Assessment

Case Study 1:

John Reesbeck is a 62-year-old gentleman who has been admitted to hospital via his GP. He has a moderate learning disability and is accompanied by his support worker David. John lives at The Willows – a supported living environment where he is visited by his support workers several times a day. His girlfriend Michelle lives in the same setting and they often attend group activities at the centre.

John is normally independent in his hygiene and dressing needs, has a good appetite but has drunk less recently because it means he must go to the toilet more often. He is asthmatic and the condition is well controlled with inhalers. His support workers help John to stay in a routine with his personal care, housework, cooking, support with budget management and remind him to take his medication. John can be unsettled in unfamiliar environments.

Investigations and observations during John’s admission have identified that he has a Benign Prostate Enlargement (BPE). With support from the hospital’s learning disability nurse, the diagnosis was explained to John and he was catheterised to relieve his urinary retention and referred for elective prostate surgery.

John has been in hospital for 3 days and his observations have not raised any concerns. As each attempt to remove the catheter have resulted in John going into retention plans are being discussed for his discharge home with the catheter in situ until his surgery can be scheduled later this month.

Although infection prevention and control in relation to the catheter have been discussed with John and with David his support worker, during his stay in the ward John has been dependent on nursing staff to support him with caring for his catheter. He has also been reluctant to drink more despite staff providing drinks John has said he likes. John is anxious about going home with the catheter particularly emptying it and being able to go out. He is looking forward to seeing his girlfriend Michelle as he usually sees her everyday but is worried about how she will feel if they can’t have sex.

Assessment questions:

1. Discuss the principles of infection control and prevention in relation to John’s indwelling catheter in the case study. (LO1)

1. Evaluate the effectiveness of three strategies which a nurse can use to support John. One strategy should support managing his catheter, one strategy to prevent and one to detect infection. (LO6)

Case study 2

Tom has been referred by his General Practitioner (GP) to a community mental health nurse. The referral states that Tom was anxious, experiencing poor sleep and drinking alcohol excessively. Tom had requested hypnotic medication however the GP was reluctant to prescribe this and referred Tom for assessment and possible intervention.

Tom is a 43-year-old man who is employed as a senior manager at a builder’s merchants. He is married to Nicole. They have twin daughters aged 12 years. Nicole’s mother, Diane, also lives with them in an annexe to their house. Diane helps with cooking, cleaning and childcare as both Tom and Nicole have busy and stressful work lives.

Tom started cycling to help him loose weight a few years ago and since he got the “cycling bug” he stopped smoking, rarely drank alcohol, changed his diet, and lost around 10 Kilogrammes of weight. Nicole found some of these changes difficult to adjust to and worries about him after Tom was involved in a road traffic collision with a motor vehicle whilst on a training ride. Tom suffered a broken clavicle, and abrasions to his skin.

Despite making a good physical recovery, Tom has not resumed cycling. He explains that the thought of getting back on a bike terrifies him and he fears history repeating itself. He reports that he often feels “on edge.”.  He experiences some nightmares and flashbacks to his accident. He says it made him realise just how dangerous cycling is and that he was lucky to survive the collision.  Tom no longer sees his friends from the cycling club. Initially they encouraged him to resume cycling but he “made excuses” and now they have stopped contacting him.  Tom is considering selling his bicycles to finance a family visit to Disneyworld.

Tom has not done any form of exercise since the accident. He has resumed eating his mother-in law’s meals. Consequently, he has gained weight and now has a BMI of 28. Tom is also drinking every evening and resumed smoking. The nurse has estimated that Tom is consuming around 60 units a week.  Tom says that the alcohol “settles my nerves” and helps him to get to sleep, “at least for a couple or three hours.”

Tom indicates that he is unconcerned about his drinking. However, he is uncomfortable with his weight gain and he misses “having the physique of an athlete.”  He regrets starting to smoke again but believes that if he stopped smoking, he would gain even more weight.

Assessment questions:

1. Identify how one relevant theory of health behaviour change may help the nurse to understand Tom’s current heath related lifestyle (LO5)

1. Evaluate two interactive strategies that a nurse could use to promote Tom’s health. Please provide a rationale for your suggested strategies. (LO2)

Case Study 3

Sergio Richards was born to Carl and Monica Richards, their first child 4 weeks ago. The family live in a rented end terrace house with two bedrooms. Carl works as a supervisor in a local fast-food restaurant; often working long and unsocial hours and Monica is on maternity leave from her factory job however she is only eligible for 4 weeks full pay. Although the couple have friends in the area, they have limited other support; Monica’s family live in Eastern Europe and Carl has a temperamental relationship with his own family who live nearby. Carl had the statutory 2 weeks paternity leave when Sergio was born. Luckily for the couple, the COVID pandemic hasn’t impacted on Carl’s ability to work, however Monica has been by herself with Sergio for the last 2 weeks.

Sergio was born at full term, via normal delivery weighing 4.5kg and 38cm head circumference.  His parents consented to routine screening for Sergio and results of the New-born blood spot (NBS) screening test, often referred to as the heel prick test, were positive for Cystic Fibrosis. There was no family history of Cystic Fibrosis and the family have little understanding of the condition or the effect that this condition would have on Sergio`s development.

Since birth Monica and Carl report that Sergio had struggled to gain weight; his current weight (aged 4 weeks) is 4.6kg. Monica originally intended to fully breast feed Sergio but due to his slow weight gain Sergio is now exclusively formula fed and the unexpected cost of the formula is putting added pressure on the couple’s finances. Monica feels guilty for not only being unable to breastfeed her baby but also for the unexpected financial implications.

In addition to his poor weight gain, Sergio appeared to be constantly full of mucus and making snuffle type sounds especially from his nasopharynx, a symptom which increases when having his feed. Monica has visited the GP with Sergio on three different occasions with a chesty cough, increased mucus production, breathing difficulties and poor feeding. Sergio also has bowel movements constantly, which both parents’ think may be abnormal.

The increased mucus is more prominent at bedtime after Sergio’s feed which results in him being difficult to settle, and usually ties in when Carl is returning from a 14-hour shift at the restaurant.

Following the positive NBS, Sergio was referred to a Paediatrician at the local District General Hospital who arranged for Sergio to have a Sweat Chloride Test. This test showed a sweat chloride concentration of > 60 mmol/L which supported the diagnosis of cystic fibrosis. Following on from this diagnosis, both Monica and Carl were referred for genetic testing.

Assessment questions

1. Evaluate factors within the case study that may lead to inequalities in health, including health economics and resource allocation within care systems (LO3).
2. Explain and evaluate the principles of two prevention strategies; one related to screening and one related to immunisation programmes which will support Sergio to maximise his health and well-being (LO4)