As part of the FETAC Level 5 Major Award in Healthcare Support the author was asked to do this assignment on Care Skills covering all aspects of caring for a confused person. The model of nursing assessment -Logan, Tierney and Roper will be used to assess the client’s needs.
Methodology will include class and tutor notes along with independent research conducted on the Internet and information from Creative Training’s Module learner book.
The client used for this assignment is Peggy, living in her own home with mild stage of Alzheimer’s disease. The client’s name has been changed to maintain confidentiality.
Peggy is a very outgoing person who enjoys horse racing, bingo and Irish music. Peggy is a roman catholic and attends mass every Sunday morning.
Alzheimer’s Disease (AD)
‘Alzheimer’s is a type of dementia that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks’(Alz.org, 2014)
AD starts off gradual but gets worse and worse overtime it is classed as having 3 Stages
Mild – Moderate – Severe
Peggy is in the mild/early stages of Alzheimer’s which means it is possible for her to continue to do lots of things under supervision bearing in mind this will change over time.
Mild stage AD
Gets confused in new places
Finds it hard to make decisions when rushed
Repeats things a lot
Forgets things easily
Lack of interest in activities
Gets frustrated and angry easier
(Alzheimer Society of Ireland, 2014)
Question 1 Development of a client profile and assessment of individual client needs.
Peggy is a 75 year old female with mild stages of Alzheimer disease living in her own home because of AD she is very confused. Family has assigned a Nurse and a Healthcare Assistant to help with her needs as well as rostering set days and nights that they will partake in her care alongside a multidisciplinary team (Patient, family, GP, nurse and a healthcare assistant). From meetings with Peggy and her family and MDT – it has been decided that she needs a holistic, person-centred approach for her care plan.
INDIVIDUAL CLIENT NEEDS ASSESSMENT
A holistic approach to care is always advised for Alzheimer’s patients after a thorough PIES analysis – for Peggy it shows:
Assessment of clients home – safety measures that need to be put in place
M.U.S.T analysis is performed – diet adjustments made and food intake monitored
Regular exercise and activities with the client completed
Try to create a regular sleep pattern
Ensure client has the correct non slip footwear when leaving the house
Assessing client at home – seeing what they can do for themselves and encourage the client to do as much as they can to ensure not to in still helplessness.
Try to find topics to talk about that interest the client and create a reminiscence book or other photo book with them.
Puzzles and other problem solving activities can be played when the client is confused – it can help to focus the mind.
Talking to the client – regardless of the topic
Ensure they feel safe and secure and gain their trust
Assign small tasks for them around the house and ask them to assist you in doing chores – such as folding tea towels or sorting socks – helps to make them feel useful and wanted
Allow the client to lead in decision making regardless of the task – such as picking out clothing, hair style, makeup etc
Note any personality changes as this can be a sign of the disease progressing
Encourage family members to visit regularly
Try to get the client to attend day care centres and research any activities they are interested in to see if they would like to attend – such as bingo or card games, horse racing meetings etc
The client is very religious – determine whether she would like to attend mass and if so on what day.
Prayers may be said throughout the day in the home – such as the rosary
Determine the level of assistance required to complete activities of daily living
Feeding – Can feed herself – food and fluids documented (intake and out-take chart)
Toileting – Manages toileting – any changes monitored as can change if AD progress’s
Selecting appropriate clothing (attire) shoes slippers etc – assistance needed
Grooming – help with hair curling
Continence maintenance – Monitored as can change if AD progress’s
Putting on clothes – can get confused needs some assistance clothes laid out in order helps
Showering – some assistance needed
Walking – mobility good Morse fall scale 0
Finance management – needs assistance gets a little confused with counting money (old money)
Transport – individual not allowed drive roster done out to bring individual places by family and close friends
Shopping – supervision needed as gets confused unless guidance given in shop and gets lost easily
Meal preparation –supervision needed
Telephone and other communication devices – Assistance needed
Medications management – supervised and documented by nurse at all times
Housework and basic home maintenance –assistance with housework – home maintenance directed by Peggy done by family
Sleeping and resting – very confused when she wakes up especially during the night one of the team stays over and night light left on during night
Maintaining a safe environment
Medications in a locked safe place as Peggy sometimes forgets she has taken her medication nurse allotted to give out medication when needed.
Lighters in a safe place
No lock on bathroom door
Good housekeeping no clutter or loose cables minimising slips trips and falls
Handrails in bathroom
Non slip mat in bath
Radiator covers to prevents burns
Supervise individual when cooking to minimise burns/scalds
Promote client involvement in social events and therapies
Telly bingo with family and friends
Individual loves horse racing days out to local racecourse with family
Day care centre Portlaoise where Peggy has attended for a number of years offers one day a week sessions with loads of different things to do ie hairdresser on site, make and do, chiropodist on site.
Old folks Christmas party annually
Creating a reminisance book of past photos of family and friends gatherings and events
When weather is good peggy likes to help out with gardening(weeding and potting plants)
Peggy’s cd collection is played for her daily as it always brings a smile to her face
Mobility including falls and pressure area care
Individual mobility good at moment but watched closely as can deteriorate in Alzheimer’s patients as disease progress’s
Morse Falls Scale result 0 at present.
To minimize pressure sores
Good nutritious diet using the food pyramid
If individual mobility deteriorates check all pressure areas every day for redness
Use of air mattress to help prevent pressure area sores
Gel cushions in chair
If client becomes bed bound to be turned every 4 hours
Constantly checking pressure areas
Risk assessment done on house to minimize falls
Good housekeeping to prevent slips trips and falls
Floors not polished
Non slip floors in bathroom
Spills cleaned up as they happen
If any falls occur they are documented and individual checked out by nurse /GP(Morse fall scale form updated
Effective verbal and written communication with client and Health care team
Always use their name when talking to them and say who you are
Get down to eye level with client and keep good eye contact as this helps them focus
Speak clearly and one idea at a time as to not confuse them more
Do not speak to them like a child
Listen carefully to client without interrupting
Listen for clues when client is trying to tell you something
Don’t rush client when they are trying to say something
Use body movements tactfully to try explain things to them by pointing to things or acting out what you are going to do with them
Include patient in conversation and decision making(may change overtime)
Don’t treat client as a child
Try keep their sense of humour going by having a laugh with them
Always hold their hand if they are feeling sad as the touch connects them to you emotionally without invading their personal space
Make sure their glasses and hearing aids are working for them correctly as this will play havoc with communication
(Alzheimer Society of Ireland, 2014)
Handovers done on person change over
All healthcare team have been told of all changes to care plan promptly
24 hour diary kept and handed over at handover
Appointments for Peggy kept in diary
Assist clients with activities of daily living
Give a choice with clothes Peggy would like to wear
Assist with shower but let Peggy do as much as she is able keeping her dignity by covering parts of her that are washed as you go
Assist with meal preparations and cooking
Nurse assists Peggy with medication
Assist with housework and laundry
Assist with shopping
Curl clients hair the way they like it promoting positive self image
When assisting with activities of daily living let client do what they are able to handle and it gives them a sense of independence and self worth
(Alzheimer Society of Ireland, 2014)
Promote the rights of the clients to dignity, privacy, independence and positive self image
Making sure client is dressed appropriately
If client is getting washed make sure no one walks in on them
Always knock on clients bedroom door and wait for a response before entering
Privacy and confidentiality contained at all times
Personal information not disclosed to public
When family call over give them some space and time alone with client
Always inform client of what the agenda is for the day and let them make their own decisions
Let client do as much as they can even if it means it is time consuming
Let client help out with light house work if they are willing
Positive self image
Hair curled the way they like it
Let them pick out their clothes
Compliment them when they look nice
Let them use their soaps, shampoos etc that they like ie imperial leather is a personal choice for peggy
If they like their nails painted help them do them
Always make sure they have their false teeth in during the day
Sorrentino, S. (2008). Mosby’s textbook for nursing assistants. St. Louis, Mo.: Mosby/Elsevier.
Search.yahoo.com, (2014). food pyramid – Yahoo Search Results. [online] Available at: https://search.yahoo.com/search?fr=mcafee&type=B211IE662D20140712&p=food+pyramid [Accessed 27 Nov. 2014].
Search.yahoo.com, (2014). pressure areas – Yahoo Search Results. [online] Available at: https://search.yahoo.com/search?fr=mcafee&type=B211IE662D20140712&p=pressure+areas [Accessed 27 Nov. 2014].
Alz.org, (2014). Alzheimer’s Disease & Dementia | Alzheimer’s Association. [online] Available at: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp [Accessed 14 Dec. 2014].
Alzheimer Society of Ireland, (2014). About Dementia – Alzheimer Society of Ireland. [online] Available at: http://www.alzheimer.ie/about-dementia.aspx [Accessed 14 Dec. 2014].
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