Comprehensive Health Assessment and ISOBAR Handover for Patient Carmela Bello
Task: How can a thorough Gordon's Functional Health Assessment be utilized to understand the health status of Carmela Bello? How can the ISOBAR handover tool be effectively employed to transfer essential patient information for her hospitalization?
Title: Foundations of Clinical Practice: Carmela Bello Case Study 2023/1
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Read the following information and then answer the five questions within this document.
Carmela Bello was born in Potenza, Italy, on 13thJuly 1961 (Patient number 12345).She married Paulo (age 73) and emigrated to the suburb of Middle Swan in Perth in 1978. They have three children, Francesco,a 44-year-old marketing manager; Allesandro,a 42-year-old law intern; and Sofia, a 39-year-old homemaker.
Carmela was diagnosed with multiple sclerosis ten years ago and, more recently, with early-onset dementia. Carmela is now wheelchair/bed bound and is unable to walk. She has a homecare service visit her twice daily to shower, dress, toilet, and hoist her into her wheelchair,then back to bed in the evening. Paulo has, until now, been managing the household chores, Carmela’s feeding and incontinence each day between the support worker visits. Over the past few months, Carmela has become increasingly disoriented in the evening and overnight. Carmella calls out at night in a confused state. It takes Paulo time to settle her back to sleep.
While Carmela and Paulo can converse in English, Carmela cannot read or write in English. Paulo has English literacy at a lower school level. Carmela has been more frequently reverting to her native tongue and answering questions in Italian.
While much of Paulo’s time is spent caring for Carmela, he does enjoytending to his fruit trees in the backyard of his quarter-acre property. He attends Roman Catholic mass weekly, and the diocesan priest visits monthly to offer Holy Communion to Carmela. Their children and extended family visit on weekends, particularly their daughter, but while they are geographically close, they are not involved in the day-to-day care of their mother.
Paulo brought Carmela to the General Practitioners clinic this morning, where you are a student nurse, for assessment as the support worker noticed an open sore on Carmela’s sacral area. Carmela felt “hot” to the touch(Temperature 37.9°C) and was less responsive and interactive than usual. Carmella is occasionally mumbling in Italian and is not answering questions. She appears distressed, but you can’t understand what she wants. Paulo reports that she is not making any sense to him. During the surgery, it was noted that her heart rate was 96, her respiratory rate was 20, and her blood pressure was 170/90)
Paulo also says that Carmela has had a poor appetite over the past few months and will only eat semolina and drink grappa. He denies any recent weight loss, but Carmella is cachexic in appearance.
Carmela's daughter met Carmela and Paulo at their General Practitioner’s surgery to be of assistance. She reports that her dad is very worried about Carmela being movedto a nursing home. However, he has admitted to his daughter that Carmela’s increasing needs are becoming unmanageable for him.
Write your answers on this document and put your word count after each section.
The word count in questions 1-4 does not include the question but does include your in-text references. The word count in question 5, includes the subheading words.
Your preceptor Registered Nurse asks you to complete a Gordon’s Functional Health Assessment on Carmela and to complete an ISOBAR handover for the hospital.
1. Why should you perform Gordon’s Functional Health Assessment for Carmela? Include evidence-based rationale from primary sources to support your answers.
Gordon’s functional health assessment is necessary to perform in order to collect, analyze and evaluate information related to the functioning as well as mental and physical capacity of Carmela. The health assessment helps in assessing nursing-based data associated with instrumental activities of daily life as well as general daily life activities of a pertinent patient. It is conducted with the help of 11 chief categories, which include health perception and management, nutrition and metabolism, elimination of waste, exercise and activity, perception and cognition, rest and sleeping pattern, self-concept and self-perception, role as well as relationships, reproduction and sexuality, stress tolerance and coping, along with values and belief of the patient. These categories help the nursing staff determine the health aspect as well as the function need of the patient to provide better care and treatment plan (Espie et al., 2019). As Carmela has been identified to lost her ability to carry out any activities of daily living and needs assistance and care from her husband, it is necessary to plan for a better nursing case based on functional activities (Gordon et al., 2019). Thus, focusing on the health condition of Carmela as well as her health condition and care needs, it will be necessary to conduct Gordon's functional health assessment.
2. After considering the information presented in the case study, what four relevant functional health patterns require further investigation for Carmella? Include evidence-based rationale to support your answers.
After going through the health data and information provided in the case study, it has been found that Carmela’s health assessment needs further investigation based on four chief functional health patterns, which include; activity and exercise, values and beliefs, coping and stress tolerance as well as nutrition and metabolism.It has been found that Carmela has been suffering from the early onset of dementia and has been bed and wheelchair-bound, which heeds assistance from her husband (Turen & Enc, 2020). She is assisted in her daily living activities by homecare services due to her lack of ability to maintain stable functioning. Also, she has been showing underlying symptoms of health deterioration, such as increased blood pressure, respiratory rate and heart rate, along with fever. Thus it is necessary to carry out an investigation based on activity and exercise. She has been currently speaking in her native language and Italian and has certain religious values and belief which needs to be maintained in her care plan; thus, values and beliefs must be investigated in the case of Carmela. She is found to be unresponsive and often distressed at a certain point which thus demands the need to investigate coping and stress tolerance for her. Also, she has been eating semolina and grape juice and is found to be cachexic, which demands an evaluation of nutrition and metabolism (Gurelr, 2021).
3. What communication strategies might you utilize to assess Carmela in this situation? Include evidence-based rationale to support your answers.
Based on the information obtained from the case study of Carmela, it has beenfound that different types of communication strategies must be implemented in order to interact and conduct health assessments. It has been found that she is unable to speak due to being unresponsive and distressed, which makes it difficult to interact using the normal verbal mode of communication. It will be necessary to use the non-verbal mode of communication to implement therapeutic interaction with the patient where body language, signs and other indications and body postures will be used to interact with the patient (Del Giacco, Anguera & Salcuni, 2020). It will also be necessary to induce a nurse with the ability to speak Carmela's native language in order to interact with and understand her needs and health condition. It will help in assisting Carmela in communicating with the nurse and maintaining therapeutic relations with the facility.
4. Discuss one risk management tool you could implement to assist in managing Carmela’s care. Include evidence-based rationale to support your answers.
Answer: Based on Carmela's case study, the major issue highlighted is her inability to manage her daily activities. Therefore, Lawton - Brody's Instrumental Activities Of Daily Living Scale will be implemented to assess her risks in order to manage Carmela's care. With the help of this tool, the major issue while completing the daily activities will be highlighted, and the score will be allocated accordingly. She will be judged based on her ability to use the telephone, food preparation, shop, housekeeping, ability to handle finances, responsibility for her own medicine, mode of transportation and laundry. With the help of these, her ability to keep up with her daily needs will be marked from 0 to 8 (Isik et al., 2020). Females marked 0 has low function and high dependency upon others, whereas females marked 8 has high function and low dependency upon others.
According to Oort et al. (2019), this assessment tool helps to analyze the functional status of an individual, especially when caring for older adults. In the case of an elderly patient, normal ageing changes, deteriorating chronic illness, acute ailment, and hospitalizationcan lead to regression in the ability to complete daily tasks without taking any external help as well as to live independently in the community. With the help of this risk assessment tool, information related to the functional assessment of Carmela can help to provide objective and subjective data. This data further helps assist with designing her care plan. It will help not only her as an individual but also her husband. Further, this functional assessment can also assist the nurses and the healthcare professional in focusing on the baseline capabilities of Carmela. It willalso facilitate early recognition of the major changes, which signifies a need either for additional resources or for a medical workup.
After a final assessment by Doctor Benjamin Kelly, Carmela is to be transferred to the Medical Assessment Unit at St John of GodHospital in Midland today for further tests and monitoring.
5. Complete the following ISOBAR handover tool using the information that you have available to enable you to give a thorough handover to the staff at the hospital.
Identify the Patient
Name: Carmela Bello
Date of birth:13th July 1961
Patient Number: 12345
Current address/suburb:suburb of Middle Swan in Perth
Referring doctor: Nutritionist, psychologist, counselling, physiotherapy, General Physician
Admission reason: Highly disoriented, confused, and unable to walk on her own
Diagnosis: With early-onset dementia
Principle issue: Demantia, bed-ridden, disoriented, issue in managing ADL, cachexic, open sore on Sacral area
Date of Admission: NA
Current observations:Temperature 37.9°C, heart rate- 96, blood pressure – 170/90, respiratory rate- 20
Cognition state: less responsive, distressed, not making much sense, mumbling
Past Medical History: Multiple sclerosis
Current Medications: Not mentioned
Any precautions: Not mentioned
Allergies: Not mentioned
Agree to Plan
Plan of Action: Treatment for the open sore in the sacral area,
Mobility: 24-hour assistance as the patient is bedridden and is on wheelchair
Diet and fluids: nutritional plan as her diagnosis shows signs of Cachexic
The activity of daily living assistance: 24-hour assistance as she cannot manage ADL on her own
Wounds: Treatment for the open sore in the sacral area
Confirm family understanding:The husband is unable to manage his increasing needs for Carmela. Though the Children visit the patient on weekends, there is no one to take care of her completely.
Expected date of discharge: within a week
Del Giacco, L., Anguera, M. T., & Salcuni, S. (2020). The action of verbal and non-verbal communication in the therapeutic alliance construction: a mixed methods approach to assess the initial interactions with depressed patients. Frontiers in Psychology, 11, 234.https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00234/full
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Oort, Q., Taphoorn, M. J., Sikkes, S. A., Uitdehaag, B. M., Reijneveld, J. C., & Dirven, L. (2019). Evaluation of the content coverage of questionnaires containing basic and instrumental activities of daily living (ADL) used in adult patients with brain tumors. Journal of Neuro-oncology, 143, 1-13.https://link.springer.com/article/10.1007/s11060-019-03136-9
Türen, S., & Enç, N. (2020). A comparison of Gordon's functional health patterns model and standard nursing care in symptomatic heart failure patients: A randomized controlled trial. Applied Nursing Research, 53, 151247.https://doi.org/10.1016/j.apnr.2020.151247