, and gets up once a night to urinate. Questions: 1.
There was no on-going monitoring of nutritional needs, and no clear care planning towards this either. In may 2011, a lady whose mother stayed in Ipswich Hospital for a month two years ago, wasn't surprised by the CQC's critical report. She stated that she had raised concerns at the time of her mothers stay, saying that her mother was not fed properly, her glass of water was out of reach. Her mother was also given nappies to wear, rather than staff having to help her out of bed to use a commode. In November 2011, CQC released another report saying that improvements in using call bells, and help with meals had improved.
Her primary physician ordered Rocephin, 1gram, IM, daily for ten days. The medication was injected and the first dose was smooth and effective. When the medication was delivered on the second day, the patient refused medication. Assignee and staff nurses tried to educate the patient about medication and disease but patient’s autonomy and right of self-determination protected her for right to refuse the medication. Then, her Doctor, and her power of attorney were contacted due to the refusal of medication.
Theory in Professional Practice Critically ill patients are at high risk for becoming deconditioned and delirious. When I started working in intensive care, keeping your patient sedated and comfortable on the ventilator was the norm. However few years ago early mobility became the new norm. Intubated patients that were mobilized within twenty-four hours from admission were weaned off the ventilator sooner; and they never became delirious or deconditioned. Using fewer sedatives that promoted a normal circadian cycle prevented delirium.
REFLECTION: Communication with Dementia Patient During my rotation in Care of Elderly on Sarratt Ward, WGH, we once had a patient with severe dementia. She came in with a chest infection and had been unwell for two weeks and therefore not mobilized during that period of time. Previously she was walking with supervision of one. She was living in a residential home and for her to be able to go back there she was expected to be able to walk again with minimum assistance of one. The nursing staff reported that her chest infection had resolved and she was now more alert.
SUPPORT INDIVIDUAL HEALTH AND EMOTIONAL WELL BEING CHCICS303A DONE BY JANELL ROBINSON PROJECT 1: Ahorangi is a seventy-eight year old Maori woman from New Zealand with diabetes and arthritis who has recently been admitted to an aged care facility because she has been living alone for several years and is unable to adequately care for herself. Ahorangi has no family in Australia, but she has an intimate relationship with a male friend who visits her twice a week and she has three female friends she used to play cards with every Saturday. Ahorangi enjoys reading and fishing. You are her aged care worker. Research Maori customs 1.
White cap: Information Marianne is a 79-year-old woman with hemorrhagic stroke. She has been placed on a respirator, unresponsive, pupils dilated and non-responsive to light. Physician recommends surgery to remove blood clot but does not offer much reassurance that she would recover function. She has no advance directives. Husband wants to try everything, but children believe she would not want the surgery and a poor quality of life, which they agree is the likely outcome.
Case Study (Mrs. B) Mrs. B is a 79-year-old retired schoolteacher who was in excellent health prior to suffering a stroke three days previously. Her physician has on file in her medical record a living will, which she wrote out some ten years before. At that time she had indicated that, should she ever suffer a stroke of any sort, she would not want to be saved. She had watched her mother live as an invalid for about four years in a nursing home after sustaining a stroke. Mrs. B wanted to be sure she would never be exposed to such an indignity nor constitute such a burden on others.
Mrs T suffers from Headaches and is prescribed medication for this on an ‘as and when required basis’. Mrs T is alert and aware when she has headaches and will express her need for this medication independently. Although Mrs T can express her immediate needs her Dementia has affected her long and short term memory. Mrs T does not have capacity and an assessment has been completed. It had been reported to the Manager by a member of staff that she had witnessed another member of staff speaking to Mrs T inappropriately and had refused to give Mrs T medication which she had requested for her headaches and had concerns regarding this conduct.
“Never events” are also known as “serious reportable events” (SREs), an official term adopted and used by the National Quality Forum (NQF). The NQF defines SREs as events that should never have occurred to the patient when receiving care in a hospital. SREs are viewed as identifiable events that cause substantial harm to the patient and are almost always preventable. (Lembitz, 2010, pg. 30) Examples of “never events” include, but are not limited to the following: • Death due to administration of wrong medication • Wrong surgery procedures conducted on the wrong patient and/or wrong body part • Patient abduction • Handing an infant patient to the wrong person during discharge NQF has compiled a list of 28 “never events” that is used in many states across the nation.