Raymond Smith is a 62 year old man who works as a supervisor in a dock-side warehouse.
He lives with a wife and two adult sons in a small terraced house in an inner-city environment within the UK. He also has one adult daughter who lives in Sydney in Australia with her partner and six-year old daughter. Raymond has a close relationship with his family.
Raymond has never travelled abroad until he visited his daughter a few months ago. Raymond was born locally and has an extensive network of family and friends.
Raymond is 1.70 metres tall and 80 kg in weight; he is of average build and has a moderately physical job. He feels he is slightly overweight but in better condition than many of his workmates. However, Raymond has noticed that he has unintentionally been losing some weight over the past two months. People that see Raymond on an occasional basis have commented on his weight loss and change in appearance.
Raymond has been in reasonable health through-out his life. He enjoys watching sport and supports a local football team. He socialises with friends on Saturday nights and drinks about six pints of beer a week. He enjoys doing word puzzles and general knowledge crosswords.
Raymond is increasingly concerned about the weight-loss as it has been accompanied by other subtle changes in his health. Raymond?s sleep is often disturbed and he has suffered night sweats. Raymond is suffering from general malaise which he attributes to his altered sleep pattern.
Raymond has developed a persistent productive cough during the past few weeks. He was concerned about this development and immediately stopped smoking. This proved surprisingly easy as he only smoked on social occasions and he found that his family and friends were very supportive. However, Raymond was disappointed that his productive cough persisted; moreover his sputum has occasionally been streaked with blood.
Raymond has rarely visited his GP and is reluctant to seek medical advice. However, his family had noticed that Raymond was becoming withdrawn and irritable. Initially, this was attributed to stopping smoking. However, Raymond eventually admitted to his wife that he thought he had lung cancer and he had been trying to suppress his health concerns.
Raymond arranged to visit his GP who arranged a chest x-ray and a subsequent appointment with a respiratory physician.
Raymond visited the chest clinic four days later. The Specialist Registrar told Raymond that he suspected that Raymond may have pulmonary tuberculosis. Raymond vaguely recalled that several children that he grew up with had suffered from tuberculosis. However, he had no understanding of the disease or prognosis.
The Specialist Registrar was concerned that Raymond was weak, pyrexial and short-of-breath. Consequently, Raymond agreed to be admitted to a local Infectious Diseases Unit (IDU) where he could undergo medical investigations and receive treatment and nursing care. Raymond was relieved to be admitted to hospital as he had struggled to use the upstairs toilet and bathroom in his home. He felt unkempt and worried constantly about getting to the toilet on time to urinate. He has not had his bowels open for two days.
The Chest-ray revealed cavitations in the right and left upper lobes. A sputum sample was taken at the out-patients clinic and a smear was analysed, which revealed live mycobacterium tuberculosis. This positive smear meant that Raymond?s sputum was considered to be infectious.
Upon admission to the IDU, Raymond was admitted to an isolation cubicle that had en-suite bathroom and toilet. His primary nurse was concerned about Raymond?s physical condition and suggested that he should rest on the bed.
The Medical SHO examines Raymond and prescribes isoniazid and rifampicin, paracetamol and oxygen at 28% via a venturi mask.
Raymond?s base-line vital signs were:
Pulse 88 regular - normal strength
Blood Pressure 180/80 mmHg
Respiration 24 shallow
SpO2% 90% on 28% oxygen via a venturi mask
Temperature 38.6ï‚°C
Raymond is relieved that he does not have lung cancer and he has been reassured that tuberculosis is treatable. However, Raymond and his family are shocked at his weak condition and infectious-status. Raymond?s wife and children are anxious about their own health and the risk of contracting tuberculosis.
Task
Using Orem?s Self Care Model as a framework:
Assess
Plan
Devise an implementation
Suggest mechanisms for evaluation
You cannot use a critical care pathway: you must develop an individualised plan of care for Raymond that will address his acute and continuing needs. The care plan must be underpinned by evidence based practice and follow the philosophy of Orem?s self-care model.
You should be able to rationalise the process that you have undertaken with reference to the framework (Orem?s model and the problem-solving approach).
You should have a particular understanding of the prescribed medication and the rationale for any intervention that you utilise to treat the pyrexia.