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CARE OF A CONFUSED CLIENT
Human Immunodeficiency Virus (HIV) is a virus spread through body fluids and effects cells of the immune system called CD4 cells or T cells. HIV destroys these cells reducing the body’s ability to fight infection. When this happens the HIV virus is then knows as acquired immunodeficiency syndrome (AIDS). When a client has AIDS they can have symptoms such as forgetfulness, confusion and difficulty paying attention. This occurs when the HIV virus has infected the brain causing a condition known as AIDS Dementia Complex (ADC). When a client presents with ADC as a healthcare provider the key aspects of writing up these clients care plans would have a strong emphasis on safety. (Centres for disease control and prevention 2014)
John not his real name for privacy reasons is a client who recently presented to the facility where i work with AIDS and has been showing signs of ADC which has made his home life very hard to manage and increasingly unsafe. The ADC has left John with episodes of confusion. As a new client i must first put together Johns care plans as they are vitally important in determining Johns care. These care plans also assist the multidisciplinary team ensure Johns mental and physical needs are met.
As a confused client, John may lack the capacity to process the basic activities of daily living (ADL). Therefore as a healthcare provider i would also have to act as an advocate to ensure his needs were met. This can be ensured on a day to day basis by gaining the respect of John and by including him and by gaining his consent on any decisions concerning his care. This may include implementing all relevant care plans. John’s personal hygiene is important in promoting his positive self-image. This can be achieved by the following steps:
- Always ensure his hands are washed after toileting
- His face is washed daily
- He has regular baths or showers
- His teeth are brushed twice daily
John may not want to allow me to carry out some of these duties but to ease the situation i may take a few steps to help in Johns care.
- Use pleasant smelling shampoo, bubble bath or soap
- Play music that John likes
- Always explain as you carry out tasks
- Be sensitive to Johns mood
- Always check toilet to ensure it is in working order and the bathroom is not too cold
- Enquire how John prefers to have these tasks completed (ie bath or shower)
- Always let john help as much as he can
Nutrition care is also very important because the healthier John is physically the less confused he may become. This can be achieved by ensuring John eats regular meals. Sometimes because John is confused he will refuse to eat so it is important the nutritionist is informed in order to provide supplements which can substitute for solid foods. This is vitally important as to force feed clients is unethical so therefore it would be more beneficial to encourage supplement drinks.
A urinary output and bowel movement chart is also an essential part of Johns care plan as it helps the multidisciplinary team regulate John’s bodily functions to prevent him from getting constipation or dehydration which would leave John who is confused more confused. Sometimes John may not have the ability to control his own intake of solids or liquids (ie too much or too little) so it is important for a fluid and solids chart to help balance his bodily needs.
Falls risk assessments should also be completed and put in practice to ensure Johns safety when he is carrying out his basic activities of daily living.
- Always assist John when he is attending bathroom or having to move from one area to another
- Ensure bathroom is clear of clutter when taking John to bathroom for washing or toileting
- Remove all clutter from Johns bedside (ie ensure all cables are tidied away and walking frame if needed is within his reach )
- Ensure John has suitable footwear (ie good fitting with rubber soles to prevent slips)
- Ensure all bathroom fittings are stable and in good working order
- Proper handrails are in place to assist Johns needs
- Walking to and from bathroom is clutter free
Other concerns i might have for John is the risk of him developing a pressure sore. Confused/Immobile clients like John are more susceptible to pressure sores through poor nutrition intake and decreased mobility. Measures put in place by the multidisciplinary team to prevent these sores are pressure relieving cushions, mattresses and regular monitoring, and turning of John as to aid his circulation. The Waterlow scale also plays important role in determining who is at risk of developing a pressure sore.
All these measures put in place will enhance the physical well-being of John however as healthcare support workers we must provide holistic care for John involving his social and mental well-being. One aspect of holistic care is ensuring John’s spiritual needs are met. This may vary from individual to individual and as a carer we must never be bias towards a client’s personal belief.
John’s dignity is vitally important but this may lack because he sometimes gets confused therefore i must act as an advocate and ensure his rights and dignity are met. Simple measures can include making sure privacy is provided when attending personal hygiene needs. At times John may lack the ability to be able to stand safely. Therefore a hoist may have to be used. This could be a frightening experience for John so as the carer it would be vital to use good communicating skills to reassure him of his safety and dignity by insuring the curtain is drawn at these times. Regular checks of John to ensure he remains properly clothed so as to prevent embarrassment for him or his loved ones during visiting times. As John’s carer I would always explain and involve him in decision making involving his clothing when dressing or the type of food he prefers to eat as not to presume I could choose just because he sometimes gets confused.
When a client has ADC the usual treatment is a drug cocktail called highly active antiretroviral therapy (HAART) which reduces the amount of HIV in the blood reducing the damage to the brain. As a carer it is important I monitor the consumption of this medication as John might forget to take it or take too much. Other important factors in treating a person with ADC are to help John stimulate his mind by motivating him with hobbies that he is interested in. It is also important to ensure the family include John in social events such as birthdays, weddings or any event for which he could attend to interact. Interaction, motivation and other therapies that are all beneficial in reorienting a confused client.(WebMD2014)
On conclusion by involving John in decision making and implementing the relevant care plans I the carer will ensure holistic safe care and optimise his ability to recover or manage his illness. This is achieved through good communication trough the multidisciplinary team always remembering that John and Johns family are the most important factor of the team.
Centres for disease control and prevention (2014) what is hiv [online],available:http://www.cdc.gov/hiv/basics/whatishiv.html[12/12/2014].
Webmd(2014)hiv and dementia [online],available:http://www.webmd.com/hiv-aids/guide/hiv-dementia[9/12/2014].
Creative training (2013)”healthcare assistant traineeship”,5n2770:care skills, Dublin:solas.
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