ASSIGNMENT 2
When someone has to spend long periods of time in a bed or chair, she may be vulnerable to developing pressure sores. These sore occur in areas where the skin and underlying tissue are compressed between a surface and the bone, cutting off the blood supply to the affected area.
Causes of pressure sores:
Residents may be vulnerable to pressures sores if:
- She remains in one positions for too long,
- She has lost a lot of weight through illness, poor nutrition and therefore has less body fat cushions the bones,
- There is friction on the skin, cause by the top sheet being too thigh or by her being dragged across the bed, especially if her skin is not clean and dry (Helping You To Care Handbook-Irish Red Cross).
Mrs Olive was born 10.10.1923. She is a widow. She has a two children (1 daughter and 1 son) She came to the Nursing Home on 11.09.2006.
Her diagnoses:
- Hypertension,
- Hypothyroidism,
- Dementia,
- Osteoporosis,
- Hypercholesteremia,
- Multiple Falls.
Physical Needs
Breathing
Yes
Eating and Drinking
She is on soft diet. She needs feeding by care assistant.
Communication
She doesn’t talk to much. We have to communicate with her in both the verbal and non-verbally for example body language.
Washing and Dressing
She is unable to continue his personal care. She needs help for washing, dressing.
Sleeping
Her normal sleeping pattern is up to 10hrs and her usual bed time is 21:00-22:00.
Mobilisation
She is not able to walk. She needs assistance for sitting, turning, using toilet. She needs help to transfer her from bed to chair as well.
Working and Playing
Yes ( activity occupancies in the dayroom)
Expressing Sexuality
No
Olive has high risk for pressure sore. Pressure sores occur in places where the bones are very near the surface of the skin. The weight of the body reduces the blood supply to skin tissues, causing the skin to change colors, initially to a pinky red. Olive’s weight is 34,2 kilograms. Her skin is very delicate. It is getting broken and bruised very easily. Sometimes we have to use dressing to help protect her broken skin. She is using pads. She has to use air mattress and change her position every 2 hours.
Waterlow Score- Pressure Sore Risk for Olive:
BUILD/WEIGHT FOR HEIGHT: BMI>20. (score 3).
SKIN TYPE, VISUAL RISK AREAS: tissue paper (score 1).
SEX: female. (score 2).
SEX/AGE: female (score2)/ 81+( score5).
CONTINENCE: urinary+ faecal incontinence. (score 3).
MOBILITY: restricted(score 3).
SPECIAL RISKS: diabetes, MS, CVA. (score 4- 6).
Total score: 23= VERY HIGH RISK FOR PRESSURE SORE.
Emotional Needs
Olive is very quite person. She hasn’t to many visitors.
But she spend a lot of time with other people in the dayroom. She needs to be loved.
Social Needs
Before she likes talk with people but now she doesn’t talk to much. Sometimes she does not understand what is being said to her. We have to explain everything what we doing very slowly. Because she has memory loses she doesn’t know about day, place, time and who is who.
Intellectual Needs
Because of dementia she has communication problems (decline in the ability to talk, read and write).
Spiritual Needs
Olive is devoted R. C. Before was attending mass on every Friday in Nursing Home, but now she is attending occasionally with the residents.
Level of assistance required:
- Olive can’t drink and eat herself. Sometimes when she is not able to drink from glasses we using a biker for her,
- She is not able to walk- we use wheelchairs for her,
- She hasn’t hearing aids, glasses and dentures.
- She has to use air mattress.
Course of actions for Olive:
1. Preventing pressure sore:
- Encourage the person to get out of bed as much as possible,
- Encourage her to move regularly,
- While in the bed We need to change her position every two hours,
- We use special mattress,
- Never allow her to lie or sit in wet or dram conditions,
- Make sure the bedding is not irritating the skin and wash the bedclothes regularly,
- Ensure that she is eating a balance diet (soft diet, milk).
2. To keep to a regular bedtime routine.
3. Provide emotional and psychological support.
4. Always encourage her to participate in some activities to make her more pleasant.
5. We have to be patient, open and honest.
REFLECTIONS
After FETAC course:
- I can better understanding physical, social, emotional, intellectual and spiritual needs of the client, referring to needs that are being met and those that are not,
- I have found out more information about pressure sore and prevention.
- Now I can provide the best and more rewarding care,
- I can use this information not only in my work but also in my daily life.
Bibliography:
1. Osteoporosis understanding, preventing overcoming, prof. J. Plant CBE and G. Tidey, 2003.
2. When someone you love has Alzheimers’s, The Caregiver’s Journey, E.A Grollman and K.S. Kosick, 1996.
3. Helping You to care- Irish Red Cross, 2007.
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