Elder Care Case Study Essay Example for Free

Elder Care Case Study Essay Mr. Trosack is a 72 year old man who fell down a long flight of stairs a month ago, underwent a total hip replacement and is in need of a discharge plan. He completed two weeks of rehabilitation in the hospital for his hip as well as diabetic teaching for his new onset of Diabetes. It was also discovered during this hospitalization that he needed to start taking medication for hypertension. Both he and his family are in denial about what it will take to get him home and deliver the care that is needed. Healthcare Issues and their Importance Discharge planning and management with an elderly person can become very complicated and should be approached with an open mind and the willingness to compromise with the family and patient himself, keeping in mind that the safety of the patient is top priority. Before Mr. Trosack can safely be discharged home several issues have to be considered. It is important that the case manager meet with the patient, his family as well as find out about the details of where he will be going and how much assistance from family and friends is available and dependable. One of the issues that needs attention is his physical preparation to move back home. In his current state, he is not able to take care of himself without help. Based on the interview of his son and daughter in law, as well as taking into consideration their lack of help prior to the surgery, it doesn’t appear that they will be able to visit him often or consistently. That will not work immediately because Mr. Trosack will n eed daily assistance, for several more weeks. A rehabilitation center may be his best option in order to ensure his safety and avoid another fall. He will be able to continue physical therapy sessions in order to continue to improve as well as round the clock help when needed. He would receive more stair climbing training, hip strengthening exercises as well as gait training. Attending the rehab program would also allow him to socialize with people facing similar obstacles and adjusting to a new way of living. An Occupational Therapist (OT) can be consulted to assist with adjusting to his activities of daily living. Continued monitoring of his new medications as well as extra help with blood sugar monitoring may help him deal with the denial of his new onset of Diabetes and Hypertension. The specialists at the rehab center will be able to assess and determine when Mr. Trosack is ready to go home and can be independent with minimal assistance. Preparing him properly the first time can avoid other accidents as well as motivate him to keep working on his strength and endurance. Another important issue to consider before discharge planning is the safety of his home. Assessing and making changes to his living conditions is a must. After the safety assessment was completed it was obvious that changes had to be made at home to accommodate a person with new disabilities. Since the apartment is cluttered, it must be cleaned up. There are several â€Å"memorable† treasures that he has at home; presently they are hazards because of their location. They do not have to be thrown out but they do have to be moved. The kitchen, bathroom, living room, entry way and one bedroom all need to be free of throw rugs, collectables and furniture that blocks the passage of a walker. There are two rooms in his apartment so one should become a storage area for all of the clutter until Mr. Trosack has moved beyond a walker or cane. The bathroom needs to have permanent safety rails installed near the toilet and bathtub or shower as well as a non-skid applied to the bathtub surface. The medicine cabinet should be cleaned out and all expired or unnecessary medications discarded or returned to a pharmacy. The kitchen is in good order but the refrigerator needs to be cleaned and the expired food thrown out. The living area needs to have minimal furniture and placed so things are easily accessible and not in the flow of traffic. Night lights or motion sensors need to be added to avoid a fall when he gets up at night to use the bathroom. Addressing the stairs is not a simple solution. As long as Mr. Trosack is able to walk those stairs following a discharge from the rehab then he can move back home. Side rails on both sides need to be secure and easily accessible to him at a safe level for him to hold on to. Some apartment complexes have added elevators or elevator chairs, if that is an option then that would be fantastic. These issues need to be addresses to avoid another injury at home such as a fall. Mr. Trosacks new diagnosis of Diabetes and Hypertension need to be addressed. There are many psychosocial issues with his new disabilities and diagnosis. These are important because he needs to be able to accept his disabilities and take care of his health, in order to avoid serious complications, heal and cope. It is clear that Mr. Trosack is having a difficult time accepting his new medical diagnosis as well as not being able to be independent. His comments about being able to handle it all himself at home but yet communicating his frustrations by having to take medications and not being able to get up and down the stairs speak volumes. Continued diabetic teaching may help him understand the importance of food choices and listening to his body’s signals of low or high blood sugar levels. Even after discharge from the rehab center Mr. Trosack should continue having a home health nurse in for periodic visits since it may be difficult to get to doctors’ visits to check blood pressure and blood glucose. A portable glucose monitor and automatic blood pressure should be purchased and kept at home. The mental preparation and coping mechanisms will need to be addressed prior to leaving the rehabilitation center. Denial from the patient and family tells the health care team that teaching needs to be done in all areas and with all heath care team members. Team Members and their Roles Discharge planning for an elderly patient requires a team of health care professionals as well as family members working together in order to have a successful transition to home. The case manager needs to be in charge of organizing the team and following Mr. Trosacks progress in order to direct the team based on his changing needs. A Physical Therapist has been working with Mr. Trosack in rehab and that work needs to continue. He needs to improve stair climbing and increase his strength. He will need to work on a generalize exercise program as well as specific gait, balance and coordination to help him become independent at home.He will need to learn to use a walker and cane. Research supports the most effective interventions to manage falls risk are those that incorporate exercise and that exercise program needs to be structured, progressed, and must achieve the minimum dose of exercise (Shubert, 2011). An Occupational Therapist (OT) should be involved with evaluating Mr. Trosack a nd making sure he and his house is ready for his return. Occupational therapy services include comprehensive evaluations of the home and other environments and recommendations on equipment and training as well as guidance and education for family members. They try to adapt the environment to fit the person. (AOTA, 2012). Mr. Trosacks son or brother should work with the OT to coordinate the bathroom safety bars and no skid flooring as well as making sure all excess furniture and collectables are placed in the second bedroom. A dietician should educate him on how to prepare diabetic and heart healthy meals. Diabetic teaching is so important for patients living alone. If he does not take his diabetic diet seriously he may end up with inconsistent blood sugars which in turn can lead to unstable mental status and generalized motor weakness. A Social Worker will be able to assist Mr. Trosack and family with financial and social needs. The Social Worker can assist with completing paperwork for financial assistance and medical equipment needs. Mr. Trosack may be able to get financial assistance for medical equipment such as safety bars for his house, stair lifts, and exercise equipment. The social worker can also assist in getting him meal delivery and get the patient involved in some social activities. Coordinating family visits and family assistance should be done with the Social Worker and should be coordinated based on lack of outside assistance. Social workers are challenged to enable patients and families to have control over decision making regarding their discharge planning(Kadushin Kulys, 1993).They are trained to help patients and families help themselves. The social worker can help the family identify resources such as home health aids to come to the house when family cannot. Social Workers are also trained in counseling and may be able to help the patient and family cope with the transition. A Home Health Agency could send in a Registered Nurse (RN), Licensed Practical Nurse (LPN) or a Certified Nurses Assistant (CAN) to monitor blood sugars, monitor blood pressure, monitor medications and continue teaching on all of those as well as assist in his Activities of Daily Living (ADL). This team needs to work with Mr. Trosack’s physician who oversees the plan of care, helps determine services and assists if consults or reports needed for insurance reasons. Safety Safety one of the main concerns when discharging a patient. The case manager needs to know that the patient is ready and equipped to make a smooth transition so he will not be readmitted to the hospital shortly after discharge. As discussed in the assessment, Mr. Trosack cannot be discharged home because of several safety concerns. He is not strong enough to climb the stairs, his home is not ready to receive him in its current state, he and his family are in denial of his needs, and the team has not been established to assist him, so it is not safe to send him home. If he is able to continue Physical Therapy he should gain enough strength to climb up and down once he arrives home. In his home, many areas need to be cleaned of clutter so he doesn’t trip or fall. He will most likely be using an assistive device such as a walker or cane and they can easily become caught up in rugs or furniture. A clear path around the apartment in required and gait training will be part of his therapy. Taking into consideration all the safety issues that will determine another fall or even more serious complications it should be strongly suggested by the case worker that Mr. Trosack continue in an inpatient rehabilitation facility in order to give him time to improve his strength, health and coping mechanisms. This will also give him and his family time to process his needs when he comes home as well as get the home and services needed. Discharge Plan Needs Family is a necessary part of discharge planning. In this case, Mr. Trosacks only family member isnot able to assist him adequately to meet his needs and avoid an injury or readmission. His son and family are too busy and his brother is elderly. Depending on this family for necessary daily needs is not realistic. Along with not being prepared physically, they appear to be in the same mind frame as Mr. Trosack regarding the denial of new medical diagnosis as well as his physical restrictions. Teaching needs to become a priority and the team may be able to help with realistic goals for the family. This is where the social worker and home health nurse could be of most assistance. Mr. Trosack will need to have some sort of â€Å"meals on wheels† delivery of food when he returns home. It may be temporary but should start out that way to avoid missing meals. After he is comfortable and capable of preparing his own food he may opt to have the grocery store deliver a few times a week. Also grocery delivery should be requested. The family can help do some of the legwork for his arrival home. They need to be educated on what are needs and wants for a patient coming home from a hip replacement so that they know what they need to do and what they need to outsource to private agencies. Educating them will hopefully allow them to see that Mr. Trosacks is in need of help even though he denies it. Social Isolation Our mental and physical states of health depend on each other. After any life altering surgery older adults end up socializing much less if their activities of daily living are affected. In Mr. Trosacks case, he will need to stay in physical rehabilitation longer and will not be as independent as before the fall. A limited physical mobility usually means limited social interaction. Limited social interaction can decrease his motivation to continue exercising and strengthening his body and could lead further to depression. Familiarity and stability are essential in order for him to be able to cope and heal (Nichols Riemer, 2008).His social interaction with his family may be strained because they are focused on helping take care of his physical needs and not focused on laughing, having fun and enjoying time together. Psychological Factors A human’s thoughts, feelings and attitudes all influence their behaviors; those behaviors then begin to determine how they will handle stress. Having a hip replacement is frustrating and stressful for patients and families not only because of the physical changes but psychological. Mr. Trosack is used to caring for himself and is now not going to be able to do that. The sudden lifestyle change is an added stressor that he needs help to cope with. â€Å"If stress becomes persistent and low-level, all parts of the bodys stress apparatus (the brain, heart, lungs, blood vessels, and muscles) become chronically over-activated or under-activated. Such chronic stress may produce physical or psychological damage over time† (University of Maryland, 2009). Mr. Trosack should be encouraged to get some cognitive behavioral therapy either one on one or support groups once he is moving around more easily. It will be important for the health care team once Mr. Trosack goes home, to motivate him to keep up with exercises, proper diet, relaxation techniques, and continually monitor stressors involved. Mr. Trosack has already shown signs on denial with his new medical problems. He is not happy to have to take medications and if he does not get help to understand and accept his new medical conditions he will run into an even further disabling state. He has lived in his home for many years so it is best to do everything possible to make that happen. Recommendation As stated earlier, the inpatient rehabilitation center is the recommended place from Mr. Trosack to go to before heading home. He needs the extra attention and encouragement in order to be able to take care of himself. He is not strong enough to move back to his house nor is his house ready to receive him. His family support is will not be consistent, soother arrangements need to be made for meals and transportation as well as activities of daily living. He may not accept the idea of more rehab because he really wants to get home but hopefully after teaching him the importance of doing things rights the first time to avoid another fall, he may agree. He also needs to be assured that the teams goal is to get him home as quickly as possible, so the harder he works the faster he may get home and become more independent. The team needs to try to avoid having him move from the place he has lived in and loves. Reference Shubert, T. (2011). Evidence based exercise prescription for balance and falls prevention. Journal of Geriatric Physical Therapy, 34(3), 100-108. The American Occupation Therapy Association (AOTA). (2012). Retrieved from http://www.aota.org/consumers.aspx Kadushin, G. Kulys, R. (1993, November). Discharge planning revisited: what do social workers actually do in discharge planning?. Social Work, 38, 713-726. Nichols, T., Riemer, M. (2008, June). Post surery social isolation. Presentation deivered at 17th world concil of enterostomal therapists (wcet) congress , Ljubljana, Slovenia. Retrieved from http://www.hollister.com/us/files/pdfs/ce09/psychosocial/910298.pdf University of Maryland. (2009, February 13). Stress. Retrieved from http://www.umm.edu/patiented/articles/stress_000031.htm

Rome :: essays research papers

Occultists the world over believe that, once a symbol is created, it acquires power of its own, and more power is generated when such symbol(s) are created without the profane [uninitiated] knowing about it. And, the greatest power of all is created in the symbol(s) if the uninitiated NEVER discover that the symbol exists. In this article, we shall demonstrate positive proofs of conspiracy to achieve the ends of Freemasonry, i.e., achieving the New World Order. And, these proofs exist right under your eyes, in Washington, D.C., the Capital district. Prepare for the unexpected. Before you read this article, you might want to go to a map store to buy a street map of Washington, D.C. The New World Order is coming! Are you ready? Once you understand what this New World Order really is, and how it is being gradually implemented, you will be able to see it progressing in your daily news!! Learn how to protect yourself, your loved ones! Stand by for insights so startling you will never look at the news the same way again. YOU ARE NOW ON THE CUTTING EDGE We will demonstrate that the street design in Government Center in Washington, D.C., has been cunningly laid out in such a manner that certain Luciferic symbols are depicted by the streets, cul-de-sacs and rotaries. This design was created by an Masonic architect in 1791, just a few years after Freemasonry assumed the leadership of the New World Order, in 1782. Remember, occult leaders in Europe were told by their Familiar Spirits as early as the 1740's that the new American continent was to be established as the new "Atlantis", and its destiny was to assume the global leadership of the drive to the New World Order. From the beginning, the United States of America was chosen to lead the world into this kingdom of Antichrist, and Washington, D.C. was to be its capital. You will need to have your maps of Washington, D.C., opened in front of you as we proceed. As we proceed through this discussion we will answer the great question of "Why" these streets have thus been laid out. Before we begin our discussion of this Washington, D.C. map, let us lay some important groundwork which will enable us to better understand the occultic meaning behind what we are about to show you. This information was given Cutting Edge Ministries by a born-again Christian who was once a medium level Satanist, Doc Marquee. At the time of his conversion, Doc was in charge of several Satanic covens West and North of Boston.

Autobiography in psychology

Ms. Darlene Gigabits August 12, 2014 Chocolate Hills The Chocolate Hills are probably Boll's most famous tourist attraction. They look like giant mole hills, or as some say, women's breasts, and remind us of the hills in a small child's drawing. Most people who first see pictures of this landscape can hardly believe that these hills are not a man-made artifact. To get back to Dignitary, you will have to walk back to the main road, and wait for a bus to pass by.The last bus room Carmen to Dignitary leaves at four P. M. Alternatively, you can use the services of the motorcyclists who often wait here for tourist, and ride ‘habit-habit,' or motorbike taxi. Boll was gifted with very amazing land formations such as these hills. It may not give you a majestic aura but it can make you appreciate how mysterious these natural wonders are. The viewing deck area may need to undergo a few more improvements El Indo Palatal Rocks and corals would hurt your feet so for those who have not been here yet, don't forget to bring and wear your best aqua shoes to avoid going home with cuts.Also, a dry bag to keep your things will make you happy especially if your camera is not water proof. As a divers, you should do at least one or two days of diving in El Indo. There are many nice dive sites in El Indo. I especially loved the rock formations and caves and of course the turtles Island hopping tours are a must in El Indo! Do them all for there is several and they are all different from each other and really fantastic. The lunches are usually cooked over a charcoal fire on a deserted beach.Kayak Tours to the lagoons and beaches around Million are many travelers favorite. For he fittest, I highly recommend you climb the cliff, towering El Indo town for a challenging hike and a breathtaking view Mayo Volcano Despite its tragic past, Caws Ruins continues to invite tourists to visit the place because of its spectacular view of the Mayo Volcano where everyone can see it with their nak ed eyes. The rich diversity of history, place and the people could be seen through the number of tourists that came over to from different part of the world.There, tourists can buy handicrafts, souvenir shirts and meet hospitable photographers who can direct you for picture-perfect shots. Drank Falls Drank Falls is one of the very accessible natural destinations in the province of Racial. The natural beauty of Drank Falls enchants visitors and guests. Its natural beauty, serenity, swimming with clean waterfalls, friendly staff, environment friendly ambiance, and other activities like rock balancing, river trekking, etc. Makes the visit to Drank Falls complete.Lunette Park Lunette park is one of the tourist spots in Manila. One thing that I like in this park is the man-made lake that has a relief map of the Philippines in the middle. Lots of people visit this place every Sunday for picnics. You will also see that some groups of martial artists are using this park every morning for pr actice like Seekers,Filipino Martial Arts, and ATA Chi practitioners. Met. Punctuation A desolate place transformed into a refuge for adventure seekers, Met. Punctuation now boasts breathtaking sceneries comparable to other tourist attractions across the country. He true Journey begins as you embark on a long and exciting trek to the volcano-mountain's center. You don't need to worry about the whole trekking thing because the reward is very promising: a paradise hidden at the heart of the mountain. Polaroid Junkies must take advantage of the place's astonishing backdrop, which is perfect for photo shoots. Portray Borealis a beautiful small island surrounded bifocal reefs and located one km north-west of Panky island in Visas of the Philippines.It is the most popular beach in the country's the most visited tourist spot in the Philippines. A peaceful atmosphere – though' fairly busy- and friendly locals. The sand is remarkably white, soft Banana Rice Terraces The Philippines ha s been visited by countless tourists from different countries due to the various tourist spots that are absolutely stunning. One of those places which have captured the eyes of many foreigners is the Banana Rice Terraces. In fact, this spot has been considered as the eighth wonder of the world.Campaign island One is simply at a loss for words to describe this lovely island which the tourists end caringly call â€Å"The Island of your Imagination†. Campaign is said to be the country's most peaceful island-paradise Campaign island is a one of an island that popular to visit the tourist and vacationers because of the unique wonderful nature and beauty, and so many beautiful places or hot spots that you enjoy or explore and Filipino students are so polite and hospitality to the tourist, many exotic food and delicious food you can avail, so we start to introduce to you a beautiful places resides in campaign.Sabbath Island The province of Batons is at the top most of the Philippine archipelago and it is the entrance of most storms in our country. No traffic, fresh air, full of culture and friendly people. You would be greeted by the locals with a refreshing good morning when you meet them on the street. The place is a bit backward which makes it more inviting especially for people from the urban Manila. It seems that everyone knows everybody. The expensive airfare makes it difficult for a local tourist to visit the place often.Corridor Island If you're a fan of war movies or military equipment, you will enjoy Corridor. Though heavily bombed during WI, the island still has some of its artillery standing The whole island is too big to be explored on foot – a new tour, though, aims to explore the sites around the parade grounds and part of Middlesex. But there's more to Corridor than Just the past. The island also has forest trails, a Jungle survival camp, bird watching opportunities, scenic boat rides, and even a beach. End your Corridor trip in a relaxi ng way.

Euthanasia Should Not Be Legal - 959 Words

Is it better to be dead than sick or disabled? Who decides when it is times for us to go? In the case of Earle Spring, his life depends on the court order. Earle Spring was an old man whose mental and physical health declined as he aged. The doctors kept him on a dialysis machine to keep him alive. Not too long after his condition began to worsen, his family requested him to be removed from the treatment and let him die peace fully because they thought that Earle Spring would not want to live as what his mental states are right now. How would the family know if that is what Earle Spring really wanted? Earle Spring is neither competent nor comatose. In recent discussion of euthanasia, a controversial issue has been argued whether a terminally ill patient should get the rights to choose when and how they live should ended. While some argue that euthanasia should be allowed to end a person life voluntary or involuntary, others contend that either should allow. Euthanasia should not be the choice to end a terminally ill patient life because it violates the patient rights, devalues some lives, and it gives doctors too much power. First of all, legalized euthanasia will violate the rights of vulnerable patients. Patients with serious illness sometimes cannot make decision by themselves, but neither should doctor intervene in the decision-making. According to Peter Saunders, author of Twelve Reasons...Why Euthanasia should not be Legalised, he stated, A patient with a terminalShow MoreRelatedEuthanasia Should Not Be Legal1683 Words   |  7 PagesEuthanasia is derived from the Greek, â€Å"eu† meaning good, and â€Å"thanatos† translating to death, together the word makes â€Å"good death†. A person who is terminally ill often goes through excruciating pain and suffering. Ultimately, the right to euthanize a terminally ill patient should be legal across the nation because that person doesn’t see an end to their anguish, so they wish to tu rn to euthanasia. Euthanasia frees the patient’s body and mind, lets them die with dignity, and their loved ones don’tRead MoreShould Euthanasia Be Legal? Essay1449 Words   |  6 Pages Euthanasia: The Right to Die Euthanasia is a concept that has been around for a very long time. It has been practiced since ancient Greece. We all have different opinions towards it; some of us might be for it and others against it. In most parts of the world Euthanasia is illegal. Many countries have denied the right to euthanasia, but is that fair and ethical? It is the painless killing of a patient’s agony from an incurable and painful disease. Euthanasia should be legal. SomeoneRead MoreShould Euthanasia Be Legal?1387 Words   |  6 Pagesunexpectedly† (Wpadmin). This shows that many people show aversion towards euthanasia and would not want themselves to be euthanized. Euthanasia occurs when someone is suffering from a painful or incurable disease and they prefer to die. It is done by taking them off of life support or not giving them essential supplies to live such as food, medications, oxygen, and more. There are countless debates of whether or not euthanasia should be legal, and whethe r or not it benefits people. Some countries allow itRead MoreShould Euthanasia Be Legal?1061 Words   |  5 PagesDetermining Euthanasia Millions of precious lives have been deliberately taken throughout the world due to the new Euthanasia Law. Euthanasia is the practicing of assisted suicide, due to terminally ill patients or depression. The practicing has just been legalized September 2015, and will be put into effect in California January 1 2016. Although, it is still being argued if adolescents should have the right fro this and if it’s morally correct all together. Euthanasia should be illegalRead MoreEuthanasia Should Not Be Legal1520 Words   |  7 Pages Euthanasia or commonly known as Physician-Assisted Suicide is defined as the painless killing of a patient who is suffering from an incurable and painful disease or is in an irreversible coma. It is an act that speeds up death. Some people consider euthanasia to be a mercy killing and others consider it to be murder. This practice is illegal in most countries. In the United States, however, six states have legalized physician-assisted suicide even though most states, 44 to be more specific, haveRead MoreShould Euthanasia Be Legal?1919 Words   |  8 Pages Euthanasia is a widely debated topic of the 21st century. Many places have legalized it, others refuse to even talk about the subject. However, more and more people are wanting their right to die to be recognized while others fight back against that right. A lot has to go into the backing and thinking about euthanasia, beginning with the different types that there are. After that, you would have to look at both sides to analyze why it would be a good practice to have, or a bad one. ManyRead MoreShould Euthanasia Be Legal?1311 Words   |  6 Pageshave used euthanasia, or physician assisted suicide. They used it with the purpose of releasing their soul and the pain that they could not endure any longer. Euthanasia is a process provided by the medical system today that involves active and passive euthanasia. Physician assisted suicide is spreading across the world, and people are using it legally. In the U.S, euthanasia has been legalized in some states so people are trying t o take advantage of it. Many people have used euthanasia so they wouldRead MoreShould Euthanasia Be Legal?1360 Words   |  6 PagesOwadara Adedamola ENG 101 Prof. Skeen 24 November 2015 Legalizing Euthanasia â€Å"Euthanasia is defined as conduct that brings about an easy and painless death for persons suffering from an incurable or painful disease or condition† (Muckart, et al 259). Euthanasia, also dying with dignity, is the practice of the termination of a terminally ill person s life in order to relieve them of their suffering. Euthanasia is one of today’s most controversial health issues with debates on people’s rightRead MoreShould Euthanasia Be Legal?2146 Words   |  9 PagesWho should be in charge of ending your life? Understanding euthanasia in its entirety can only be met when one knows the various forms it can take. They include passive, active, voluntary, and involuntary. Passive euthanasia refers to the practice of medical practitioners refraining from providing treatment in turn, allowing death. Active euthanasia, on the other hand, involves the deliberate killing of a person, using medical skills and knowledge as an instrument (Sheldon). The primary concern inRead MoreShould Euthanasia Be Legal?1183 Words   |  5 PagesThe word euthanasia is defined as good death, but this meaning cannot be taken literally without analyzing its underlying implications (Vaughn 595). The primary issues that must be raised when discussing euthanasia are differentiating between active and passive forms, analyzing the values that people place on their life and realizing that euthanasia is beneficial. Euthanasia provides a means for patients who are in agony to be relieved of their condition while ensuring that doctors follow appropriate