Directed Case Study Case Study: Mrs Cheng 78 year old Mrs Cheng has lived in Australia for 60 years after coming from China as a bride shortly after the 2nd world war. Mrs Cheng worked hard raising her children and helping her husband to run a small Chinese restaurant until he died 10 years ago. Her eldest son, now runs the family business. Mrs Cheng had four other children, one died in infancy and three live overseas or interstate. Two years ago, Mrs Cheng’s family, concerned that she was becoming more forgetful moved her into a ground floor one bedroom flat, close to their home. She lives there alone with a home care worker coming in Mon to Fri in the morning. Her eldest son, daughter‐in‐law and their four children, all students aged 15 to 21, live within walking distance. Different family members take it in turns, most days, to visit at lunch time and in the evening, bringing her food from the restaurant and provide care. However Mrs Cheng’s increasing dementia and episodes of incontinence are making it difficult for them to cope. According to her daughter‐in‐law, in the last three months Mrs Cheng has been voiding on the floor occasionally and does not seem to understand that this is inappropriate. She does not seem to remember anything she was told; she seems to recognise her son but not her grandchildren. She has been taking the broom to her grandchildren and trying to chase them out of the flat, as well as accusing her daughter‐in‐law of having seduced her dead husband. When she is upset she becomes incoherent. However, when she is calm she is able to communicate her needs very well in Cantonese but less well in English, she is having difficulty remembering English words.
The children are becoming increasingly reluctant to be involved in her care, and this has been causing some family disputes as the parents work long hours in the restaurant, relying on their children’s help with their grandmother. Until she moved two years ago Mrs Cheng was a keen mah‐jong player, regularly attended a Cantonese‐language, Christian church, and enjoyed a gossip with friends over yum cha once a week, all a short walk from her home. Now she will frequently wander around the neighbourhood or sit in a chair outside her front door and will chat to the neighbours about her children. Whilst the neighbours are beginning to get to know her; some are helpful, some are not. She has twice managed to get back to her old home five kilometres away, and no one is sure how she did this. Disputes between her and her neighbours have been reported by the family. Apparently there is some suspicion within the family that she has also been intruding into other people apartments without an invitation; she was found on one occasion rummaging through the garbage bins, and clothing items that are not hers have been found in her laundry. Mrs Cheng has a past history of hypertension, osteoarthritis and last year was diagnosed with Alzheimer’s disease. She is active, but has been losing weight, has good hearing but poor vision, and often forgets she needs her glasses. She is prescribed the following medications: Avapro HCT 300 Mane Aricept 10mg Mane Panadol‐Osteo 2 tabs BD. V1 4th July 2016 Five months ago the family asked the GP for a prescription for a sedative and have been giving her Temazepam 10mg medication every night to help her sleep. She had been discovered on the floor by the morning home care worker twice in the last three months and was found on one occasion on the ground in the street by a neighbour who called an ambulance but Mrs Cheng refused to be taken to Emergency and appeared unhurt.
Assignment details The case study of Mrs Cheng highlights a number of common issues for the older person with chronic illness. Using the case study data adopt the role of primary health care nurse and case manager and with reference to current literature and evidence based practice: 1. Identify and discuss the health issues and support needs for Mrs Cheng; 2. Discuss Mrs Cheng’s strength’s that she may use to counter her problems; 3. Discuss the strengths and potential support needs of the family and community in which Mrs Cheng lives. 4. Critically discuss the potential cultural, legal and ethical concerns related to planning consumer directed care for Mrs Cheng and her family 5. Using the care plan template provided, develop a nursing care plan for Mrs Cheng addressing her physical, cognitive, behavioural, social, health and nutritional wellbeing. Ensure that the plan reflects Mrs Cheng’s goals and uses her strengths 6. Conclusion Assignment presentation A template will be provided to assist with formatting your assignment. The assignment should be presented as an academic paper. It should contain the following headings:‐ Introduction, Discussion, Care Plan, Conclusion.
Subheadings may be used if necessary. The assignment should be left justified; double‐line spaced and contain your student number and page numbers in the footer. Your assignment should be referenced according to American Psychological Society (APA) 6th edition requirements. Please refer to the APA 6th guide available on the Monash library website Please save with a file name . For example:‐ Smith 1234567. Instructions for submission are included in the Unit Guide