Week 4 Case Study Presentation- Ertha Williams
Ertha Williams is 74 years old, retired, and living with her husband Henry. Henry and Ertha had one son who was killed in the war 10 years ago. They have a daughter-in-law, Betty, who is a nurse, and one grandson, Ty. Ertha and Henry have experienced a lot of change in the past year. Henry was hospitalized with COPD and became more and more concerned about Ertha because she was experiencing frequent memory lapses. They were recently able to get an apartment in an assisted living facility. Neither of them can drive.
Ertha describes her journey over the past year. She talks about Henry’s hospitalization and says she doesn’t know what she will do if she ever loses her Henry. She relates that she has some good days and some bad days, and gets very anxious and cries when she recognizes she is confused and realizes that she has forgotten some important life events. Ertha tries to describe what it’s like to know she is getting confused and forgetful and how it feels to be so dependent on others. She is hoping the doctor can give her some medicine to help her get better. She says she likes the new apartment and she gets to go in the van a few days a week to a nice center where they have a lot of activities.
It is six months later; Henry passed away three months ago. Ertha is more confused, cries frequently, and looks everywhere for Henry. She is not eating well and has lost weight. The nurse at the assisted living facility does not feel she meets their guidelines any longer and will need a higher level of care. She asks Ertha’s daughter-in-law, Betty, to come in to discuss a move to a long-term care, skilled nursing facility. During the scenario Betty reports that Ertha calls her frequently every day, forgetting that she has called earlier.
Name: Ertha Williams
Date of Birth: 01/19/xx
Gender: F Age: 74 Weight: 130 lb (63.5 kg) Height: 64 in
Race: African American
Major Support: Betty Williams (daughter-in-law) Support Phone: 320-222-1111
Allergies: none known Immunizations: up to date
Attending Provider/Team: Joan Rivers, MD, and Mary Lake, MS, APRN/Geriatric Nurse Practitioner
Past Medical History: Hypertension, depression, hyperlipidemia, arthritis.
History of Present Illness: Increasing confusion, Major neurocognitive disorder
Social History: Son killed during the Gulf War. Daughter-in-law Betty and her son visit frequently. Used to be very active in her church and loved to cook, read, and do quilting. Cannot concentrate long enough to engage in these activities now. Husband Henry died 4 weeks ago.
Primary Medical Diagnosis: Major neurocognitive disorder; Alzheimers v. Vascular etiology
Surgeries/Procedures & Dates: Hysterectomy at age 38
Time: 1800
Person providing report: Day shift nursing supervisor
Situation: Ertha has shown some marked deterioration since Henry died 4 weeks ago. She is unkempt, more confused and agitated, cries frequently, and looks everywhere for Henry. We called her daughter-in-law Betty and she will be here shortly.
Background: Ertha was diagnosed with major neurocognitive impairment, Alzheimers vs. Vascular etiology, about 2 years ago. Other than that, she has been healthy, except for arthritis pain that is relieved by acetaminophen. She has hypertension that is controlled with atenolol, and she is taking rosuvastatin for her hyperlipidemia. She had a bout of depression several years ago when her son died while serving in the war. She and her husband Henry moved into the facility four months ago; Henry passed away 4 weeks ago.
Assessment: Ertha is not eating well. A staff member has to go and get her and take her to the dining room. She cant sit at the table very long and eats very little. Other residents have tried to be supportive, but she cannot socialize. Ertha had clear deficits on the Brief Evaluation of Executive Dysfunction when it was done a few months ago, but we think she is worse. Her living space is very messy and she only comes out of her room when we go to get her. Dr. Rivers prescribed fluoxetine and trazadone and increased the dose on her rivastigmine transdermal patch a few days ago, but it has not helped. We now have staff administering her medications, but we all feel that Ertha needs a higher level of care now. We called our long term care facility and there is a room available.
Recommendation: Get some vital signs on Ertha and do a Mini-Cog. Meet with Betty and help her see that Ertha needs more care than we can provide in assisted living. If she agrees, we can move her tomorrow. Dr. Rivers will be waiting for your call and is prepared to write a transfer order, so call as soon as you finish your visit.
Scenario:
Ertha is up wandering in her room; the room is messy and papers are all over. She cries and keeps repeating herself throughout the scenario.
Betty: I cant believe how thin she is and how sad! I got real busy at work after taking time off for the funeral and getting Henrys affairs in order, so I havent been here in 2 weeks, but Ive been calling almost every day.
Ertha: Im looking for something Where is Henry? He never leaves me Stop bothering me.
Ertha remains agitated. Can recall only one of three words. Makes attempt to draw clock.
When asked to repeat 3 words, she says, Word, word, word! How would you like it if I was asking you all of these questions?
Betty: Ertha likes music, especially the hymns they play in church. And Henry used to rub her back and that seemed to help her be calmer.
Betty: Cant we try some new medications?
Betty: I can see that she is not able to care for herself. I wish I could take her home with me, but I have to work. OK, lets try the nursing home and see how it works out.
What issues do you hear in the monologue that may be related to early cognitive concerns?
2. What are Erthas strengths? 3. What are your concerns for Ertha?
4. What other information would you like to have?
5. How do the recent life changes Ertha has experienced complicate her ability to manage her health care needs?
Give a brief summary of this patient.
What were the main problems that you identified?
Discuss the knowledge guiding your thinking surrounding these main problems.
What were the key assessment and interventions for this patient?
Discuss how you identified these key assessments and interventions.
Discuss the information resources you used to assess this patient. How did this guide your care planning?
Discuss the clinical manifestations evidenced during your assessment. How would you explain these manifestations?
Explain the nursing management considerations for this patient. Discuss the knowledge guiding your thinking.
What information and information management tools did you use to monitor this patients outcomes? Explain your thinking.
How did you communicate with the patient?
What specific issues would you want to take into consideration to provide for this patients unique care needs?
Discuss the safety issues you considered when implementing care for this patient.
What measures did you implement to ensure safe patient care?
What other members of the care team should you consider important to achieving good care outcomes?
How would you assess the quality of care provided?
Please include pictures they can be animation or realistic.
