Case Study 1

1. Case Study 1 You are have just started a shift and Mr Smith is being transferred to your ward due to being admitted today. On arrival you review his notes. Mr Smith was born in 1932. He came into hospital because he has got kidney failure, and he is retaining fluid in his legs. He is a smoker, and has had respiratory disease for some time. He struggles to breath when he is laid prone. He is on oral prednisolone to manage the inflammation of his airways. His respiratory disease has affected his ability to eat and drink well, and has put him off his food.Mr Smith has recently lost weight. Two months ago he was 72 kgs. On admission he was weighed 62 kgs. He is continent, but struggles to do more than transfer from chair to bed and to commode. He cannot get out to a toilet or bathroom. Questions: What is this gentleman’s Waterlow score? Please describe how you would plan his care? Please describe what your clinical priorities are for this gentleman?

2. Case Study 2 You have just come back off holiday and are meeting Mrs Jones for the first time. Mrs Jones is due to go home next week but will need to become more independent before she goes home. Mrs Jones has grade 2 pressure ulcers on her sacrum and heels. She has been in bed for the last three weeks, but will need to start sitting out next week before going home. She has a catheter and is incontinent of faeces. She is using an alternating mattress. Mrs Jones was born in 1952. She is diabetic, and was admitted due to an acute hypoglycaemic attack. Questions : Mrs Jones care plan and Waterlow scoring need updating so : Please reassess Mrs Jones’ Waterlow score? Please describe what her care plan should include? Please describe the particular issues that would concern you about this patient?

3. Case Study 3 Mr Riggs was admitted to hospital, and was admitted to ITU due to multi organ failure. He is recovering and was extubated three days ago, and moved to the surgical ward that he is now on today. Mr Riggs has mottled areas on his arms and legs, partly due to the inotropes that he had administered while in ITU, and also partly due to his poor circulation. Mr Riggs has had a left lower limb amputation in the past, and usually walks with a prosthesis. There is no evidence in Mr Riggs’ history that he was previously malnourished. Mr Riggs has been bedbound since his admission to ITU. Mr Riggs was born in 1946. Questions : Please calculate this gentleman’s Waterlow score. What issues will be presented by this gentleman as he moves towards being independent? What issues will need to be considered for this patient to be discharged?