Reference no: EM133915239

Question

Roy Campesie is 78 years of age and lives in Caloundra , in South East Queensland. He lives in a three bedroom apartment and is the primary caregiver for his partner of 45 years Jim who is 84 years of age and is partially paralysed after a stroke three years ago. Jim needs help transferring from his bed to a chair and needs a wheelchair to get around the apartment. Roy helps Jim dress but Jim is fiercely independent when it comes to his personal care. Roy has to be very diplomatic to ensure Jim has regular showers and attends to his personal hygiene. After Jim's stroke community nurses were arranged to help them get settled once Jim was discharged home, and they come by each month now to see how they are getting on.

Roy still has the occasional cigarette to relax and de-stress, despite a long standing diagnosis of mild chronic obstructive pulmonary disease (COPD) for which he has taken a corticosteroid puffer every morning for many years. He says he enjoys reasonable health but has been having difficulty recently using the stairs to reach his second floor apartment, and is occasionally breathless on his daily walks pushing partner Jim along the Caloundra coastal walk. He carries a Ventolin puffer with him when he's out and about, and finds he has been needing to use it more frequently. Fortunately for Roy and Jim their apartment has a lift.

Roy and Jim both enjoy sunbathing on their balcony when the weather is cooler, but Roy has noticed that his own skin is getting quite dry and he is bruising very easily. Dark blotchy areas of bruising can be seen on his forearms. Although Roy makes sure as advised by his GP to use non-perfumed moisturiser to ensure Jim's skin integrity after showering, he has been struggling to find the time for his own skin care regime.

Roy's GP recently increased his hypertension medication as his blood pressure has been higher than it should be for quite a few months, but Roy forgot to mention his increasing breathlessness. Their GP also announced that she was moving to Victoria and Roy is anxious about finding another gay friendly GP who they will feel comfortable with. They both express great anxiety about ever needing to go into an aged care facility fearing they would experience discrimination.

Roy and Jim used to both enjoy volunteering at their local St Vincent's de Paul opportunity shop, but since Jim's stroke have found that this was no longer possible. Roy feels he has a full time job looking after Jim now but really misses the social interaction that they enjoyed with the Vinnies team.

Raylene, Jim's 57 year old daughter lives in Brisbane and comes up to see them both about once each month. She says she has noticed that Jim is not as sharp as he used to be and has had trouble remembering the names of some everyday items. Roy is estranged from his children and hasn't seen them for over 20 years. Roy still drives but recently caused a minor accident when he failed to see a car coming up on his right as he was leaving the car park, and pulled out in front of them. He says he was distracted by worrying about what Raylene had said about Jim's deteriorating memory.

This morning Roy and Jim were out on their walk when Roy suddenly felt breathless again and needed to rest on a bench. When he tried to get up, he felt dizzy, lost his balance and ended up falling back on the metal rail of the bench tearing the skin on his left forearm. Jim says Roy briefly passed out on the bench, but Roy says he was just dehydrated. After a little while Roy felt better, and using a napkin he had in his bag, wrapped up his wound and pushed Jim back to the apartment. Once they reached home, Roy noticed that his forearm was still bleeding a little and a large area of skin seemed to have peeled off and was hanging loosely from the tear.

Luckily it was the day the community nurse (in this case you!) was scheduled to visit.

Roy and Jim are well known to the community nurses. You are worried about Roy's fall today and know you must conduct a full assessment. You also notice that the apartment is a lot more cluttered and messier than usual and Jim appears not to have washed for some time.

1. Discuss the biophysical processes pertinent to the case.

2. Discuss the psychosocial processes pertinent to the case.

3. Identify a screening tool for assessment appropriate in this case and discuss key elements of the tool.

4. Discuss your three priorities of care for Roy and Jim.

5. Discuss any equity, rights and access issues relevant to the case.