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Using the A-E approach, what are the nursing priorities for Patience’s care?

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Patience Williams

Patience is a 58-year-old woman who has lived in the UK since coming with her parents from Jamaica in the late 1960s. Patience trained as a nurse in the 1980s but gave up after marrying her late husband, Lionel. After marriage, Patience lost contact with her parents and two brothers as they disapproved of her marriage to a white man. Patience has four grown-up children, her eldest daughter Amber lives nearby with her wife Susan, but Patience refuses to maintain contact because she disapproves of her same-sex relationship.  Patience’s second daughter Rebecca and eldest son Aaron both now live in Australia and her youngest son Rodell has just started university in Liverpool. Lionel died in a road accident sixteen years ago when Rodell was under two. After this Patience began to struggle with depressionand started to gain weight. Patience is visited daily by her friend Cantrice from the local Kingdom Hall of Jehovah’s Witnesses that Patience used to attend, she shops and cleans for Patience and provides her with cooked meals five days a week.

Patience now has a BMI of 37 and struggles with mobility; she lives in a third-floor council flat. She was diagnosed with Type-2 diabetes 10 years ago and this is poorly controlled.

Patience is visited at home by the community nurse who is anxious that her condition is deteriorating and feels she needs reviewing by the diabetic consultant clinic. Patience is not keen on attending the hospital.  

Following review by the diabetic consultant Patience’s diabetic control improves. On her latest visit, her blood sugar was 12.5mmol/l and her HbA1c has improved from 13.8 to 10.9. However, Patience is still gaining weight and has become even more depressed and immobile.

OBSERVATIONS TAKEN BY COMMUNITY NURSE AT TIME INITIAL OF HOME VISIT

Airway: Able to talk in full sentences when at rest.

Breathing: RR 25 at rest, feels breathless with deep gasping breaths.

Circulation: HR 114, BP 205/110,

Disability: AVPU: Patience is alert and orientated.

Exposure:  Temperature 36.4C, Blood sugar ‘HI’ on BM test.

Problem 1:

Using the A-E approach, what are the nursing priorities for Patience’s care?

 
 

 

 

 

 

 

 

 

 

 

 

Problem 2:

Provide a rationale for the care you have suggested in Problem 1.

- Remember to use relevant pathophysiology, pharmacology and appropriate care guidelines to support your argument.

 

Developing Scenario:

Two years later Patience is much better. Following counselling and successful help with dieting, her BMI is now 28 and she has regained considerable mobility and is again attending the Kingdom Hall. Patience’s type-2 diabetes is now much better controlled. Microvascular complications from Patience’s diabetes persist however.

Problem 3: How might Patience’s rehabilitation in terms of regaining movement and returning to previous life activities have been managed in the community taking into account the multi-disciplinary team and the likely availability of services to help Patience to rehabilitate.

 
 

 

 

 


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