Health Care Team Challenge Client Profile

Health Care Team Challenge 2011 - Client

***(NOTE: the Health Care Team TREATMENT PLAN/REPORT can be found at the following link)
http://expfiles.blogspot.com/2011/07/health-care-team-challenge-treatment.html

Medical & Social History

Mr Turner is a 67-year-old male who resides with his wife on a ten thousand acre property in the shire of Mt Magnet. He and his father-in-law built their present two-storey home with the first floor fully wheelchair accessible to accommodate his mother-in-law, who used a wheelchair prior to her death two years ago. Mr Turner and his wife live on the ground floor and use the top floor of the home for visitors when their 3 children and 7 grandchildren visit.

Mr Turner has a 20-year history of type 2 diabetes mellitus, complicated by retinopathy, peripheral and autonomic neuropathy, coronary artery disease and peripheral vascular disease. He has had progressive amputations of his toes and right forefoot. In addition, he has had a four-vessel coronary artery bypass. Five years ago, because of chronic renal failure he received a kidney transplant, with the kidney being donated by his son. Four years ago he had a cholecystectomy. Prior to his kidney transplant he had been hypertensive. Following the transplant he has had orthostatic hypotension which is controlled by making postural changes slowly, sleeping with the head of the bed raised, and a high salt diet. Also, because of the kidney transplant he takes immunosuppressive drugs. His prescriptions are very expensive.

Two years ago Mr Turner quit his 1 pack of cigarettes per day smoking habit of 30 years but he has resumed smoking a “few” cigarettes per day in the past three months. He denies chest pain or shortness of breath but he does have a persistent cough. His wife states that he snores at night and is often restless. He sleeps best propped up with two pillows. He describes his feet as “pretty numb.” He has not reported any falls but recognizes a fall could be a problem.

Prior to his kidney transplant, Mr Turner was an active farmer and his wife volunteered part time at the local Meals on Wheels. Since the transplant, Mr Turner can no longer manage the farm and his wife has had to take on many of the farm chores with the help of casual farm labourers. She finds it difficult to assist him during the day and to transport him to and from his frequent medical appointments which at times require a long drive to Geraldton.

Hospital Treatment

Ten days ago Mr Turner was admitted to the Geraldton Hospital for a non-healing foot ulcer. He had driven 800 miles to attend his sister's funeral. When he returned home, his right foot was badly swollen and erythematous. A large blister was evident over the metatarsal plantar aspect of the foot. Upon arrival at the hospital, his temperature was 39.4° and the ulcer was draining green purulent material. He was immediately admitted to the hospital for evaluation and treatment.

Upon admission he was started on antibiotics. In the operating room the infected area of the plantar space of the right foot was incised and drained. Purulent material was collected and submitted for culture.

Culture results: Staph. aureus, Strep. intermedius and Strep. constellatus.

Antibiotic treatment was changed to IV only.

Mr Turner and his wife were presented with two treatment options:

1. Aggressive debridement, infection control and surgical revascularization

2.Amputation of the right leg.

They decided to have his right foot removed. He felt he would be better off without the problem. It was recommended that he have the amputation above the knee but he insisted that it be below.

The right leg was amputated approximately 8 inches (20.3 cm) distal to the knee joint. Large vessels were tied off with silk suture material and a posterior myofascial flap was used to cover the stump. Skin edges were joined with staples. Fluff was used to pad the end of the stump, which was then wrapped with a Kerlix® roll and an Ace® wrap. No intra-operative or post-operative complications were noted.

During his hospitalization, he received acute care services from OT and physio. Initially, he required a maximum assist of 2 persons for transfers postoperatively. But within 3 days he was able to transfer to wheelchair with minimal assistance. He was independent in sink activities such as oral care and hair care and washing his upper body. He fed himself independently. He was able to dress his upper body independently but required moderate assistance to dress his lower body due to fatigue from exertion and trunk instability.

He required maximum assistance with all other lower body care, e.g. bathing, toileting, and changing the wound dressing. The operation site remained clean and dry and slightly edematous, with the skin pink and cool to the touch. He reported feeling tired following very little exertion such as sitting up on the edge of the bed.

Rehabilitation Treatment

Ten days after his operation, Mr Turner was admitted to the rehabilitation unit with the following: Immunosuppressants, enteric-coated Aspirin, Multi-vitamin, Fludrocortisone, Proton pump inhibitor, stool softener, Magnesium oxide and Insulin, 2400-calorie ADA diet with 3 gm sodium, 3 meals/3 snacks per day.

You are the interprofessional team tasked with Mr Turner’s rehabilitation and his return to the community including risk management and ongoing support.

Describe your priorities within the rehabilitation unit and then for the first 6 weeks post discharge, justify who would be the lead professions during Mr Turner’s journey and how they would be supported by the remainder of your team. Also consider which other health professionals outside of your team you might want to involve.

You are required to develop an integrated care plan for Mr Turner and his family