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Info from the  Frailty (Failure to Thrive) Video Case Study

           Video case study 1

The story of Bob and Mabel

Bob is 85 years old and lives in a home with his wife Mabel who has Dementia. Bob has diabetes, and high blood pressure and is prone to UTIs. January 2016, Bob is feeling unwell. He visits his GP who decides that he needs a nursing and care package to remain at home. The GP contacted intermediate care (Fast Response service) who arrange this. A few weeks later, Bob feels really unwell and dials 999. Paramedics assess Bob and conclude that it is cellulitis which can be treated at home, and he does not need to be taken to the hospital. The paramedic called CWPT. They speak to the clinician who arranges to review Bob to keep him at home to avoid admission to the hospital. Bob is reviewed daily and future care needs to be assessed. The referral will be made to the appropriate service. E.g. INT, district nursing, and admiral nurses for a carer’s Assessment. The care plan will be updated, and their GP is informed. Sometime later, Bob’s daughter takes her to A&E as she is worried about him. Bob is assessed by an A&E doctor and hospital admission is not required. He is assured that the right care is available outside of the hospital via CWPT. Some months later, in another incident, Bob’s wife Mabel has a fall and is admitted to A&E. She is screened and taken to the medical decision unit where it is decided by the Frailty MDT that she is well enough to be discharged under the clinical responsibility of GP in ED and a community Matron will visit and c0-ordinate care at home. The Matron will coordinate appropriate services taking into account Mabel’s dementia. Care will be reviewed at seven days and up to 30 days. Care will be adjusted or stepped down throughout this period as appropriate. An integrated package of care for Mabel covers her dementia care need including: 

Appropriate support through liaison with mental health services
Four support calls per day to assist with personal care (CWPT)
Referral to telecare to prevent further falls.
Direct access to physiotherapy and occupational therapy to assess mobility and identify any aids required.
Bob will be supported through Age UK

After discharge by the community Matron, it is decided that Bob and his wife Mabel need some ongoing coordinated care provided through INT in their home.

The package of care was coordinated through a key worker, so they only had to tell their story once- including ed: 

A rescue pack of antibiotics for use in the event of a future infection
Self-management plan
Exercise regime and mobility aids/equipment provided by a physiotherapist.
Review of an existing care package, benefits check, and career allowance
Referral to the CRESS service (Urgent care for patients when the main carer is admitted to the hospital
Carer breaks for Bob (up to 3 hours a week)
Pendant supplied to Mabel to be used in event of fall.
Meal on wheels service

Ongoing case management was continued by their GP and a Community Matron

Three months later, following INT support Bob and Mabel were considered safer, happier, and less risk of falls and admission to the hospital.

The team update the Frailty registry

THE END

 

 

This video case simulation prepares learners to:

1. Apply knowledge in advanced health assessment to form differential diagnoses based

upon scientific knowledge to differentiate between normal and abnormal findings in

the physiological, psychological, and sociological presentation of frailty.

2. Consider the safety of a patient with limited mobility in ambulation and transferring.

3. Recommend resources as a means of coping mechanisms to patients and family members

of a patient recognized as frail. 

4. Distinguish between signs and symptoms of frailty.

5. Establish with the patient a mutually established plan to manage a chronic health condition.

6. Adapt teaching on the management of symptoms of fatigue and limited, painful mobility on

the patient’s readiness to learn, literacy, and resources.

 

 

Answer the following questions based on the above info from the video :

1. What are the pertinent positives and negatives learned from the HPI and review of

systems (ROS)?

 

2. Based on the subjective findings of the chief complaint and HPI, what are the top five

differential diagnoses? Support your choices with rationales.

 

3. Is/are there any medication(s), over-the-counter drugs, vitamins or herbs that can

potentially be causing this patient’s symptoms?

 

4. What are some symptoms and physical findings that you would expect to find in a

patient with frailty? In a patient with depression?

 

5. Identify pertinent positives and negatives in the physical findings. Explain the meaning

of these findings. How do they assist in ruling in or out a differential diagnosis?

 

6. What diagnostic tests are the most appropriate to order during this visitation? Explain

your rationale or ordering each test(s).

 

7. Based on the differentials and plan of care what are some preventative care measures or

health promotion initiatives that could be included.

SCIENCE
HEALTH SCIENCE
NURSING
NURSING 776