Clinical Scenario: Mr Charles Williamson
Mr Charles Williamson, a 76 year old man, has been admitted to your ward for respite care. He was diagnosed with Parkinson’s disease (PD) 10 years ago. His wife, Elsie, is his primary carer. Charles’ mother died of pneumonia at the age of 78, having had PD for 22 years. He has nil other significant medical history. Charles’ PD symptoms are being managed with Sinemet CR ® (200/50 mg tablets) every 4 hours during the day.On general appearance, Charles is alert, oriented, but appears slightly anxious with a noticeable tremor in his upper limbs. During the assessment, he has a ‘mask-like’ face and speaks in a hoarse, monotonous voice. Charles’ physical exam reveals a normal blood pressure (120/72) without orthostasis. Heart rate is 76 with a regular rhythm. Charles is able to arise from a chair without pushing off with hands and there is a noticeable ‘drag/scuffing’ of the right foot, heard better than seen. His movements are slow and rigid and his balance appears to be unstable. He has had a recent fall at home sustaining bruising and a skin tear to his right lateral lower leg. He complains of constipation and a lack of appetite. It is also noted that he starts to cough when given a drink of water.Elsie informs you that Charles is ‘very particular’ about taking his PD medications ‘on-time’. Charles thinks that the effectiveness of his levodopa therapy starts to wear off after 4 hours. He says that he has relatively little ‘good time’ and he alternates between a state of immobility, requiring assistance with activities of daily living (ADL), when the effect of the medication wears ‘off’, and a state of excessive, uncontrolled movements when the medication is in effect.Charles will be admitted to the ward for 5 days and will require specific nursing interventions to successfully manage his respite care.
The case report must include the following:
Introduction (200 words)
Introduce the client and provide a brief overview of their case. Provide an outline of the purpose and structure of the report.
You might like to think about the overview of the case study like a verbal clinical handover: what is the key information from the case scenario that would be relevant for the plan of care for this client?Primary admission diagnosis (300 words)
Identify the primary diagnosis for the client (i.e. the reason the client was admitted to hospital). Provide a brief description of the pathophysiology and demonstrate how the presenting manifestations support the client’s primary diagnosis. Support this discussion using current literature (last 5 years).Nursing problems (300 words)
Use your knowledge of pathophysiology and the manifestations, identify two (2) nursing problems that arise as a result of the client’s primary diagnosis. These problems may be actual or potential nursing problems. Provide a brief description for why these problems arise for this client. Support this discussion using current literature (last 5 years).
Nursing Management (500 words)
The nursing management must focus on the nursing assessment, nursing interventions and the role of the Registered Nurse (RN) related to medication management for this client and will address the two (2) identified nursing problems.
Nursing Problem 1: Nursing assessment, nursing intervention, medication management.
Discuss one (1) method of nursing assessment that would need to be performed related to the ongoing nursing management of this nursing problem. Provide a rationale for this type of assessment and briefly describe how this assessment would be conducted in this case.
Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing management of this nursing problem. Provide a rationale for the intervention.
Discuss the role of the RN in the medication management related to the ongoing nursing management of this nursing problem.
Nursing Problem 2: Nursing assessment, nursing intervention, medication management
.Discuss one (1) method of nursing assessment that would need to be performed related to this nursing problem. Provide a rationale for this type of assessment and briefly describe how this assessment would be conducted in this case.Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing management of this nursing problem. Provide a rationale for the intervention.Discuss the role of the RN in the medication management related to the ongoing nursing management of this nursing problem.
Discharge planning (500 words)
Identify two (2) issues/challenges that you may need to address for this client prior to discharge home. Discuss how you would facilitate a multidisciplinary discharge plan for this client, with consideration to these two (2) issues/challenges?Summary (200 words)Summarise the major findings of this case report.ReferencesPlease refer to the Harvard Referencing System to accurately reference your case report
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