Case Study Assessment

This case study assessment focuses on Mrs Walker's health condition and the assessment tools used. It discusses the sources of retrieving medical history, interviewing skills, assessment tools for the elderly, communication with registered nurse, use of restraints, reasons for weight loss, oral health assessment, dementia and palliative care, and care plan for behavior improvement. Find expert solutions for your assignments at Desklib.

Running head: CASE STUDY ASSESSMENT
CASE STUDY ASSESSMENT
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1CASE STUDY ASSESSMENT
Part A:
Answer 1a) The sources that can be used to retrieve the information regarding the past
medical history of the patient (Mrs Walker) are her laboratory test reports, handover reports
and electronic health record (EHR) data that includes the necessary information of treatment
and medical history of the patient.
Answer 1b) The interview stage of a health assessment is built for the nurses in order to
obtain a detailed medical history of a patient by building a professional and therapeutic
relationship between the patient and the nurses which helps to record precise health
information. It is important for the nurse to use effective interviewing skills which includes
verbal and non-verbal communication (Webster, 2014). The non-verbal communication
includes the body postures and gestures of the patient, attitude and also listening skills, and
the verbal communication includes open and closed set of question regarding the patient’s
health, family background, medication and treatment especially in older population.
Answer 1c) It is an essential criterion to use the various assessment tools which are
specifically designed to address the elderly population as they are vulnerable to multifaceted
health complications. In case of Mrs Walker, it would be helpful targeting the rapid
weightless she has been witnessing for the past few years and then identifying the reason,
managing and helping her overcome the issue. It will also be useful to consider Mrs Walker’s
right hand contracture which is impaired and incorporation of the independent care and
addressing her other needs. It will help her recover with her issues in a better manner. The
tool considered for Mrs Walker is cognitive assessment tool and functional assessment
screening tool.
Answer 2a) I would instantly communicate my apprehensions regarding Mrs Walker health
to my Registered nurse. As Mrs Walker was very emotional and anxious, it was difficult to

2CASE STUDY ASSESSMENT
manage her without any expert supervision hence, I would have taken down the notes of the
issue I am most concerned with regarding Mrs Walker and made sure that it is within
confidentiality. I will feel comfortable to communicate with my registered nurse (RN) on Mrs
Walker’s health condition like she is very anxious, hard to engage and emotional. I will also
convey the registered nurse that the family members of Mrs Walker is also distressed
regarding this. I would lastly discuss with her regarding reassessment and using cognitive
assessment tool and asking her if this tool will be beneficial or not.
Answer 2b) According to NMBA standard 6, the nurses provides care to the patients who are
not in a state to meet their needs which can be mental or physical (Nursing and Midwifery
Board of Australia, 2019). It guides the RN in assessment of the individual’s health progress
in the direction of anticipated outcomes and the formulation of care plan in a better manner.
These standards promote active appointment and the independence of people’s independence
while receiving healthcare within any health care facilities by involving the individual as an
active participant.
Answer 3a) Restraints focuses on restriction or prevention of movements of any inhabitant.
In a patient, restraint is used in order to maintain safety regarding the health condition of
patient and the healthcare professionals. Though restraint of patients has become a major
issue of ethical care in healthcare settings. The stakeholders are responsible for authorising
the use of restraint in a dementia patient are the family members of the patient and the
healthcare professionals. As the patient is no longer in a state to take their own decisions.
Answer 3b) Because of the dementia condition, Mrs Walker was not allowed to go out of her
house to the neighbour or to the street as it might be harmful for her as well as the people in
the neighbour. She was only allowed to roam around and walk inside the house. The
obligation is to ensure all the exits from the house are locked well.

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Answer 4a) There are possibly 4 reason behind Mrs Walker’s loss in weight for the past few
years. At first, it starts with rejection to eat. Mrs Walker’s peer and family members advised
that she has been refusing to eat hence, that can be considered as the first possible reason.
The next possible reason will be her Alzheimer’s dementia. Due to her dementia, there was a
high possibility of her forgetting to eat, which may result in unintended weight loss. The third
possible reason will be loss of dentures (Hendriks et al., 2014). Mrs Walker family stated that
they have found her dentures around some bizarre locations of the house, which might be a
causative factor for her weight loss as she cannot find food and avoid assistance and might be
associated with her Alzheimer’s. The last possible reason for her weight loss will be due to
contracture that is damaged on her right hand. Because of hand impairment it will be difficult
for her to eat or cook independently thus contributing in her weight loss (Sheffrin et al.,
2015).
Answer 4b) The physical impairment or disability of Mrs Walker that contribute to her
weight loss was contracture oh her right hand that was likely to be barrier effecting her daily
activities of life (ADL) like eating or cooking independently to maintain a healthy weight.
Answer 4c) the three specialist health expert that the patient should refer in order to
overcome her weight loss are as follows:
 General practitioner can offer an active weight gain guidance and deliver protective
care to Mrs Walker on a daily basis.
 Dietician can offer expert dietary advices and can also assist Mrs Walker to upsurge
her dietary intake.
 Nutritionists can offer best advice Mrs Walker regarding the nutritional intake and
assist her to manage her health.

4CASE STUDY ASSESSMENT
Answer 5a) It is important to focus on poor oral care factors while performing an oral
assessment (Elad, Horowitz & Zadik, 2014). The following four examples details about how
poor oral care is found to contribute to poor health condition in the elderly people:
1. Oral discomfort: pain in the oral can lead to discomfort and difficulty in eating and
drinking, also affect their skin, weight and continents (Mercadante et al., 2015)
2. Bad odour from breath: foul or bad odour from breath can effects a person’s confidence in
speaking in front of people (Aimetti et al., 2015).
3. Disease risk: poor oral is found to increases infections and illness in people by increasing
their cardiovascular disorders, stoke chances and pneumonia.
4. Complication related to illness: poor oral health induces the complication that are related to
their present health issues.
5b) Create a list of things you will look for during the oral health assessment for Mrs
Walker (100)
Answer 5b) Oral health is an important aspect when comes to taking care of Mrs Walker, as
it could lead to caries and periodontal diseases. Moreover, that it could lead to mucosal
lesions like chelitis and worsen the quantity as well as quality of saliva (Aragón et al., 2018).
Hence, the following parameters showed be clinically assessed especially in case of people
who could suffer from oral health diseases (Masman et al., 2015). The oral health does not
take a lot of time and it could be done on a regular basis by oral health assessment tool in
which the lips, gums, tongue, saliva, natural teeth, oral cleanliness and dental pain are
checked and monitored.
Answer 5c) Mrs Walker’s daughter has an idea regarding dentures and that they expensive,
delicate and fragile that requires care and maintenance, when a person is cleaning them. For

5CASE STUDY ASSESSMENT
cleaning and dusting the dentures, cleaning solution and distinctive soft brush are required to
be used. Use of regular brushes can scratch or cut the dentures and can possibly be embraced
by bacteria. During denture cleaning, one should make sure to avoid any kind of food debris
found in the denture. The denture should be placed on a bowl full of water while cleaning in
order to avoid any kid of break in the denture if accidently dropped. If the denture is not
placed in the patient mouth, it should be immersed in a beaker containing cold water to avoid
nay deformation due to hot water. When the denture is taken out from Mrs Walker mouth, the
nurse should not forget to clean Mrs Walker tongue and gum. At least once in a day this oral
hygiene and denture activity should be performed for Mrs Walker.
Answer 6) Functional assessment is referred for Mrs Walker and will be performed by a
physiotherapist. Functional assessment is considered useful to discover if Mrs Walker is
suffering from pain during her movement, muscle strength and in active series of motion.
After assessment the physiotherapist can advise on using various actions to help Mrs Walker
instability.
Answer 7a) Dementia is not considered as a disease but is a collection of symptoms related
to failure in memory and thinking skills that eventually reduces the ability of a patient to
perform daily activities of life (ADL). There are various symptoms of dementia such as
cognitive changes include difficulty in communication, problem-solving, coordination and
confusion and psychological changes include anxiety, depression, paranoia, agitation and
hallucination. Dementia is caused due to loss or damage to nerve cells and the connections
present in the brain. There are various types of dementia like vascular, lewy body,
frontotemporal, mixed dementia and Alzheimer’s disease. Alzheimer’s disease is considered
as the common type of dementia that results due to mutation of genes and can be passed
down to another generation. The patient with Alzheimer’s disease often have tangles and
plagues in any portion of their brain that is responsible for the progression of this condition.

6CASE STUDY ASSESSMENT
Answer 7b) Palliative care is defined as the type of care that concentrates on improving and
refining quality of care and life foe the patient who are suffering from life-threatening illness,
communicating the goals of care, identification, assessment and treatment of health problems
and pain, helping the family members by preventing and relieving the patent from suffering
associated with other spiritual, physical and psychosocial issue. On the other hand, end-of-
life care is defined as the type of care that occurs during the past phase of any patient’s life
depending on clinical course and diagnosis that result in development of care plan for end-of-
life care. End-of-life care is included under the palliative care. End-of life comprises care,
support and treatment for the patient who are close to their end of life or few months of their
life. Hence, the primary objective of end-of-life care is to help the patient live comfortably
for the maximum possible time they have with them.
Answer 8a) Mrs Walker has shown no improvement in her behaviour as she was not
effectively engaging in any activities, hence it is beneficial to suggest a separate care plan in
order to assess her behaviour and to identify the primary reason, why Mrs Walker was not
engaging in any activities. As discussed with the activity officer a care plan was devised that
included few therapies to engage her attention in activities and to motivate her to participate
in these activities. Mrs Walker might be introduced to music therapy for improvement. Music
therapy has the capability to engage the patient and trigger the past memories that will reduce
their anxiety level. It is very useful for the patient suffering from dementia. Another therapy
suggested for Mrs Walker is validation therapy, which can generate a sense of trust and
empathy within her that can result in reduced stress and anxiety levels.
Answer 8b) As Mrs Walker was suffering from dementia and Alzheimer’s disease, it was
necessary for her to feel safe and comfortable both emotionally and physical to be at peace
with no anxiety and stress issue. Mrs Walker was shifted to a residential facility to promote
her safety and also to provide her with safe environment including both physical and

7CASE STUDY ASSESSMENT
emotional safety. Dementia affects the person’s ability to think and often make it difficult to
recollect few things. This reduces the patient capability to communicate, hence an
unfavourable environment can further result in be extreme stress and anxiety. On the other
hand, a safe atmosphere provides a routine with positive reinforcement and higher benefits of
recovery.
PART B
Answer 1) Carer Recognition act of 2010 was implemented to enhance the recognition as
well as the awareness about the roles of the carers in terms of giving attention and care to the
people who have certain disabilities, suffering from some medical disorder or mental illness,
and to assist people with old age (Federal Register of Legalisation, 2019). The act has been
implemented keeping in mind to avail the personalized care for the people, as the disease or
the ailment can differ from person to person. The Act has mentioned specific guidelines and
principles that could establish the importance of the Public service agencies in relation to take
all the pragmatic steps and measures so that awareness about the statement for Australia’s
Carers are well informed. The ACT has specified particular guidelines which have certain
rights in which a Carer should have as an individual and should be valued as well as
respected.
Answer 2) 3 Legal or ethical considerations included in 10 key principles include:
1. The carers irrespective of the age, sex, race, and sexuality, religious or political beliefs
should be treated with the same rights regarding choices and opportunities.
2. The carers who are young people and children should have same rights as all the other
children and young people and should be supported so that they reach their full
capacities.
3. The people who are offering care should be understood, acknowledged and treated as

8CASE STUDY ASSESSMENT
individuals who have their own needs inside them and which can be beyond the
caring role (Australian Government- Department of Social Services, 2016).
Answer 3) It is important for the carer or caregiver to treat the body of the deceased
client with dignity and respect in accordance to their wishes, which also involves
understanding and respecting the personal needs and feelings of the family members who
were related to the patient. As per the organisation’s rules and policies the legal
requirements have to be followed, for the preparation of the body. The verification of the
death should be done by the registered nurse of a general practitioner. The time should be
given to the family members, after the death of the client, which has to be followed by the
washing the feet as a part of palliative care and cleaning other body parts (Caresearch,
2019). It is essential to cover the wound and apply clean dressing, however, while
cleaning the medical devices like the syringes and other support system should not be
removed until the death has been verified by the doctor. Apart from this, the carer needs
to ensure and build trust with the family and assist them with their forward proceedings
for cremation or funeral.

9CASE STUDY ASSESSMENT
Answer 4) Personal hygiene and self-care is an important aspect when caring for a
deceased body, and standard precautions should be followed accordingly. The standard
precaution is also known as standard infection control should be applied to the person
who has deceased, which includes handling of autopsies of the body which are do not
have risks. However, the procedures should be followed according to the Mortuary
Procedures Manual that would have the proper guidance for specific arrangement for high
risk autopsies, which include wearing of protective equipment for the carer. The autopsy
and the reconstruction should be performed by wearing specific surgical clothing which
includes protective gloves, impermeable footwear and masks. It double gloves might be
required along with cut-prove gloves (Australian Government-Department of Health,
2019).
Answer 5) The loss of a person can cause immense grief in a family, death of a loved one is
one of affecting factor that could lead to shock and can be difficult for the family members to
cope up with the situation they are in (Kobel et al. 2019). Hence, the supportive structure,
education or counselling of the bereaved person, could be beneficial and also help them cope
up with the depressive circumstances. It is important as a nurse to understand and respect the
wishes of the family members, and therefore, it is important to build a sense of trust and
support in that environment. The nurse should develop better communication with the family
so that they could discuss and also give consent accordingly (Aoun et al. 2017). It is an
important step for providing better palliative care.

10CASE STUDY ASSESSMENT
References
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estimation of halitosis and its association with oral health‐related parameters in an
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Aoun, S. M., Rumbold, B., Howting, D., Bolleter, A., & Breen, L. J. (2017). Bereavement
support for family caregivers: The gap between guidelines and practice in palliative
care. PloS one, 12(10), e0184750.
Aragón, F., Zea-Sevilla, M. A., Montero, J., Sancho, P., Corral, R., Tejedor, C., ... &
Albaladejo, A. (2018). Oral health in Alzheimer’s disease: a multicenter case-control
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the-bereaved

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Caresearch. (2019). Care of the Body. Available at:
https://www.caresearch.com.au/caresearch/ProfessionalGroups/NursesHubHome/
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