Clinical Scenario You are working in a community clinic as a…

Clinical Scenario You are working in a community clinic as a… Clinical ScenarioYou are working in a community clinic as a registered nurse. Your next patient is Ms Florence ‘Flo’ Ljukuta and her husband Lionel. Flo is 70 years old, and Lionel is 84 years old. Flo is the primary carer for her husband who has physical disabilities due to a stroke and was recently diagnosed with dementia. Flo would normally attend the clinic regularly, but you notice in her records she has not presented in nearly 12 months. The last entry on the eHealth record is a hospital visit due to a fall last year.When Flo and Lionel arrive, you notice that Flo is limping and they both appear underweight. You also notice Flo and Lionel looking untidy wearing clothes which appear to be dirty, which is very unusual for them. You read both Flo and Lionel’s medical file and identify no services are currently linked to them and Flo is looking after a lot of family in her house.When you ask Flo, what has brought her in, Flo tells you she has a wound on her right foot which she has been dressing at home for three months, but it is not getting better. Flo tells you she hasn’t seen a doctor about her foot earlier because it was only a small wound and she didn’t want to trouble anyone. Flo also stated because she doesn’t drive, she is finding it difficult to catch public transport with Lionel. She can’t leave him at home because he sometimes becomes agitated and upset plus the children are so busy looking after their little ones, she doesn’t want to bother them.ParameterPatient profile Presenting complaint History of complaintPhx AllergiesAssessment dataFlorence ‘Flo’ Ljukuta 70-year-old female from Alice Springs Diabetic foot woundSmall wound appeared over 3months ago, unsure what caused it. Applying pawpaw ointment and dry dressing every few days. Hypertension, Type 2 diabetes, Angina, Hypercholesteremia, Asthma, Osteoarthritis. Complete hysterectomy 30years ago for treatment of endometrial cancer.Nil Known AllergiesMedicationsAspirin 100mg manePerindopril 2mg maneMetformin XR 2g maneGTN 600mcg tablets S/L prnOsteo paracetamol 1330mg TDSCodeine 60mg QLD as required for acute painAtorvastatin 40mg maneSalbutamol inhaler 2-4 puffs PRN Ethnicity/languageAlcohol use Tobacco useDrug useAboriginal. Speaks Waramungu, Walpiri, Eastern and Western Arrentre, EnglishFew wines or beers with family and friend 3-4 times per week Smoker 1/2 packet per day/ whole family smokes. Regular exposure to campfire and passive smokeNil Home environmentCurrently lives in town camp in 3brd house with extended family. Approximately 13 family members staying at the house.Flo’s husband who requires assistance due to physical deficits from a stroke. Lionel has dementia, always needs supervision as he likes to walk off and becomes disorientated easily. Lionel needs prompting to eat/drink and assistance to wash and dress.Adult daughter and her 4 teenage boys Adult daughter and her 2 toddlersAdult son and his partner and their new baby Adult sonWork environmentEducation Economic statusReligion/spirituality ADLsIADLsCognitive function DietSleepHealth check ups Vital signsRetired 10 years. Previously manager of community health clinicVET level certificateFamily land and house in remote community but staying in town to be with children and support needs for husbandBaptised Catholic by missionaries when youngIndependentDoes not drive anymore due to decreased vision (diabetic retinopathy). Starting to develop cataracts. Had glasses a few years ago but they don’t help much now.No concerns identifiedDiabetic diet when able5-6 hours a night, broken sleep. Gets up several time to assist Lionel with toileting. Falls asleep in the chair whilst watching TV most eveningsLast checkup 11months agoTemp 36.8oC, HR 84bpm regular, Resp 24, SpO2 93% RA, BP 145/80, BGL 11.0 mmols/L, Pain 6 out of 10StressCurrently eldest daughter receiving treatment for breast cancer. States she is doing very well. Teenage boys have been a little naughty – two are heading to boarding school soon. Eldest son is working in the mines ‘FIFO’ which helps financially.NeurovascularBilateral feet appear normal colour, cool to touch, cap refill >3sec, Pedal pulse diminished bilaterally, Numb sensation bilaterally, Weak strength but full range of movement. Skin to heels very dry and cracked. Assessment QuestionsQuestion 1: Aged care services and interdisciplinary care to maintain independence Students must:Identify TWO (2) aged care services/packagesIdentify TWO (2) interdisciplinary referralsDetail the goal or purpose of each of these services/packages/referralsProvide a rationale for each service/referral you have selectedExplain how each service/referral relates to Flo’s presentationExplain the impact of Flo’s geographical location may have on accessing these services andinterdisciplinary referralsHint: you can identify services in your local area to help increase your knowledge of services you will be referring to in your local health network.Question 2: Medication management The older person is vulnerable to adverse drug events. Examining Flo’s medication history answer the following questions.Identify and describe Three (3) factors in the case study which increases the risk of an adverse drug eventChoose TWO (2) medications and describe:what is the indication for each medication?any potential complications that Flo may experience while taking this medicationTwo (2) nursing actions or health promotion you would implement to minimize adverse drug events. Health Science Science Nursing NUR MISC Share QuestionEmailCopy link Comments (0)

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