Gerontology

Assignment Gerontology

Hi are you Finn? I’m Lima peters a nursing student. Oh hi Lima, you're looking after Miss
Greta Kazowski today. have you taken care of her before? No, today will be my first
time. Okay well, Greta is a 66 year old female who has had a right-sided cva about three
months ago and as a result she has left-sided weakness. Greta also has a history of
hypertension. Last night she was quite restless and needed help to the bathroom a
couple of times. right now she's seated in the dining room and is ready for breakfast. Oh
and I should also let you know that over the past few weeks she has shown a lot of
improvement with her strength and is more independent with her meal now.

Q. What priority information is missing from the report on Ms. Greta Kasowski?

Ans: Therapeutic Diet

Is Miss kasowski on a special diet? Oh yes, she has dysphagia and is on a period diet
with thickened fluids. Also she has no food allergies. You can find her in the dining room
at table 3. Do I need to help her with breakfast? Greta usually starts her meal on her own
using her affected arm. However she tires easily and may need help completing her
meal. Okay thanks, I’ll go see her now. All right.

Good morning miss kazowski. My name is Elena peters and I’ll be a nursing student for
today. Would you like me to call you? oh please call me Greta. Okay Greta well I’m here
to assist you if you need any help with your breakfast. Oh that would be great thank you.
So how was your night oh my night last night wasn't very good because i was up to the
bathroom a couple of times but I’m feeling fine now and my granddaughter ale is
coming for a visit today. Well that's exciting it is! So do you want to get started on your
breakfast and we can get ready for allie? Oh that would be great thank you.

Q: What is your next action?

Ans: Ensure Greta has the appropriate diet.

Oh I just noticed that your coffee hasn't been thickened yet. Let me help you with that.
Oh thank you. I'm so looking forward to my coffee this morning I love coffee. Do you
smells great? So what would you like to start with? Um, I think I'll start with my oatmeal
because while it's still warm. That sounds good. I'm so looking forward to Allie coming
today she's so much fun. I bet and it's so nice outside today all the sunshine and the
warmth. Maybe you Guys could go to the garden or you can even show the library. Yes.
Oh don't forget to show her the roses in the garden. How's uh how's your oatmeal? It’s
nice.

Q: How should you respond to Greta's eating technique?

Ans: Correct Greta's technique.

Oh hang on just a second Greta, I know you're hungry but try taking smaller bites, so you
get better control of your swallowing. Oh you have a point. I know when I take larger
bites I cough more than usual, but I feel like it's just a spoonful. That's true but why don't
we try taking half a spoonful with a smaller spoon instead. a smaller amount will help
prevent coughing. Okay. that's perfect also it's good to swell at least two times with
each bite. Eating slow prevents aspiration so the food will go into your stomach and not
into your lungs. Okay. that's good and you're not clearing your throat or coughing as
much anymore. Is that feeling better for you? Oh it's good. So it's exciting your
granddaughter is coming today. What time are they going to be here? I’d love to meet
her. Mm-hmm it's exciting! Coughing..

Q: What is your priority response?

Ans: Call for help.

Greta is coughing… Okay Greta I’m right here with you. Can someone help me please!
(Liam came to assist) Are you chilling? Well we were just talking she started coughing a
lot. You’re doing okay Greta? Just keep coughing just keep coughing because that will
help a lot. you're doing a great job clearing your throat you're doing well Greta and just
like a lima said if it's important that you keep coughing so you can clear your airway
that's good Greta huh that's better you're sounding so much better too Greta would you
two like me to stay a bit longer um I, I think we're okay now thank you. thank you Liam
all right I’m better now okay that's good and it's also good that you called me over
because I’m just right here by the table if you need me all right okay thanks Liam.

Q: What is your priority assessment?

Ans: Check for pocketing.
Greta do you have any more food left in your mouth? No I don't think so. Okay well just
to be sure I’d like to check for any pocketing of food in your mouth. Let me just put my
gloves on first. Okay. Can you just lean in and open your mouth for me? thank you, okay
well, sometimes when people have difficulty swallowing they can get some food stuck
in their mouth and between their cheeks and gums especially it looks like you're all clear
though, um and also because if you have any food left in your mouth that could lead to
choking. Oh I wouldn't want that to happen again that was so scary.

Q: How should you respond to Greta?

Ans: Acknowledge feelings.

Oh Greta I can see how that was scary for you but I’m here if you want to talk more
about it. Thanks for offering. I know its all part of my recovery and I have to get used to
all these changes but sometimes it's just so overwhelming. They are big changes to get
used to. they are. well I see you haven't finished your breakfast yet do you want to
continue or did you have enough? Yes I’d like to finish I, I’ll just eat a bit slower I have my
applesauce and my yogurt to finish. Okay let me just get the oatmeal out of your way.
Thank you. So when you're eating just remember to place the food on the right side of
your mouth because that's where the muscles we're swallowing are stronger. Okay. and
I really like how you're sitting upright when you're eating that helps as well and we can
also add a chin tuck when you're swallowing because that'll help the food go down the
right way. Okay. that's great. So I saw the activities calendar and I saw that there's a
choir coming after dinner tonight. Oh don't forget the chin ta da perfect and there's dog
therapy tomorrow too. That looks good Greta. Oh Greta are you getting tired? My arm is
getting tired but I still want to eat some more.

Q: How should you respond to Greta?

Ans: Suggest Greta to use her unaffected hand.

Greta, why don't you try using your other hand? Okay, it always feels weird though when
i use this hand for eating. Yes I can understand that but let's just see how it goes? Okay.
Looks like you're doing okay with that hand. Oh god yeah stun hmm. Great work I guess
you're all done now would you like me to take you to the lounge. Um, no thanks I would
like to go back to my room and have a nap I'm really tired and I want to nap before my
family comes today.
Q: What should be your next action regarding Greta’s request?

Ans: Encourage Greta to remain in the chair.

Greta after your meals it's important that you stay sitting upright for 30 minutes to make
sure the food doesn't go into your lungs. Oh, I forgot that point. That’s okay. I can help
you back to bed in half an hour if you still want to take a nap. Oh that'd be great I’ll go to
the lounge instead then. Of course.

Key Points to Remember:

Ensure a client diagnosed with dysphagia has the appropriate thickened diet prior to the
beginning of their meal.
Correct a client's technique to decrease the risk of choking on food items.
If a client begins to choke, call for help and stay with the client. Encourage them to
continue to cough to help clear their airway.
Check for pocketing of food in the client's oral cavity as needed.
Encourage the client to remain sitting upright or in the chair for at least 30 minutes after
eating.