Wednesday, June 10, 2009

Case Review

I have an interesting case at the moment - well kind of complex

She is a 77 year old that as had numerous admissions to hospital over the last year. This admission was not directly linked to why she was referred to me. She was referred to me because she was presenting as very confused on the ward and repeating things that she had talked about already.
I went to see the patient and she presented rather "different". There was something about her that i couldn't pin point. She made a cup of milo indpendanly and safely on the ward but i chose to re-assess as i wasn't happy with the assessment data that i had gather.
I chose to do a standardised assessment - Hierarchic Dementia Scale. The results concluded that this patient had a severe short term memory impairment and mild-moderate attention/concentration, registration and long term memory issues.
From here i was concerned about the patients ability to manage in the community as she was home alone all day and was required to attend to personal cares, taking medications, and preparing lunch/breakfast throughout the day. So i decided to do a more complex functional task - preparing and light meal. From my observations she required assistance with searching and locating items (which shouldn't be problematic in a familiar environment) and remembering each instruction i had asked her to do e.g. "please can you make a pouched egg pn a piece of toast, present it on the table, and make a cup of tea to have with your meal...when you are finished can you please tidy up after you. The patient safely and Indep. prepared the meal but required prompting to tidy up. At times the patient became distracted and lost attention - pausing in the middle of the task - it was like she was thinking about what to do next - however she independently continued on with the task without prompting. I have no concerns about her ability to prepare simple meals and went back to talk to the team about my concerns about discharge

(1) - taking medications
(2) - managing finances

The team thought that a family meeting was appropriate so i went to contact the SW and family to organise this.
I got lots of useful information about the patient from contacting the family.

-The ST memory had been concerning them - she was been experiencing this for about 4-5 months however it has declined since her stroke about 6 weeks ago.

-They were concerned about her discharge location and the support that her partner could provide - as her partner had mentioned that he didn't know if he could cope with her ST memory decline - repetitiveness...

The goal of the family meeting is to
a) sort out discharge destination
b) sort out appropriate support for the patient - family or services

All will be relieved tomorrow - however this may take a bit of working with the family as it potentially could be a complex situation


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