Get Answer: Bill Year Resident Question Guide

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Original Question

Bill is an 83-year-old resident of an aged care facility. He has dementia and end stage heart failure secondary to advanced coronary artery disease. Len is Bill’s son and enduring guardian, and visits Bill daily. Bill and his son are very close and prior to moving into the aged care service Bill lived with Len for 5 years. Len comes to the aged care service and has lunch with Bill every day. Over the past three months Bill has become immobile, physically frail and has had recurrent chest infections. Len has recognised that his father’s condition is deteriorating and has discussed with the staff that he does not want his father to suffer. Over the past week, Bill has been unable to leave his bed, due to another chest infection. Despite being prescribed Amoxicillin (antibiotic), Bill has continued to deteriorate further with a diagnosis of bronchopneumonia. Bill is now refusing food and fluid and he is quite sleepy. The RN at the service and Bill’s GP meet with Len to discuss his father’s deterioration. The GP informs Len that Bill is no longer able to swallow and recommends that all oral medications be ceased. Len agrees with the decision to treat Bill palliatively and explains that he wants his father to have a peaceful death. Bill has commenced on an end-of-life care pathway and Len has been encouraged to spend as much time as he needs with his father. The RN at the service has done a Braden Pressure Ulcer Risk Assessment for Bill and he has scored 8 (severe risk). Bill has been placed on a pressure relieving mattress (alternating air pressure mattress). Bill is also incontinent of urine and faeces. Incontinence pads are being used. Subcutaneous PRN analgesia has been charted for pain management. When staff move Bill in bed he is assessed having an Abbey Pain Score of 13 (moderate pain). Len has spent many days sleeping in the visitor’s room. Len is worried about his father’s death and unsure what will happen to his father as he continues to deteriorate. You are reviewing sections of Bill’s care plan since the decision to treat him palliatively was made. Domain Nursing Goal Intervention Nutrition and Hydration Encourage Bill to increase his oral intake Provide Bill with nutritional supplements to increase intake and weight gain. Offer Bill regular drinks. Oral Health Maintain moist lips and oral mucosa Clean Bill’s teeth three times a day to avoid bacterial build up. Inspect Bill’s mouth on a daily basis for signs of dryness and infection. Use oral swabs soaked with water or normal saline. Skin Care Maintain skin integrity Reposition Bill every 2 hours to promote circulation and reduce pressure on bony prominences. Question 4: Reflecting on the information provided in the scenario, identify three (3) skin care interventions (1 mark each) and explain how each intervention (1 mark each) can support Bill’s needs and quality of life at this stage

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