Assignment title –How effective was your choice of nursing model in carrying out a holistic assessment of a patient?
Scenario –Evelyn
Evelyn is an 87-year-old woman with hypertension and rheumatoid arthritis. She lives at home on her own in a semi-detached four bedroom house in a residential part of a city in the South East of England. She is an owner-occupier. Evelyn is a retired secondary school (English) teacher and her husband James died (from bowel cancer) 5 years ago. They had been married for sixty two years.
Evelyn takes pride in her appearance and she likes to dress neatly and keep her hair well tended. She enjoys reading, doing crossword puzzles and talking with her good friend Gladys on the phone a couple of times a week. She used to like gardening outdoors but can no longer do that. However, she can still tend to her impressive range of indoor plants which she thoroughly enjoys.
Evelyn’s daughter (Matilda) works full time and lives 35 miles away (in the countryside) and visits her mum weekly (travelling by car) on Saturdays. Matilda helps her mum with shopping and laundry when she visits. Evelyn also receives daily support from a care worker to help with activities of daily living. Evelyn manages to put on her clothes with dressing aids that the domiciliary Occupational Therapist (OT) provided her with, but she needs help with washing her back and legs (which the
carer does for her). Evelyn also has a hairdresser who visits to wash and set her hair once a week.
She is currently prescribed the following medication:
· Bendroflumethiazide 2.5 mg daily
· Lisinopril 10 mg daily
· Simvastatin 40 mg at night
· Methotrexate 20 mg once weekly on a Wednesday
· Folic acid 5 mg daily except on Wednesday
· Paracetamol 1 g four times daily when needed.
On Friday evening, an on-call (out-of-hours) GP visits Evelyn because she has been feeling unwell with symptoms of urinary frequency, dysuria and urge incontinence for a few days. The GP diagnoses a urinary tract infection (UTI) and prescribes Trimethoprim 200 mg twice daily for 3 days. During her weekly visit the next day ( Saturday), Matilda picks up the Trimethoprim from the chemist for her mum and when she leaves that evening Evelyn promises her that she will ‘drink plenty of water’, and that she will be absolutely fine. On Sunday, the care worker is very concerned that Evelyn has deteriorated and is nauseous and confused. She calls an ambulance and Evelyn is admitted to hospital via A&E. A hospital doctor changes the trimethoprim to co-amoxiclav because her UTI symptoms have not improved.
When you meet Evelyn in the hospital ward, she has a temperature of 38.6C, a BP of 138/92 mmHg and a pulse rate of 95bpm. She keeps trying to get out of bed and you have had to help her back into the bed on more than one occasion. Her daughter has been called and is on her way to the hospital (by car). Evelyn looks dishevelled and keeps looking for her powder compact in her handbag. Evelyn asks you repeatedly ‘Is it Monday today?’ and each time you clarify it is Sunday, she repeats the question to you within a few short minutes.
ASSIGNMENT BRIEF –Description:
In this assignment you will use a nursing model to carry out a holistic assessment of one of the three scenarios. You can choose both the nursing model and the scenario.
You will discuss and evaluate the chosen nursing model as a basis for holistic assessment and in the development of person centred care. You will then reflect on how this assignment might inform your future practice
