3: – What services were provided to client and did they… 3

3: – What services were provided to client and did they… 3:- What services were provided to client and did they work?List any services? (Services are any assistance from any sort if provider – HACC, NDIS, Meals on Wheels… – Did all the teams work together successfully? write little more if necessary- What reports were needed? (Reports is feedback or information in how things are going, what else is needed, what can be done better, what no longer needs to be done?- Were any changes to the client’s care made? Client 3:Case Study Ms Gwenda Arnold Name: Ms Gwenda Arnold D.O.B.: 12/06/1954 Address: 2 Elmore St, Baldivis, 6171BackgroundGwenda Arnold was born in 1954 in Melbourne. She is the second eldest of four children, Gwenda’s mother is from Greece and her father was born in Australia., Both her parents are still alive although her father is quite frail, Gwenda attended school until she turned 15 and then worked in a variety of jobs starting in a cafe and then moving on to factory work, where she became the floor supervisor after a few years. She married at the age of 18 years of age and had two daughters, Elisa and Grace. She continued working after having her children with the support of her family. Gwenda divorced in 1992. Gwenda has never remarried and has four grandchildren. Elisa, her husband and two children moved to Perth for work reasons and Gwenda followed her 15 years ago. The family is close but busy and Gwenda sees Elisa about once per month but talks to her on the phone every week. Grace has moved to Sydney. Gwenda found work in Perth as a cleaner in a Nursing Home. The difference in housing prices from Melbourne to Perth meant that Gwenda could live mortgage free in Perth. Gwenda left work when she became too ill to continue with the heavy work as a cleaner. Gwenda enjoys cooking and gardening and socialising with her friends., She is Eastern Orthodox Christian and goes on Sundays to the Greek Orthodox Church a few suburbs away.Health historyGwenda has struggled with depression at various stages in her life. Looking back, she feels that she had post-natal depression that was never diagnosed. She became depressed when her marriage failed and was treated with anti-depressants for 2 years. Gwenda had a episode of having painful joints in some of her fingers prior to moving to Perth but attributed the pain to the work she was doing at the factory and her gardening. However, she started to suffer pain and swelling in both wrists after she moved to Perth. After seeing her G.P. who conducted some investigations she was referred to a Rheumatologist who diagnosed her with rheumatoid arthritis (RA). Gwenda was given cortisone injections for her wrists and started on medication for RA. The pain in her wrists resolved and other than some small flare-ups in her hands, Gwenda was able to live and work normally. She was able to manage her pain by taking paracetamol and anti-inflammatories. However, her mood became low and she became depressed and anxious. She had very little social support in Perth and didn’t want to be a burden to her family. She was worried about her future and how she would support herself if her arthritis became worse. After talking to her G.P. she started anti-depressant therapy and he put her on a Mental Health Plan that involved seeing a counsellor and exercise. She ceased taking antidepressants about a year later after making connections with the local church and her exercise group.Gwenda left work at the age of 60 when she needed to have knee replacements for both knees. Her rheumatoid arthritis had worsened, and she has RA in the joints in her fingers and wrists. Unfortunately, a side effect of her medication and age, Gwenda has also developed osteoporosis and osteoarthritis, She has struggled to manage her pain and started taking opioid medication on her bad days. Exercise and distraction helped but Gwenda found herself relying more and more on her analgesia.Current SituationGwenda suffers from chronic pain and struggles to get through her everyday tasks. The side effects of her pain medication sometimes make her feel dizy and she gets constipated. The pain makes her feel exhausted and depressed. Gwenda walks using an elbow crutch for support that was given to her when she had her knee replacement 5 years ago. She has trouble keeping up with the housework and cooking for herself and she hasn’t done any gardening for a while. Gwenda can still drive and manages shopping by buying small amounts every day. She was buying frozen meals so she didn’t have to cook but didn’t like them. Most days Gwenda buys take-away which is expensive. Gwenda has given up her exercise class as it is too painful for her and wouldn’t bother to go to church If her friends didn’t take her. She has started to put on weight and is now overweight. Gwenda has a very low mood and becomes very anxious when thinking about her situation. She doesn’t want anyone to know that she is struggling and has avoided having Elisa over to the house, instead meeting her at her daughter’s place, She is worried that her daughter will want to move her into a nursing home like the one she used to work at. She feels embarrassed about the extra weight she has put on and has started to lose interest in her appearance. Recently her friends have been making comments. They don’t understand how difficult it is for Gwenda to go out with them. Gwenda knows they are just concerned but doesn’t want to tell them what is wrong. She doesn’t want to feel pitied. Recently she had a fall on the way to her letterbox. The pathway is very uneven and weeds have grown up between the cracks. Her neighbour heard her calling out and called an ambulance. In the Emergency department, Gwenda had a panic attack as she was frightened that she wouldn’t be able to go home, After being reassured that her injuries were bruises and not fractures and that she was safe to walk Independentily, Gwenda was sent home the same day with a referral to the Falls Specialist at the hospital.Health ManagementGwenda attended the Falls Clinic a fortnight after her fall. The physiotherapist conducted a thorough assessment of Gwenda’s mobility as well medications, past medical history and current ability to perform her activities of daily living. Gwenda was asked to set some goals of what she would like to achieve. Gwenda’s goal was to live safely and comfortably in her own home without being a burden on anyone. She also wanted to be able to enjoy life s strength and balance. She also asked Gwenda about her mood, more and feel less anxious. Because Gwenda was taking medication for her RA as well as pain medication, anti-depressants and anti- anxiety medication, the physio referred her for a medication review with a specialist pharmacist and asked the G.P. to refer Gwenda to a Pain Specialist. The physio also referred her to the social worker and the occupational therapist for services and aids in the home. After assessing her mobility, the physiotherapist convinced Gwenda to trial using a four-wheel walker instead of the crutch until she was stronger. Finally, Gwenda was set up with an exercise program to improve her strength and balance. The occupational therapist (OT) organised to visit Gwenda at her house to do a falls risk asseut Gweng thought was a trip hazard and said he would come back with some samples of kitchen uteisis tr buving naving the groceries delivered as most supermarkets have a delivery service. Finally, the of hee 2 a lo arounu the outside of Gwenda’s house, He surgested moving the letterbox closer to the divewen offer. Gwenda would have to get a handyman to make the changes. The social worker, with Gwenda’s permission, sent a referral for the Regional Assessment Service (KASI- Jane, the co-ordinator from RAS, suggested Gwenda recelve cleaning services for her bathroom and fioors S well as hanging up and taking in laundry. She also said that the Commonwealth Home Support Program Oifered limited gardening and maintenance services. They could move her letterbox as it contributed to her falls risk and she could receive an hour of gardening every six weeks. Jane suggests that Gwenda get a pendant alarm as she lives by herself. Gwenda attended her appointment with the Pain Specialist. He reviewed her medication and suggested some alternative treatments such as physiotherapy and massage as well as heat and cold treatments. He provided her with a TENS machine to trial. The Specialist also gave her some information about the Chronic Diseases Medicare Plan, where she can access 5 free allied health sessions per year.OutcomeGwenda considers her options. She decides to have home help for house cleaning and the maintenance service but she has decided to ask her grandson if he would like to earn some money by doing some gardening every week. Gwenda feels that she will be able to afford this if she stops buying take-away. She has decided to organise a pendant alarm and will ask the neighbour if she will be a contact person for the alarm as well as her daughter. Gwenda has continued with the exercise program and would like to get back to using a crutch as the four- wheel walker is difficult to get into the car. Gwenda is still anxious about her future and is worried that once the Falls Clinic program finishes that she will return to the way she was. The physiotherapist has suggested talking to a psychologist that specialises in chronic pain and has sent a referral for her. The physiotherapist has also organised for ongoing community exercise classes including hydrotherapy. Gwenda still struggles with eating well, especially when she is in a lot of pain however her daughter is now coming over once a week and they cook together and freeze meals for the rest of the week. Gwenda has joined an online support group and finds it helpful to talk to other people in her situation. The TENS machine and a combination of resting and better medication management has reduced the amount of pain Gwenda suffers from. While she knows the pain will never be gone completely she is better able to manage it so the number of bad days is reduced. She reserves her energy for doing things she enjoys. Gwenda hopes going to the Pain Psychologist will help her manage even better.Health Science Science Nursing MED 101

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