Will Case Scenario

WillINTRODUCTION TO WILL, HIS HOME AND HOUSEMATES

Will Thompson is 54 years of age and lives in a house in an outer suburb of the city. The clients have day, evening and night support (if necessary).

Will had been sharing a unit in a large public housing block with Nigel (60) for 10 years and they are good mates. They moved to this house only a year ago because they needed increased support; they now share with two other men, John and Terry. All the residents have chronic health conditions and some intellectual impairment. Three have long-standing mental illness, and they have all struggled with independent living.

The house is a bit run down and sometimes a bit grimy. The residents are responsible for keeping the house clean and tidy, with support from staff; however, it is often difficult to maintain good standards.

Each resident has his own bedroom, with one having a small ensuite bathroom. The other three (including Will and Nigel) share a bathroom. All residents are involved in food shopping and cooking with support from staff members. The kitchen is roomy and well-equipped. There is a barbecue and pleasant outdoor eating area on the back deck.

SERVICE

The Open Door Fellowship is responsible for Will’s home. This is a religious affiliated organisation that provides housing and support programs for people with disabilities, primarily mental illness. The organisation receives government funding.

Staffing consists of:

  • One Support Worker for morning shift (6.30am – 4pm)

  • One Support Worker for afternoon shift (3.30pm – 9.45pm)

  • One Support Worker for night ‘sleepover’ shift (9.30pm – 7am)

A Manager is responsible for the operation of this house, as well as four others in the area.

Residents in the home access local community health services (including mental health) and General Practitioners.

Will and Nigel have few interests apart from watching TV and hanging out at the local shopping mall. They used to smoke heavily but ceased last year. They like to go to the local pub once a week for a few beers.

BACKGROUND

Will has no contact with family and nothing is known of his family history. Will says: “My family got rid of me when I was young and sent me to the mad house”.

CURRENT SITUATION

Will has recently been discharged from hospital where he was treated for chronic osteomyelitis (bone infection related to an old elbow fracture following a fall). He is unable to straighten his left arm which causes him significant pain. This has made him cautious about moving around. However, the doctor in the rehabilitation hospital has prescribed regular pain medication and Will now moves more willingly. He also participated in a program of graduated, gentle exercise, and is now stronger and his risk of falling is reduced.

When in hospital, Will was diagnosed with diabetes. He has been started on oral medication to reduce blood glucose (oral hypoglycaemic); and this should control his diabetes, in combination with good dietary management and exercise.

If not successful, Will may require injections of insulin which would be very difficult for him to manage. Will has an aversion to needles and refuses to do his own blood glucose levels (BGL). Following education in the hospital, he understands the necessity for BGL monitoring and will usually cooperate if someone does BGL for him.

The hospital dietitian’s assessment of Will’s usual eating and drinking at home identified the following:

  • irregular and erratic eating patterns

  • a preference for big meals with large meat serves

  • high energy food and drink intake with a preference for fatty foods

  • frequent high energy snacks when at the pub and shops

  • high intake of soft drink, such as, 1 litre of regular cola a day

  • low fibre – minimal fruit and vegetables

  • uneven carbohydrate distribution

  • 3-4 beers a week

Will was discharged from hospital on a ‘diabetic diet’. However, staff organised for Will to see a private dietitian so he could have a detailed nutrition plan. He needs ongoing monitoring and support.

When in hospital he independently managed all meals provided, but his intake was variable. He often purchased foods and snacks from the hospital kiosk and vending machines. Will states: “I like to have my favourite foods and drinks and they make me feel good. I need my ‘sugar hits’”.

WILL’S HEALTH ISSUES

Medical Diagnoses

  • Type 2 diabetes mellitus (see diabetes)

  • Chronic osteomyelitis – related to a fall causing fracture to left elbow three years ago

  • Hypertension

  • Chronic schizophrenia

  • Depression

Threats to Health

Problem

Current

Risk

Pain

X

 

Poorly controlled diabetes (with health risks, e.g., Cardiovascular Disease , stroke)

 

X

Reluctance to engage in physical activity

X

 

Erratic food intake and poor food choices

 

X

Medication effects

 

X

Alcohol intake

 

X

Potential for constipation (OxyContin and diet)

 

X

Allergies

Nil known

Medications

  • Will’s medications are pre-packed by the Pharmacist.

  • Will requires prompting and supervision to ensure medications are taken at correct intervals.

  • Metformin is unlikely to cause hypoglycaemia (BGL <4mmol/L). However, if Will shows signs, e.g., shaking, sweating, weakness, irritability, then support worker is to do a blood glucose level (BGL). If < (less than) 4, follow Management Plan.

Medication

Dose

Route

Frequency

Intended Action

REGULAR MEDICATION

Metformin

500mg

Oral

Twice daily (bd). With morning & evening meal

Helps lower blood glucose

Thiamine

100mg

Oral

Daily

Enhances carbohydrate metabolism

Augmentin Duo Forte

875/125mg

Oral

Twice daily (bd). Immediately before morning & evening meal

Antibiotic. Treat bacterial infection

Caltrate

1500mg

Oral

Twice daily (bd). With drink after morning & evening meal

Maximise bone strength

Risperidone

2gm

Oral

Twice daily (bd). With morning & evening meal

Antipsychotic. Reduce psychotic symptoms

Amitriptiline

50mg

Oral

Daily. At bedtime (nocte)

Antidepressant

Ramipril

2.5mg

Oral

Daily

Lowers blood pressure

OxyContin

15mg

Oral

Twice daily (bd).

Reduces moderate to severe pain

Coloxyl with Senna

50/8mg

x2 tablets

Oral

Daily. At bedtime (nocte)

Reduces constipation. (Softens faeces and promotes peristalsis)

 

In the Resources section there is an information sheet on Hypoglycaemia and Diabetes if you want to know more. If you are viewing this on a computer in Acrobat you click here to open this (Resource 10). This resource is also available on the accompanying CD-ROM.
 

Data to be Used in Lessons

Weight: 77kg

Will weighed about 87kg some months ago. Illness has caused some weight loss, along with improved nutritional management in hospital. However, his weight is borderline.

Height: 178cm

Will has the following plans in the Case Scenarios section of the package: