Healthcare Assessment 7: Analysis of John Doe's CCF Case Study

Verified

Added on 2022/08/21

AI Summary

This assignment is a case study analysis focusing on Mr. John Doe, a 78-year-old male diagnosed with Congestive Cardiac Failure (CCF) and multiple comorbidities. The case study provides a detailed account of John's medical history, physical assessment findings, and current symptoms, including nocturnal hypoglycemic episodes, shortness of breath, and chest tightness. The assignment requires an understanding of CCF's pathophysiology, risk factors, and its impact on various body systems. It explores the roles of healthcare professionals, specifically the palliative care physician, RN, and family care physician, in the decision-making process regarding treatment and palliative care. The assessment also involves identifying actual and potential health problems and describing the process of addressing specific symptoms like chest tightness, while outlining the role of the Enrolled Nurse. The assignment demonstrates a comprehensive understanding of CCF and the multifaceted approach to patient care.

Assessment 7 – Three Case Studies
Instruction
 You will receive a Satisfactory (S) or Not Yet Satisfactory (NYS) result for this assessment.
 The assessment criteria are stipulated on the rubric to help guide you in this assessment.
 There are three case studies, each representing a different person with a different condition (i.e.: Congestive
Cardiac Failure (CCF), Chronic Obstructive Pulmonary Disease (COPD) and Parkinson’s disease respectively).
 Each of these case studies will be the focus of learning in the classroom, you will be provided with simulated
activities using industry documentation to enhance your learning for each of these three case studies.
 This assessment provides students with the opportunity to work collaboratively in the classroom to help prepare
them for the advantages and pitfalls of collaborative work on the job. Working collaboratively means that you
can draw upon the strengths of all group members i.e. one student may be stronger in critical thinking skills and
another may excel in organisational skills. By working in groups, students learn from each other while they
complete assigned tasks. However, you must be careful when submitting your individual assignment that you
submit your own work and do not plagiarise (refer to the Plagiarism & Cheating Policy).
 Read the given scenarios carefully and provide your response in the given space.
 You must attempt to answer all questions to demonstrate competency in this unit.
 Ensure you answer each part of the question with the required amount of detail.
Scenario – 1: Mr John Doe (CCF)
John Doe is a 78-year-old man who lived in a supported accommodation house until his physical condition deteriorated
requiring hospitalisation in 2009.
John spent several weeks as an inpatient in the sub-acute wards whilst waiting for an aged care assessment for high
level care. During this admission, John had many nocturnal hypoglycaemic episodes.
John was admitted to a high level residential aged care facility for permanent care in 2009 due to his self-care deficit. He
continued to have many nocturnal hypoglycaemic episodes as well as many during the day as he refused to eat meals
and monitor his diabetes correctly.
John has a history of:
 Congestive Cardiac Failure (CCF)
• Type 2 diabetes mellitus, he is now insulin requiring, the diabetes is classed as “brittle”.
• Bilateral pleural effusions
• Gastro esophageal reflux disease (GORD)
• Anaemia
• Hypothyroidism
• Alcohol abuse
• Aortic stenosis
• History of bilateral lower lobe and mid right lobe pneumonia
• Peripheral neuropathy
• Pancreatitis.
John’s medications include:
• Gemfibrozil
• Creon
• Thyroxine
• Aspirin
• Levemir
• Novorapid
• Actrapid

Paraphrase This Document

Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser

• Metamucil
• Perindopril
• Cholecalciferol
• Pantoprazole
Physical appearance:
• Average height – 172 cm.
• He has good color tones, pink complexion.
• He weighs 78 kg – gained 2.5kg since admission
• BMI - 28
Cardiovascular system:
• Skin on hands pick, warm and intact, no indication of cyanosis.
• Peripheral refill is under three seconds for the capillary beds in finger tips.
• Good skin turgor.
• Nails are clean, pink and dry with no indications of other disease processes.
• Left and right radial pulse rate and rhythm on the day of examination are both within normal range.
• John refused palpation of the femoral pulse.
• Unable to auscultate or palpate blood pressure, which is not unusual, GP has difficulty in finding the BP.
• No scars or pigmentation changes are present on face.
• Pale conjunctiva on examination, which is an indicator of anaemia. This is explained in the results of last full
blood examination; indicating slight anaemia (may be related to constant blood noses where large clots are
being passed mostly at night or in the morning shower). This is still under investigation at present.
• John’s mouth is pink, moist and very clean, tongue is also pink moist and clean.
• Chest shape form the anterior is symmetrical, no deformities. No scars present.
• There is an audible murmur between S1 and S2 when heart sound auscultated.
• John’s jugular vein pressure (JVP) is 5 cm, unable to visualise the carotid pulse.
• JVP alters when abdominal pressure is applied; it flickers more times during this examination. This strongly
indicative of abnormalities to the ventricle.
• The results from the echocardiogram show physical changes to the heart.
• Notes state there is a grade one impairment of the left ventricle.
• He also has both mitral and tricuspid valve regurgitation as well as severe aortic stenosis.
• These are audible on auscultation.
• No oedema present to sacral area or to lower limbs.
• Both the pedal and dorsal pulses were unable to be palpated.
• Skin to lower legs is shiny, pale and there is sparse hair growth.
• Feet and toes are pale and cool to touch.
• Peripheral refill to toes is five seconds, indicating changes to perfusion of the feet, still able to feel touch to
feet, nil complaints of pain.
Respiratory system:
• The chest appearance is normal, both sides look symmetrical and respiration rate at rest is eighteen breaths
per minute.
• No sign of dyspnoea.
• No accessory muscles used to breathe.
• No cough present and his trachea is midline.
• Respirations are normal 18 breaths per minute
• No clubbing to fingers
• Fingers are clean dry and pink in colour there is no wasting present.

• Dupuytren’s contractures present to both hands.
• Pulse rate and rhythm is regular 80 beats per minute.
• Sclera is clear in both eyes.
• Mouth is clean pink and moist, and no hoarseness or alterations to voice are audible.
Gastrointestinal system:
• On visual examination there are no obvious deformities, scars of pigmentation changes.
• No wasting or jaundice noted.
• Obvious layers of adipose tissue to the abdomen on visual examination.
• The abdomen looks normal, no scars or pigmentation changes, there is an obvious large layer of adipose tissue
on the abdomen, no distension noted.
• Visually there are no prominent veins, bruising or masses.
• Unable to palpate any organs due to the amount of adipose tissue present on the abdomen.
• Unable to percuss any of the organs for the same reason, the sound is the same dull sound across the entire
abdomen.
• Auscultation of the bowel was normal, bowel sound present with normal sounds and amount.
• No audible sounds auscultated over the general region of the liver and kidneys.
• John stated that he experienced intermittent upper epigastric pain.
• Repetitive episodes of vomiting and nausea.
• Abdominal x-rays show increased faecal loading, no obstruction
• Refused groin examination.
• No oedema or bruising present to his legs.
• Biochemistry shows a small discrepancy in his potassium and bicarbonate levels.
• Other biochemistry markers are within normal ranges
• HbA1c is 7.3 mmol/l; indicating fair control.
Muscular Skeletal System:
• Skin is pink, slightly cool to touch and symmetrical when compared side by side.
• No nodules on fingers.
• John denies pain in joints or muscles.
• Nails are clean, dry, and pink with white nail tips.
• No ridging or pitting present
• There is small round scars on the right middle and ring phalanges.
• The scars are from blisters that rise for no known reason, burst, ulcerate then heal; this condition is called
Diabetic bullae and is common to the fingers.
• Dupuytren’s contractiures on palmar surface to both hands
• The right hand is significantly more affected than the left hand.
Neurological System:
• Cognition:
• Good cognition and communication skills.
• Able to understand and follow directions for the nervous system assessment.
• Cognitive function test score of ten out of ten.
• Psychogeriatric Assessment Score (PAS) is two indicating minimal impairment
• Cornell Scale for depression completed with a zero score.
• Like his own company and spends most of his time in his room reading, watching TV and spending time with
the facility cat.
• Able to undertake his own activities of daily living.
• Able to shower, dress, groom, toilet and eat with minimal assistance.
• Denies experiencing any dizziness or seizures.

• No visual tremor.
• No muscle weakness.
• No swallowing difficulties or speech changes.
• Problematic issue with hypoglycaemia.
• Blood glucose levels drop rapidly and without symptoms, most of the time.
Deterioration of medical condition:
• Over a period of several weeks John Doe’s condition changed.
• Increased lethargy
• Increased shortness of breath on exertion
• Complaints of dizziness
• Increased nausea and vomiting
• Disinterest in food
• Oedema to ankles present
• Chest tightness
• Dry cough
• Nocturia
• Altered blood glucose levels – increased hypoglycaemia
Vital signs:
• BP 114/61
• Pulse 76
• Respirations 18
• Temperature 36.6
• O2 saturations RA 97%
• Height 172cm
• Weight 78kg
Medication changes:
• Lasix 80mg daily PO
Conservative medical treatment:
• Due to current multiple co-morbidities John Doe was not considered to be a candidate for valve replacement
surgery.
• Palliative approach to care was undertaken.
Qs
1 Define CCF
Congestive cardiac failure refers to a chronic health condition characterised with fluid build-up
around the heart that eventually impairs its pumping mechanism. The incapability of the heart to
effectively pump the required amount of blood leads to peripheral or pulmonary oedema.
2 Describe the pathophysiology of CCF
Congestive cardiac failure is a condition that is caused by many abnormalities such as a decreased
efficiency of heart muscle, pressure and volume overload, primary or excessive peripheral demands
like a high output failure. These are caused by various conditions like hypertension, myocardial
infarction, and amyloidosis. These conditions gradually augments the workload that will bring about

Paraphrase This Document

Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser

Qs
modifications to the heart. In a usual heart failure, the cardiac muscle has decreased contractility,
which in turn produces a decline in cardiac output that becomes insufficient to address peripheral
demands of the body.
3 Describe the ageing process on the cardiovascular system.
The heart act as a natural pacemaker responsible for controlling heart beats. Some pathways of the
system also lead to the accumulation of fat and fibrous tissue. The natural pacemaker (SA node)
gets depleted of several cells that decrease the heart rate.
4 From John’s history, what are two risk factors associated with CCF?
- High blood pressure
- Diabetes mellitus
5 Name two (2) other body systems directly affected by CCF. Identify two (2) signs and symptoms that
John is experiencing that relate to these two (2) other body systems you have identified.
His respiratory system might have been affected by CCF and the associated signs and symptoms are
shortness of breath on exertion and chest tightness
CCF also affected the gastrointestinal system, as evidenced by signs of vomiting and nausea, and
disinterest in food.
6 Describe the pathophysiology of three (3) signs and symptoms John is experiencing in relation to his
CCF and deterioration of medical condition.
John is reporting signs and symptoms of shortness of breath on exertion, chest tightness, and
dizziness. These symptoms are due to pulmonary congestion. The condition occurs when the left
ventricle is unable to effectively pump blood to the body. Congestion of blood in the left ventricle
decreases the flow of blood from the pulmonary vessels thereby increasing the pulmonary blood
volume and pressure rise. Fluid is forced out of the pulmonary capillaries impairing gaseous
exchange.
7 Explain the role of three (3) different members in health care team during the decision to withhold
valve replacement therapy surgery for John and to refer to palliative care treatment. Describe each
member’s duty of care to John?
Palliative care physician: The palliative care physician provides information about the patient’s
health and refers palliative care services if necessary and improves the quality of care by preventing
and alleviating suffering
The RN: Ensures provision of comfort and relief of pain. The RN is responsible for recording,
monitoring and reporting changes or symptoms of the patient. Other responsibilities include
maintaining patient report, medication administration, diagnostic tests, preparing patients for
assessment and giving advice to families.
Family care physician: Provides information about the patient’s health and refers palliative care
services if necessary.
8 From the physical assessment above, identify two (2) actual and two (2) potential problems
regarding John’s health status (you may decide to choose one problem from each body system
listed).
Two actual problems are nocturia and shortness of breath

Qs
Two potential problems are respiratory distress and loss of consciousness or seizure due to high
blood glucose levels.
9 From the physical examination above, describe how you would refer John’s chest tightness in line
with organisation requirements. Explain the role of the Enrolled Nurse in this process.
John has a pressured chest pain. Role of enrolled nurse include; oxygen supplementation, patient
education on signs and symptoms, and enhancement of patient self-management.
Additionally, the nurse must also reduce anxiety by exploring the implications given by the diagnosis
and providing necessary information to the patient about the illness, severity of the illness,
treatment approaches available and monitor their vitals and conduct laboratory values and ECGs.
10 Explain the significance of the medication change. Your answer should address how Lasix helps
John, and explain in detail the Enrolled Nurse’s role in monitoring the effect of Lasix. Please provide
one (1) example of when a nurse may need to withhold Lasix and who should the nurse report this
to.
Considering, the severity of the patient’s condition, it is important that his vital signs such as blood
pressure is monitored since it can drop due to the new medication.
The patient’s signs and symptoms such as dizziness that relates to blood pressure must be observed
and monitored.
Patients tend to fall due to low blood pressure, thus, these signs must be monitored.
Fluid chart of the patient must be checked.
Lasix should be withheld when there is a change in blood pressure. The nurse should report the
problem to the attending physician.
11 Identify two (2) impacts on John that may be caused by health interventions (iatrogenic).
 John may have an increased risk of fall due to a lower blood pressure.
 John may suffer from disturbed sleep since his blood sugar is not stable.
Scenario – 2: Rudy Muir (COPD)
Rudy is a 56-year-old male with a primary diagnosis of Multiple Sclerosis (MS). He also has chronic obstructive
pulmonary disease (COPD) and bipolar affective disorder. Rudy has a supportive family, his elderly mother visits twice a
week. Rudy grew up in the country and worked in agricultural clearing (burning) of waste crops.
Rudy has a sister in Adelaide who visits for several weeks a year. Rudy was admitted to the residential aged care facility
in 1996, due to his disease process and need for full physical assistance with all activities of daily living. There are very
few activities of daily living that Rudy can still manage independently.
• It is suspected that Rudy’s disease process was exacerbated by the trauma of seeing his sister pass away in a
tragic accident which Rudy witnessed.
• Rudy has a permanent indwelling catheter due to urinary retention.
• Rudy is a past smoker; he smoked a packet of cigarettes a day for approximately 20 years.
Multiple Sclerosis
• Multiple Sclerosis is a disease of the central nervous system that is progressive.
• It is a process where the myelin sheath on neurons is inflamed and irritated leading to progressive loss of
myelin cover which impedes the flow of messages along the neuron.
• Rudy has been in the residential aged care facility for the past 16 years due the progressive nature of the

disease
Bipolar Disorder:
• Bipolar disorder is a major psychological disorder that fluctuates between episodes of mania and depression.
• One phase is usually dominant at a time followed by the other.
• Rudy often has more manic symptoms than depressive, typically evidenced by ideas of grandeur and
excessively fast thought processes and very little sleep.
• Rudy also exhibits verbal aggression and physical agitation, often verbally abusing staff when in the manic
phase.
Chronic Obstructive Pulmonary Disease: (COPD)
• Chronic Obstructive Pulmonary Disease is a chronic, irreversible and progressive disease involving reduced
inspiration and expiration.
• COPD has associated symptoms – coughing, excessive sputum production, two of the main issues Rudy has.
Allergies:
• Allergies: Rudy has allergies to all types of adhesive tapes and dressings.
Change in condition:
• At morning handover night duty staff reported that R was a little off and had been for the last day, no other
information was given.
• Medications were given at 0900hrs which Rudy swallowed well, Rudy did not respond as he would normally –
affect low, mood labile and Rudy stated he was tired.
• Medication round finished and returned to Rudy for a full assessment.
Medications:
• Carbamazepine
• Hexamine Hippurate
• Esameprazole
• Baclofen
• Senokot tablets
• Movicol
• Olanzapine
• PRN Medications:
• Paracetamol
• Salbutamol
Cardiovascular system:
• Heart sounds auscultated, unable to hear any heart sounds.
Observations:
• Respirations 20 rpm Pulse 115 bpm and bounding
• BP 120/85
• Temperature 37.5 degrees
• Oxygen saturations 95% RA.
• Rudy began to shiver during the examination, moist cough present at end of examination.
• Nil complaints and no non-verbal indicators of pain or discomfort from Rudy.
• Rudy at high risk of chest infections and pneumonias, concerned symptoms were early onset.
• Staff made aware of Rudy’s potential to deteriorate and temperature checks set for 30 minute intervals.
• Frequent observation chart commenced.
Plan:
• GP contacted via phone, discussed Rudy’s symptoms and observations.
• Bloods ordered ESR, CRP, FBE and U&E’s.
• MSU to be collected.
• Plain view chest x-ray ordered, report if temperature rises above 37.5 degrees.
Plan:

Paraphrase This Document

Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser

• Rudy’s temperature by 1115hrs had risen to 39.2 Celsius degrees, with rigors at the time.
Interventions:
• Cool cloths applied to bring temp down, window opened, bed linen removed.
• 1gm Panadol administered prn.
• GP contacted again.
• Augmentin Duo Forte 500mg BD ordered.
• Blood tests booked for next day.
• Antibiotic arrived at 1230hrs and first dose administered to Rudy.
• MSU obtained when indwelling catheter blocked, IDC changed.
• X-ray taken and Rudy returned to facility by 1545hrs.
• Rudy very unwell on return to ward.
• Excessive sputum production, instigated changes to fluid consistency to facilitate less chance of aspiration.
• Rudy’s temperature was 38.5 degrees by 1800, and his oxygen saturations had dropped to 89% RA.
• O2 therapy commenced at 3Lpm via nasal prongs, saturations returned to 95%.
• All oral intake refused.
• Rudy complained of nausea and upper abdominal pain.
• Deterioration of Rudy’s condition was discussed with family – decision for Rudy to be transferred for further
treatment.
Condition deteriorating:
• On-call GP assessed Rudy at 2110hrs.
• Chest x-ray clear.
• Audible rhonchi inspiration /expiration post pharynx / larynx
• Abdominal soft, non-tender.
• Bowels open X2.
• Poor cough effort.
• Prednisolone 50 mg for 5 days.
• Add Ventolin nebuliser & Atrovent nebuliser to reduce secretions.
• Keep resident at the unit.
• GP reviewed on 22nd March
• Chest X-ray indicated nil infection, elevated right hemi-diaphragm.
• One course of Rulide 300mg added.
Qs
12 Define COPD
According to Qureshi, Sharafkhaneh and Hanania (2014) Chronic obstructive pulmonary
disease (COPD) refers to a prevalent and treatable disease characterised with chronic
inflammation of the airways causing breathing difficulty, increased mucus production,
coughing and wheezing.
13 Describe the pathophysiology of COPD
The pathophysiology of chronic obstructive pulmonary disease (COPD) encompasses the adaptive
and innate and adaptive inflammatory response of the immune system to the toxic materials and
gases that are inhaled. The changes in immune inflammatory response, in relation to COPD are
correlated to a process involving tissue-remodelling and repair that leads to the production of
mucus, thereby leading to emphysematous obliteration of the lung surface that exchanges gases
(Tuder & Petrache, 2012).
Emphysema refers to the physiological ailment that affects the alveoli in which its fibers are

Qs
damaged, thereby lose their elasticity and are not able to recoil during exhalation. This makes it
difficult for the carbon dioxide to be removed out of the body. Bronchitis results if the lungs become
inflamed. Increased mucus production follows, and if the bronchitis prolongs, chronic bronchitis
develops.
14 Describe the ageing process on the respiratory system.
During aging, the respiratory muscles reduce in strength, thus weakening effective coughing which is
vital for clearance of the airways. There occurs an increase in alveolar dead space thusaffecting the
arterial oxygen levels in the blood. With aging
15 From Rudy’s history, what are two risk factors associated with his COPD?
The fact that Rudy is middle aged and has a history of smoking makes him more susceptible to COPD.
16 Explain the significance of the results for each of the following tests ordered by the doctor:
 Blood test
 MSU
 Chest X-ray
Blood Test-
Blood test was carried out to check the Levels of blood gasses.
The blood test helped in examining the lungs for blood infection.
Blood check also helped for finding the electrolyte imbalance.
Mid- Stream- Urine
Urine culture and sensitivity test was performed to check for Urinary Tract Infection.
Chest X- ray
More structural problems of the lungs as a result of emphysema can be seen on X-ray.
17 Identify one (1) responsibility the Enrolled Nurse has for each of the above tests.
Blood test
 It is the duty of the EN to label the blood taken in the test tube by mentioning the
patients name and date.
 It is their duty to send the blood to the laboratory and should remember to send it on
time.
 The EN should ensure that that the test tubes in which the blood will be stored is safe
from any pathogen and they should ensure that the surrounding are is clean from
pathogens.
 The EN will elaborate on the procedures which will be conducted on the patient. If any
kind of test like checking glucose level or measuring RBC count or any testing will be
conducted, then it is mandatory to describe them to the patient.
MSU (Midstream specimen of urine)

Qs
 The EN should ensure that while conducting the MSU test, all the personal details
collected from the patient is correct.
 The EN will elaborate on the procedures which will be conducted on the patient. The EN
should ensure that the patient knows the steps which will be taken.
Chest X – ray
 The EN should make sure that the patient is comfortable and they are not experiencing
pain.
 The EN will also conduct documentation procedure.
18 From the physical assessment above, identify two (2) actual and two (2) potential problems
regarding Rudy’s health status (you may decide to choose one problem from each body system
listed).
It has been seen that Rudy has been experiencing breathing issue and used to require help with daily
living. This would become a potential problem for him.
When he would not get help with daily living, he would require him to move alone even after having
multiple sclerosis. MS will limit his movement. As a result, it will either increase his blood pressure or
may decrease it, which can be severe for him.
Because of his age and his condition, he will have a low bowel action and as a result it will lead to
constipation.
Also, his condition will most certainly make his mobility limited. It can impact on Rudy’s hygiene and
thus skin infection may occur.
19 From the physical examination above, describe how you would refer Rudy’s high temperature in line
with organisation requirements. Explain the role of the Registered Nurse in this process.
Temperature is a vital sign which is required to be measured whenever any patient is admitted. From
the physical assessment of Rudy, it can be seen that the initial temperature was 37.5OC which later
gradually increased to 39OC ~ 102.2OF. Also, high temperature can result in increased breath rate.
Thus, it was necessary to reduce the temperature back to normal.
The RN can help Rudy with the following things –
 RN is responsible with evaluating the medication chart and can give medicines to Rudy.
 The RN will review the patient’s health condition and would suggest further actions to
the junior nurses who are taking care of Rudy.
 The RN will check the vital signs of Rudy frequently to see if his health is improving or
worsening.
 The RN can look after ADL because patient will need to go to the patient toilet often
because of fluid intake.
20 Explain the significance of the four medications ordered when Rudy’s condition deteriorates. Your
answer should address how each of the four medications help Rudy, and explain in detail the
Enrolled Nurse’s role in monitoring the effect of each of these four medications you have identified.
Also describe one (1) caution for each of the four medications.
a. Augmentin
Nurse role- observe for signs and symptoms of anaphylaxis, asses for infection and

Paraphrase This Document

Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser

Qs
monitor bowel function
Caution- use cautiously in patients with renal insufficiency
Help – It will help in treating different infections such as sinusitis, pneumonia, and many
more.
b. Prednisolone
Nurse role- assess client for sings of adrenal insufficiency
Caution- use cautiously in adrenal suppression
Help – It is a corticosteroid. It inhibits the release of inflammatory substances.
c. Atrovent
Nurse role- monitors respiratory status before administration
Caution- used cautiously in patient with glaucoma, prostatic hyperplasia
Help – It will relax the oesophagus muscles and will increase the air flow to the lungs.
d. Rulide
Nurse role- check for allergic reactions such as skin rash, shortness of breath and
itching.
Caution- used cautiously in patients with kidney failure and liver problem
Help – It will help in treating respiratory tract infections, and skin and soft tissue
infections.
21 Identify two (2) impacts on Rudy that may be caused by health interventions (iatrogenic).
The two problems that can occur as a result of health interventions are -
 Nausea and abdominal pain
 Long, adventitious and continuous sounds produced due to obstruction in the
respiratory passages.
Scenario – 3: Jayne (Parkinson’s disease)
Jayne is a 75-year-old retired school teacher. Widowed for 12 year and diagnosed with Parkinson’s Disease 15 years ago,
she has two adult children who both live overseas. Jayne lived alone at home until 2014 when she had to enter
residential care due to her increasing debility.
Medical history:
• Parkinson’s disease
• Diverticulitis
• Osteoarthritis both shoulders, right knee & left ankle
• # (R) NOF surgical repair 2010
• Anxiety
• Depression
• Subdural haematoma 2016 resulted from a fall in her bathroom
Vital signs:
• BP 120/62
• Pulse 90

• Respirations 16
• Temperature 36.2 Celsius degrees
• O2 saturations RA 98%
• Weight 50kg
• Height 156cm
Cognitive:
• Increased anxiety and worry
• Increased fatigue
• Sleep disturbances present
• Visual and auditory hallucinations especially at night
• Confusion & disorientation present
Autonomic:
• Complaining of being too hot
• Constipation
• Dyspnoea
• Nausea
Sensory:
• Akathasia during the day
• Increased generalised pain at night
Medications:
• Madopar
• Siferol
• Calcium and Vitamin D
• Paracetamol
• Serequel
• Maxalon
• Osmolax & Senokot
Signs:
• Resting tremor to both hands and the right leg
• Speech slurring more pronounced
• Right foot drag on ambulation
• Poor balance
• Short shuffling gait with frequent ‘freezes’
• Backward tilt when standing
Signs:
• Affect is flat
• Incontinence of both urine and bowels is occurring, especially overnight
• Increased muscle rigidity to passive movement
• Loss of facial expression
• Increased history and risk of falls due to postural instability
• Jayne is now full assist with all aspects of physical care including hygiene, dressing, grooming and oral care
• Jayne requires full assistance with all aspect of care with toileting – requires continence aids at all times
• Jayne has lost weight, nutritional supplementation has been introduced.
Qs
22 Define Parkinson’s disease.
According to Sveinbjornsdottir (2016) Parkinson’s disease is thought of as a nervous system disease