ANPC: Summative Assessment Level 4 Case Study

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Introduction Of The ANPC Summative Assessment

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Appropriate nursing care development is needed to support the patient with several health issues to improve their health position. The study has been developed based on the given case study, where several issues are identified in the family members. Arnold is selected as the patient who needs the most effective care support, and he is the father of Suzie. Therefore, a study has been developed to examine the serious issues which the selected patient faces. The whole discussion is based on the nursing process for the treatment process of the selected patient. In the nursing assessment process, one should need to assess the patient to identify the current situation of the patient for the development of an effective care plan. Therefore, the present study has focused on the area of the selected patient to improve the health issues which he faces.

The assessment tool MAT is used in the present study to inform the patient and develop an appropriate care plan for Arnold.

Main body

Description of case study

“The family” case study developed on some family members where several issues are identified in the members. In the identified members, the study mainly focused on the health issues of Arnold, who is the oldest member of the family with critical issues. Arnold lost his wife one year ago, and his wife was his main carer as he was diagnosed with dementia for the last six-year (Given). As per the view of Tilburgs et al. (2018), support for family members is also needed besides the “Abbreviated Mental Test (AMT)” for patients with dementia. In the present case, Suzie and his daughter take the role of carer as support is needed for him. On the other side, Suzie is diagnosed with “postnatal depression”, which impacts their care perspectives of Arnold. Besides this, appropriate nursing support is needed for a patient with dementia as memory loss is identified and support of family members is needed.

Another health issue identified in the given case study such as Arnold was diagnosed with a leg ulcer and visited a care home to get dressed by community nurse team. Some unethical issues are also identified in the care plan where family members of Arnold confirmed his unethical behaviour. He gifted a gold watch of his wife to a nurse who gave him dressing support for a leg ulcer, and the nurse accepted the gift. The analysis of the present situation of the given case study identified those impacted by the bioethical principles of nursing (Tilburgs et al. 2020). The common symptoms of dementia are identified in Arnold and those impacted by the management plan of nursing care. The patient worked as a postman, and he aged 82 years at the present time, which impacted his health severely.

Assessment of patient (Assessment tool and techniques)

Various patient assessment tools are present, which are effectively helpful for the management of health by identifying their requirements. In the present case, the patient was diagnosed with dementia and a leg ulcer, where appropriate assessment is needed to understand the needs of the patient effectively. “Abbreviated Mental Test (AMT)”assessment tools may be used in the present study to identify clinical settings required in cognitive functions (Harrison et al. 2018). The identified assessment tool has measured various cognitive domains of the patient “language, visuospatial, memory and attention”. Additionally, as the patient is diagnosed with dementia, where changes are identified in the cognitive elements use of the present assessment tool is appropriate (Beishon et al. 2019). Identification of scores in the present assessment helps to identify risk factors which are facade by the patients in the present situation. The identification of scores under the present assessment helps to determine dementia and the level of dementia with the use of “The Six-item Cognitive Impairment Test (6CIT)”.

In the below section of the study, the assessment table is developed to identify the severity of Dementia in Arnold. The identified assessment tool was identified in 1972 to identify the possibility and severity of dementia in elderly people (Takenoshita et al. 2019). In the below table, a total of 10 questions are present, which help to identify the appropriate score to determine the level of dementia.

Abbreviated Mental Test score

Elements

Score

Arnold score

Age

0= Incorrect or 1= Correct

1

Time

0= Incorrect or 1= Correct

0

Give an address to patient

0= Incorrect or 1= Correct

0

Year

0= Incorrect or 1= Correct

1

Name of the present place

0= Incorrect or 1= Correct

1

DOB or Date of birth

0= Incorrect or 1= Correct

1

Name of present Monarch

0= Incorrect or 1= Correct

0

Who is the present person

0= Incorrect or 1= Correct

1

Backward count 20 to 1

0= Incorrect or 1= Correct

0

Recall address

0= Incorrect or 1= Correct

0

Total score:

5

Table 1: Abbreviated Mental Test (AMT) assessment table

(Source: Bgs.org.uk, 2022)

The table mentioned above helps to identify the level of severity of a patient who suffers from dementia or is identified with the symptoms of dementia. An identified score of the present assessment is 6 or less 6 is identified as dementia or severe dementia (Calderón et al. 2021). In the analysis of the present score that is identified, the total score is less than 5, which confirms severe dementia in the patient.

In addition, the given case study shows that other health issues are identified in the patient. Arnold suffered from leg ulcers for a long period of time, and for the last six years, he has suffered from dementia. The general physical assessment is identified as the process which helps to identify the severity of leg ulcers (Li et al. 2019). The identified AMT score is identified that the patient suffered from dementia where nursing care besides the personal care needed at an effective level.

Identification and discussion of one major health issue (signs and symptoms, pathophysiology)

The person who identifies as the targeted patient in the present study has been diagnosed with severe health issues. Based on WHO, some signs and symptoms are identified which are seen in dementia patients. Those are listed below;

  • In the early stage: forgetfulness, loss in a familiar place and losing time.
  • In the mild stage: forgetful of recent events, difficulty with communication and confusion
  • The last stage: is unaware of time and place, difficulty recognizing family members, difficulty walking, increased self-care needs and aggression (Who.int, 2022).

The analysis of the present stage that identified AMT score is identified as 5, which is identified as a mild stage of dementia. Therefore, in the present case of Arnold that is identified, he is not able to recall his time and the patient who gave him care. Therefore based on the score of the assessment tools identified patients faced issues which are related to issues elderly (Peixoto et al. 2018). In addition, another issue is identified as physical health issues besides mental health issues. A leg ulcer is identified and diagnosed at the server level, as patients need to get dressed twice a week. Based on the signs and symptoms of the patient, the risk of elderly is identified; therefore, he needs quality nursing care (Tilburgs et al. 2018). In addition, some behavioural issues are identified in the present case of Arnold, where he gifted his wife a watch to a nursing staff member.

In the present case study, three severe issues are identified, which are psychological issues such as dementia, physical issues, leg ulcer and behavioural issues. The person identified with the age of 82 years and that age group is identified as a group with a risk of various health issues. Some common risk factors of elderly people are “physical health issues (Alzheimer's disease and others), chronic pain, social isolation, psychological issues” (Schneider et al. 2021). In the case of Arnold, those health issues are identified, which may be managed with the care of family and nursing specialists. Support of the family is reduced in the case of Arnold as his main carer faced issues of depression. Therefore, based on the critical analysis that is identified, appropriate care support is needed for Arnold to improve his dementia along with his leg ulcer. Various risk factors are identified for leg ulcers, such as problems with blood circulation in vain or diabetes (Nie et al. 2021). Based on those identified issues, a care plan has been developed for Arnold, where support from the family members is also needed.

Care plan for the patient

The assessment process, which is identified in the vibe section, has been helping to develop the care plan. The use of the appropriate care plan based on the results of the assessment developed quality care for Arnold. Based on the results of the AMT assessment, the identified patient has suffered from dementia (Niznik et al. 2021). The nursing care plan and goals are identified for the management of dementia which needs to develop with some goals;

  • Inaccurate interpretation of the environment
  • Non-reality-based thinking to assist patients (Nie et al. 2021).

The identified goals help in the management of the nursing intervention process effectively. Some effective nursing interventions may be followed by the nursing professionals, and those are listed in the below section;

  • Encourage patients for reorientation and lead them with prospective caregivers,
  • Orient patients to reality and surrounding situations,
  • Communication support and face-to-face interaction
  • Discussion with the elderly person about the negative effects of the potential situations (Mosti et al. 2020).

The identified strategies are effectively helpful for the management of health issues of Arnold and those help in the management of behavioural issues aligned with dementia. In addition, NICE recommended “Cognitive stimulation therapy” in the care plan for dementia (Agespace.org, 2021). The development of daily routines helps dementia patients to manage themselves, which may work effectively in the case of Arnold. A person with mild or moderate dementia gets benefits from the adoption of the CST process in nursing care. The use of the present therapy may help Arnold to improve their memory and language with the appropriate care plan. The use of “Behavioural therapy” is identified as an alternative to the care plan, which helps to manage behaviour issues in a patient (Haltbakk et al. 2021). In the present case, behavioural issues are identified in Arnold, which may be managed with the present therapy in his care plan.

In the management of leg ulcers, Arnold needs to manage personal hygienic management where the support of his personal carer or family members. “Compression therapy, dressings, debridement, and medication” are identified as nursing management processes in the care plan (Niznik et al. 2021). In the given case that is identified, Arnold already gets support for dressing and medication. Therefore, in the identified nursing care plan, support of the family members and palliative care of the nursing professional is needed. “Biomedical ethics and the NMC Code” are needed to be followed during the development of an effective nursing care plan (Bifarin and Stonehouse, 2021). Therefore, person-centred care includes well-being as a patient priority, relationship development and meaning activities development process. Those steps are followed by the healthcare professional for the management of health issues, Arnold.

Conclusion

It is concluded that the study has identified medical issues and health issues which are faced by Arnold, who is a selected patient of the present study. Besides this, the AMT score is identified with the use of an assessment tool where Arnold's score is 5, which shows that the patient has mild dementia. The scores of the assessment help to identify the area where issues are identified, and based on the identified issues care plan is developed. “Cognitive stimulation therapy” and “Behavioural therapy” are identified as therapeutic support, which is included in the care plan of Arnold. Therefore it is concluded that besides medication support, Arnold needed supportive care from his family. Developed issues of leg ulcer impacted his walking activity where the support of the carer is needed. Cognitive and nursing care may improve the present situation of the patient by improving the health of the patient. The study focuses on flexibility besides an effective supportive care plan for Arnold to improve his health.

Therefore, it is concluded that appropriate patient care with the use of ethical codes increases the quality of care.

Reference

Beishon, L.C., Batterham, A.P., Quinn, T.J., Nelson, C.P., Panerai, R.B., Robinson, T. and Haunton, V.J., 2019. Addenbrooke’s Cognitive Examination III (ACE?III) and mini?ACE for the detection of dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews, (12).

Bifarin, O. and Stonehouse, D., 2021. Autonomy and capacity: the ethical and legal considerations. British Journal of Healthcare Assistants, 15(11), pp.545-549.

Calderón, C., Beyle, C., Véliz-García, O. and Bekios-Calfa, J., 2021. Psychometric properties of Addenbrooke’s Cognitive Examination III (ACE-III): An item response theory approach. PloS one, 16(5), p.e0251137.

Haltbakk, J., Graue, M., Harris, J., Kirkevold, M., Dunning, T. and Sigurdardottir, A.K., 2019. Integrative review: Patient safety among older people with diabetes in home care services. Journal of advanced nursing, 75(11), pp.2449-2460.

Harrison Dening, K., Sampson, E.L. and De Vries, K., 2019. Advance care planning in dementia: recommendations for healthcare professionals. Palliative Care: Research and Treatment, 12, p.1178224219826579.

Li, X., Yang, L., Yin, J., Yu, N. and Ye, F., 2019. Validation study of the Chinese version of Addenbrooke's cognitive examination III for diagnosing mild cognitive impairment and mild dementia. Journal of Clinical Neurology (Seoul, Korea), 15(3), pp.313-320.

Mosti, G., Cavezzi, A., Bastiani, L. and Partsch, H., 2020. Compression therapy is not contraindicated in diabetic patients with venous or mixed leg ulcer. Journal of Clinical Medicine, 9(11), p.3709.

Nie, X., Kuang, X., Liu, G., Zhong, Z., Ding, Y., Yu, J., Liu, J., Li, S., He, L., Su, H. and Qin, W., 2021. Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers. Journal of Orthopaedic Translation, 27, pp.1-7.

Niznik, J.D., Li, X., Gilliam, M.A., Hanson, L.C., Aspinall, S.L., Colon-Emeric, C. and Thorpe, C.T., 2021. Are nursing home residents with dementia appropriately treated for fracture prevention?. Journal of the American Medical Directors Association, 22(1), pp.28-35.

Peixoto, B., Machado, M., Rocha, P., Macedo, C., Machado, A., Baeta, É., Gonçalves, G., Pimentel, P., Lopes, E. and Monteiro, L., 2018. Validation of the Portuguese version of Addenbrooke’s Cognitive Examination III in mild cognitive impairment and dementia. Advances in Clinical and Experimental Medicine, 27(6), pp.781-786.

Schneider, C., Stratman, S. and Kirsner, R.S., 2021. Lower extremity ulcers. Medical Clinics, 105(4), pp.663-679.

Takenoshita, S., Terada, S., Yoshida, H., Yamaguchi, M., Yabe, M., Imai, N., Horiuchi, M., Miki, T., Yokota, O. and Yamada, N., 2019. Validation of Addenbrooke’s cognitive examination III for detecting mild cognitive impairment and dementia in Japan. BMC geriatrics, 19(1), pp.1-8.

Tilburgs, B., Koopmans, R., Vernooij-Dassen, M., Adang, E., Schers, H., Teerenstra, S., van de Pol, M., Smits, C., Engels, Y. and Perry, M., 2020. Educating Dutch general practitioners in dementia advance care planning: a cluster randomized controlled trial. Journal of the American Medical Directors Association, 21(6), pp.837-842.

Tilburgs, B., Vernooij-Dassen, M., Koopmans, R., van Gennip, H., Engels, Y. and Perry, M., 2018. Barriers and facilitators for GPs in dementia advance care planning: a systematic integrative review. PloS one, 13(6), p.e0198535.

Website

Agespace.org, 2021. 6 of the Best Dementia Treatments AvailableAvailable at: https://www.agespace.org/dementia/treatments-used-dementia [Accessed on: 2nd December 2022]

Bgs.org.uk, 2022. Abbreviated Mental Test Score. Available at: https://www.bgs.org.uk/sites/default/files/content/attachment/2018-07-05/abbreviated_mental_test_score.pdf [Accessed on: 2nd December 2022]

Nursingnotes.co.uk, 2022. Nursing Assessment Tools help you to provide safe and evidence-based care to patients. Available at: https://nursingnotes.co.uk/resources/guide-nursing-assessments/ [Accessed on: 2nd December 2022]

Who.int, 2022. Dementia. Available at: https://www.who.int/news-room/fact-sheets/detail/dementia [Accessed on: 2nd December 2022]

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