NMIH105 Primary Health Care Nursing


Case Study

Mr Harry Pitman, an 83 year old veteran, tripped on a mat at home going to the toilet and fractured his left Neck of Femur. He was admitted to hospital for a total hip replacement.
He has now returned home and his discharge summary recommends that he is to meet with his GP for follow up. 

Mr Pitman’s GP works in a large superclinic in the Illawarra which offers multidisciplinary care and access to GPs, nurses and allied health professionals, including exercise physiologists, clinical psychologists and a dietician. 

Mr Pitman’s GP reviews his hypertension and pain medications and suggests that he meets with Mark Stamford, the registered general practice nurse (GPN) for a health assessment and review of his wound. 

Mark has known Mr Pitman for several years and is familiar with his history of hypertension and osteoporosis. The GPN also knows that since the death of his wife, Mr Pitman has lived alone with his dog “Ruby” and enjoys going to his local RSL to catch up with mates. Mr Pitman has a son who lives interstate and a daughter who lives locally.

The GPN arranges a convenient time for Mr Pitman to come in for a health assessment. Mark knows that the assessment for people aged 75 years and older is a detailed and prolonged assessment, and explains this to Mr Pitman (Medicare Benefits Schedule (MBS) Item 707). 
On assessment the GPN records the following:

HR: 68
BP: 145/78
Respirations: 14                     

On inspection, Mr Pitman is ambulating well with support of a walking frame and his wound is clean and dry with a small amount of exudate on the distal fringe. Pain originating at the wound site is manageable with his current medications. On a scale of 1 to 10, with 10 being severe pain, Mr Pitman rates his pain level at a 2-3 when ambulating. As the GPN progresses through the health assessment he explores how Mr Pitman is coping with his activities of daily living. Mr Pitman states that his daughter brings him an evening meal each day and sandwiches for the following lunch.
Since being discharged he has had many friends drop in with ready-made meals. However, he is finding it difficult to manage the re-heating of these meals so often eats them cold. Mr Pitman also confides that he is feeling constipated and is sometimes incontinent at night as he can’t seem to get out of bed in time to reach the toilet. He also tends to remain in his pyjamas over the weekend unless his daughter is able to help him. 

As part of the 707 health assessment, the GPN conducts cognitive screening on Mr Pitman through a Standardised Mini-Mental State Examination (SMMSE). The GPN records that while Mr Pitman is coping independently as best he can at home there is moderate cognitive decline.  To prevent any further decline to Mr Pitman’s physical and psychological health, the GPN arranges referrals/home services so that he doesn’t end up in hospital again.

Structure your assignment so that it meets the following requirements: 

This is a  case study report, and does not require an introduction and conclusion. Use the following headings to structure your assignment.

GPN health assessment

Provide an overview of the general practice nurses role and the 707 health assessment for people aged 75 years and older. Access the MBS benefit paid for this specific health assessment. Present the aims of the 707 health assessment and identify Mr Pitman’s risk factors based on his physical, psychological and social functions. 

Activities of Daily Living

Explore the incidence and causes of falls in older people. Discuss deficits relating to Mr Pitman’s activities of daily living (eating, bathing, dressing, toileting/continence, mobility/transferring). Provide one paragraph on each and describe how these may impact his overall health. Support your findings with evidence from the academic literature (eg Applying the Roper-Logan-Tierney Model in Practice (ebook available via library)

Nursing Care Recommendations and Rational

Discuss recommendations that the GPN could provide Mr Pitman so that his ADL needs are met in his home environment. Consider home care options and referral pathways that are available to Mr Pitman. For example, explore the options that an Aged Care Assessment Team (ACAT) 

Also explore the services available through the multidisciplinary team at his own superclinic and those available to him in his community. Provide rationales for your recommendations and support these with evidence from academic literature and Government websites. 
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