QUESTION
Assignment 1 Case-Study -Interview
Introduction
For the purposes of this assignment an 85 year old widow,Mrs.Smith (pseudoname usedfor confidentiality). This assignment seeks to explore the nature of how she lives and function in her community, where she lives in an aged care facility. This report will discuss the issues that impact on her ability to live independently including physical and, psychological and socio- economic factors .I used the Jarvis proforma, which consist of biographical data, past medical history, family history and review of systems. The Jarvis proforma is easy to follow it captures the past and current, physical, socio-economic status and psychological.
PAST MEDICAL HISTORY
As a child she suffered from asthma and hay fever, which she grew out of it as she grew older. (Asthma is a common childhood illness which-usually starts at two years of age, may persist through to childhood but usuallyimproves, as the child gets older as in the case of Mrs. smith (Elliot& Ellis, 2005). When she was 21 she was involved in a motor vehicle accident and sustainedmany fractures in different parts of her body but she recovered and managed to regain her normal body function get back on her feet within a year. According to Min,Ding and Tejwani (2011), the average time of healing of fractures is 18,7 -24 weeks . She had two children with no abortion or miscarriage, her immunization is update and every year since she has been at the nursing home she receives flu vaccine injection yearly as encouraged by the department of health as it is believed that the flu vaccinations have a positive outcome especially in the elderly (Gill, Taylor & Watson, 2007)
Over the years she has been suffering from memory loss and mild dementia prompting her family to place her in an aged care facility.
Present illnesses
Currently she is suffering from Arthritis and chronic back pain. Arthritis is common condition, which is prevalent in the elderly (JAMA), whichshe is taking huge doses of analgesia for it, endone 10mg every 4hrs prn, mscontin 100mg twice daily and tramadol and .She is now mobilizing with a four-wheel walker which is often the case with this age group with arthritis. She has a physiotherapist who visits twice a week to help hermobilize more functionally. Her mild dementia and forgetfulness is less pronounced that if she engages in a conversation it’s not easily picked up unless after engaging with her in a conversation for a very long time.
SOLUTION
Introduction to the assignment
The assignment focuses on developing a systematic approach for analyzing the history and for the physical assessment of the subject chosen. It explores the physical, psychological and socio economic factors that affect the subject. It also gives an overview of how the subject lives and functions in his/her community. The present condition of the subject is also described.
The main objectives of a complete assessment programme are:
- To describe the complete health history components
- To identify the significant findings of health history and physical assessment
- To discuss the abnormal findings
A case study is basically an intensive study of the subject, wherein all aspects of the subject have to be explored. It is either descriptive or explanatory. Instead of following a rigid protocol, a case study should be flexible enough so that there are no questions left unanswered. The study should be systematic in approach following the process of data collection, interpretation and result analysis.
The process of data collection has to be intense and complete. The subject has to be made comfortable so that there is no question or doubt that remains unanswered. The subject should not feel shame or guilty while answering the questions. Complete privacy has to be maintained. Before the process of data collection, ample amount of time should be spent on framing of the questions. The questions should be relevant and related to the subject’s conditions. The factors to be kept in mind while framing the questions are age, sex, social conditions, economic conditions, mental state, etc. The questions should be complete, leaving no area unexplored. The framed questions should be asked in such a manner that it goes with the flow. The subject should not feel uncomfortable and the following questions should be asked in a way that they seem linked. Questions should be simple and easy to understand.
Interpretation has to be done in an analytical manner. Nothing should be assumed. Every interpretation must have a backing, either in the form of literature or practical proof.
Finally, conclusion should be done after all data has been interpreted in a rational and intelligent manner. The interpretation should be logical and in compliance with the interview answers.
For the purpose of the assignment, the proforma used is the “Jarvis proforma” which uses biographical data, past medical history, family history, etc. for the purpose of evaluating the subject. This proforma is quite helpful as it looks into the past and also the present status of the subject. The data gathered however, varies in accordance with a persons age, culture and health status (Physical examination and health assessment).
Analyzing the past data of the subject helps to find out the answers for some of the present conditions. There are certain conditions which are linked to the past. On analyzing the past medical history, one can interpret a number of present conditions.
Moreover, for the complete analysis the data has to be complete in all senses i.e. it should include all aspects of one’s life. These include medical details, social conditions, economic conditions, etc. The interview comprises of a set of questions which are in a continuum and the broad categories of the interview are as follows:
ñ Biographical data
ñ Health perception
ñ Health management
ñ Health habits
ñ Health promotion activities
ñ Family data
ñ Functional health pattern
ñ Activity and Exercise
ñ Cardiovascular and respiratory activities
ñ Musculoskeletal system
Introduction to the subject
The subject chosen is an 85 year old widow, named Mrs. Smith (name changed for the purpose of study). She lives in old age home, as her children do not stay with her and she has nobody to take care of her. Prior to this, she was working in a nursing home. Before this, she had also worked as a waitress and a chef. This paper explores the conditions and the nature of living in the place where she lives and the factors affecting it. Her past and present medical status is also explored. The interview data is interpreted and a conclusion, as per the understanding is written.
Interview structure and details:
ñ Biographical data
This set of questions included details like name, age, gender, marital status, birthplace, occupation, living conditions, etc.
Mrs. Smith (name changed) is a 85 year old woman, living in an old age home. She has her parents from England, who migrated to Australia decades ago. She has grown up in the farms and has spent her youth working as a waiter. During later years of her youth, she also worked as a cook (perhaps, the chronic back ache could be because she was always standing while working). She has two children, who stay in Tasmania. As they stay at a far off place, they are unable to take care of her, as is the case in most of the western world.
ñ Health perception
This section included questions to the subject regarding her health status at present and during the past one year. It also included questions regarding comparison with other people of the same age. This section also includes rating questions, where the subject is asked to rate her health.
According to the subject, she has a good health. However, she is suffering from arthritis and chronic back pain. As arthritis is extremely painful, she is taking huge doses of analgesic for it. She takes Endone 10 mg every 4 hours, Pm, Mscontin 100 mg twice daily and Tramadol. Due to difficulty in walking, she uses a four wheeler walker to move. For some relaxation, she has a physiotherapist visiting twice a week, which helps her mobilize more functionally. She uses hearing aids as she has some problem with hearing. She is also suffering from Dementia. Her problem of dementia becomes less severe when gets engaged in a conversation.
The subject rated her health as fair, as she blamed most of her problems to old age.
ñ Health management
This section included questions regarding health management and behavior. The questions included also consist of reasoning questions as to what factors prevent the subject from not following the health advice, like past experiences, time, etc.
The subject is suffering from dementia and arthritis. As her kids are not staying with her and she could not take care of herself, she was staying in an old age home.
ñ Health habits
This section comprised of questions regarding immunizations and drinking/ smoking habits.
As the subject was working in a nursing home prior to being admitted in the old age home, she regularly received vaccinations for flu. She never smoked, but took alcohol occasionally.
ñ Health promotion activities
In this set of questions, she was asked about the breast self examination techniques. Questions relating to dental and eye check up are also asked.
In this section, the subject was taught the breast self examination technique. She had not visited the dentist for quite a while. But wore dentures as her teeth had decayed due to old age. Her eyesight is also fine, but she wears reading glasses.
ñ Family data
In this section, questions relating to the family tree were asked. Questions like illnesses and diseases of family members are also included in this section.
Many chronic conditions are present in her family lineage. These include diabetes mellitus, migraines, obesity, hypertension, arthritis.
She however, suffered from arthritis (out of these), which I think was inherited. According to Majeed and Barakat, certain bone diseases are hereditary.
ñ Functional health pattern: Sleep, Skin, hair and nails
This section targets on questions regarding the sleep patterns and conditions of skin, hairs and nails. This assessment is very important as one’s skin, hair and nails reflect the internal body conditions. Any deficiency is initially reflected in terms of problems with the skin, hair or nails.
Mrs. Smith answered that she has problem while sleeping and suffered from mild headaches at regular intervals.
Her skin is good, but dry. The hairs and nails are in fine condition, as per her age.
ñ Activity and Exercise
The next set comprised of questions regarding her days’ activities and exercises.
Mrs. Smith spends her day with no/ minimal exercise. Due to limited motion, even her neck has become very stiff.
ñ Cardiovascular and Respiratory activities
The next set of questions comprised of questions on cardiovascular activities and questions relating to the thorax and lungs.
To all the questions, Mrs. Smith answered that she has no problems.
ñ Musculoskeletal system
The last set of questions comprised of information on bones, joints and muscles
Mrs. Smith is suffering from Arthritis and chronic back pain. These are extremely painful and Mrs. Smith takes in a lot of analgesics for them.
In addition to the interview details, Mrs. Smith was asked about her past medical history, which is summarised below:
Past medical history
Mrs. Smith has two children with no abortion or miscarriage. As she was working in a nursing home, she regularly received vaccinations for flu. The department of health also encourages flu vaccinations, as it is believed that it has a positive outcome, especially in the elders (Gill, Taylor and Watson, 2007).
However there are three major concerns regarding her past medical history. They are as follows:
- As a child, she was suffering from asthma and hay fever. However, with age she grew out of it. According to Elliot and Ellis, 2005, asthma is a common childhood illness which usually starts at two years of age and gets cured as one grows up.
- When Mrs. Smith was 21 years of age, she met with an accident and had many fractures. However, she managed to regain her structure within a year of the accident. The average time taken by the fractures to heal is about 7- 24 weeks. Mrs. Smith however, had sufficient amount of time for healing.
- Over the years, she had been suffering from memory loss and mild dementia. This forced her family to send her to an old age home, as there was nobody to take care of her.
Present illnesses
Presently, she is suffering from 3 major illnesses. They are as follows:
- Chronic back pain
- Arthritis
- Dementia
These three illnesses are her major concerns as Arthritis and back pain are extremely painful and she has to regularly take medicines for them. Due to Dementia, she tends to forget things and finds it difficult to concentrate.
Conclusion
A complete health assessment is very important and also a crucial part which needs to be done for every adult. This helps to determine some of the future problems by looking at the present situations and also by analyzing the past medical conditions. The benefits of a health assessment, as was also seen through this analysis are as follows:
ñ It helps the subject to get an overview of the present health conditions
ñ It provides the subject with data, thus leading to a lifestyle change, if required.
ñ These assessments lead to result oriented programs.
The subject in the study has had a difficult life as the kind of work she did demanded her to be on her foot always. This caused her the problem of chronic back ache. Now, even at this age of her life she is left alone to look after herself.
Her eyesight was weak because of her age and she wore dentures, as she had lost her teeth due to decay. These two problems were because of her age.
The subject mainly suffers from Dementia and Arthritis. Arthritis is probably inherited and dementia may be due to her old age. As is the case in most of the western world, her kids do not stay with her. As she could not take care of herself, she was forced to stay in an old age home.
As arthritis is extremely painful and she is also suffering from chronic back ache, she takes in a lot of analgesics (pain killers). The quantity of intake is very high and this will probably be very harmful for her.
References
Elliot, F. Ellis, M.D., 2005, Asthma in childhood, Journal of Allergy and Clinical Immunology, vol.72, 5, pp. 526- 539.
Gill, T.K. Taylor, A.W. and Watson, M., 2007, Trends in influenza immunisation amongst an elderly Australian community, vaccine, Vol. 25, 29, pp. 5428- 5432.
Majeed, H.A. Barakat, M., Familial Mediterranean fever (recurrent hereditary polyserositis) in children: Analysis of 88 cases, European Journal of Pediatrics, vol. 148, 7, 636- 641.
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