NURS3003 Dynamics of Practice 3 - Assignment 1

Case 1

Amelia 13yo – (pronouns she/her )

• Mum: – Sandra – Dad: Derek
• Siblings James (16yo) and Darcy (5yo)
• Lives in Marion South Australia

General medical background

• Childhood asthma – eczema as a child – still has the occasional flare up
• Triggers, pollen, dust, dander (cats), grasses
• No other allergies

Medications

• Preventor – Pulmicort Turbuhaler (Budesonide) – only during hay fever season
• Reliever – Salbutamol (Ventolin)

Current situation

Recent admission to ED after a sustained asthma episode at school – unrelieved by 2 rounds of 4 puffs of the reliever.

Amelia and her Mum report that the frequency of asthma episodes have increased over the last 6 months – since Amelia has started at high school.

Amelia does not have an asthma plan in place – and has been reluctant to address this as she believes she is able to manage the episodes on her own now she is in high-school.

Amelia states she does not want to draw attention to herself as making friends at school has been difficult.

Amelia’s new group of friends like to sit on the school oval at lunch time – and although Amelia knows that the grass on the oval does trigger an asthma episode, she is reluctant to mention this as she does not want to lose her friends.

Amelia has a ‘spacer’ – but does not use it at school – again this is something that may draw attention to herself as different

Case 2 David    20-yo – (pronouns he/him)

Lives on his own – Renmark - Riverland South Australia

• Parents Mum: Mary, Dad: Tom - live in the same town

General medical background

• Spinal cord injury (complete L2) from a motor vehicle accident 2 years
• No allergies
• No current medications

Current situation

Following rehabilitation David lived with his parents for 18mths but has just recently moved into a rented unit.

David is independent with his ADLs and is licences to drive a hand-controlled vehicle – however he currently does not have his own car and relies on friends or his parents.

David uses the wheelchair accessible taxis in the Renmark to get to work, but friends or parents take him home.

David works part time in the local library – and goes to Uni part time (online) to complete his graphic design degree.

Recently David has been diagnosed with Type 2 diabetes, he has found it difficult to manage his weight as since he moved out from home – where Mum and Dad cooked most of the main meals - it has been easier to eat takeaway food or food that is quickly prepared at home such as food that can be prepared in the air fryer.

Mum, Mary has been taking medication for Type 2 diabetes for 5 years.

David has some funding through NDIS to assist with the regular (4 – 6 weeks) changing of this suprapubic urinary catheter.

David’s last HbA1c was 11.5 mmols – and the GP has indicated that if David is unable to modify this by diet / lifestyle changes in the next 3 months then he will have to be started on Metformin – David has indicated he is vehemently opposed to taking any medication – he takes no other prescribed medication

Case 3

Phillipa 50yo (pronouns she/ her)

Partner – Duong 52yo – secondary school teacher Children: Jamie 12yo and Mason 14yo

Lives in the Adelaide suburb of Parkside

General medical background

10 years ago, Phillipa was diagnosed with Multiple Sclerosis, the presenting symptoms of the disease were fatigue and muscle weakness – Phillipa was an active long distance trail runner and initially thought her symptoms were due to too much running as she was training for a ultra-marathon.

Relapse episodes had been intermittent over the past 9 years and medication has been taken intermittently during flare ups.

Up until 6 months ago Phillipa was working parttime as a manager at one of the larger grocery retailers. However, following a recent relapse in her condition, while at work when she was checking stock she lost balance and fell from a step –and even though there were no injuries incident has caused her to lose confidence in her mobility and she is reluctant to return to work.

Current situation

Phillipa was admitted to hospital for relapse treatment – and given a 3-day course IV Methylprednisolone.

Since returning home on sick leave – the family, including Phillipa, have been discussing the possibility that Phillipa may not be able to return to work. Phillipa workplace is supportive and prepared to work with her to see if there are options to do some work from home or to modify the work environment.

Phillipa has also been experiencing increasing issues with bladder & bowel continence and extreme fatigue and over the past 2 weeks has spent most days resting in bed or on the couch.

Phillipa has expressed she is feeling very down about her future and is not positive that after this episode her condition will improve.

Duong is contemplating giving up work to care for her as he recognises that her condition is deteriorating.

Phillipa does not want this and has indicated she would prefer to see if she is able to qualify for help at home from a healthcare service.

Medications

Phillipa administers her own SC injections and has not been experiencing any physical limitations around this skill.

• Glatiramer acetate SC 20mg Daily
• Oxybutynin 5mg PO BD.

PERSON CENTRED CARE NEEDS

• Philippa has asked to be put into contact with a healthcare professional who can help her and Duong to navigate the healthcare The NDIS system is sometimes confusing, and the online services are difficult to find via the website.
• Initially Phillipa would like to have support around the everyday household activities, such as cleaning and washing
• Phillipa would also like to explore using aids for
• Phillipa would also like someone to support her with preparing and freezing some meals ahead of time– that way Duong can work and come home with meals prepared and this will meal more quality family
• Phillipa has asked for more support regarding the occasional issues she has with urinary incontinence – she is embarrassed to discuss this with her husband and is concerned that urinary incontinence may progress, and that this may extend to bowel
• Family counselling / financial planning – Phillipa would like for herself & Duong to be able to discuss some of the ‘future’ financial pressures they may experience as her condition deteriorates and how they can work to reduce the
• Phillipa stated that her periods of feeling down and depressed about her future have been more frequent lately and she would like to see if there are services / information / groups that may be available to reduce or manage these feelings.