Steven Hawks 55 year old male with mid stage ALS Diagnosed 2 years ago

Steven Hawks 55 year old male with mid stage ALS Diagnosed 2 years ago

1. Nursing Care

   • Relational Practice
     • Respect
     • Compassion
     • Empowers client
     • Empathy
     • Active listening
     • Self-Awareness of own beliefs, values, and practices
     • Therapeutic Nurse-Client Relationship
     • Genuiness
   • Health Teaching
     • Call for assistance during ambulation
     • Catheter care
     • Signs and symptoms of infection
     • Medications
     • Diet & Nutrition
     • Hygeine
     • ALS overview education
   • Collaborative Practice / Interprofessional Team
     • Neurologist
     • Dietician/Nutritionist
     • Nurse/Nurse practitioner
     • Occupational therapist
     • Assistive technologist
     • Physical therapist
     • Speech pathologist
     • Social worker
     • PSW
   • Safety
     • Safe eating
       • Risk of aspiration
     • Breathing exercises
     • Ambulation
     • Proximity of personal items
     • Home hazards
   • Tanner's Model
     • Noticing
       • Progression of symptoms
       • Health deterioration
       • Increased susceptibility to co-morbidities
     • Interpreting
       • Patient and family are struggling to cope
       • Need for ALS education
       • Provide resources
       • assess need for medication
     • Responding
       • Provide ALS education
       • Provide external resources
         • Support group for patient
         • Support group for family
         • counselling
         • Financial assistance
         • mobility devices
       • arrange for home care (PSW)
       • pharmacological intervention
     • Reflection
       • effectiveness of medication
       • family coping well
       • patient mental health is stable
         • is more informed about about ALS
       • interprofessional consultations
       • Mobility devices are beneficial

2. Social Determinants of Health

   • Culture
     • Caucasian
     • Catholic
     • ALS Support Group
   • Housing/Physical environment
     • 2 story house
       • Ramps
       • Renovate first floor
         • Wheelchair accessible bathroom
         • Bedroom
         • No carpets
         • Wider hallways
     • Rural Area
       • Extended Family located neighbouring town
       • Access to Groceries 10 km away
       • less pollution
       • Population 800 people
   • Income/Employment
     • Treatment and equipment expenses
     • Single source of income (as Steven can not work)
       • Wife works and earns less than $30,000 annually
     • Ontario Disability Support Program [ODSP]
   • Social Exclusion/Inclusion
     • ALS Support group
     • Most social interaction is only with family
     • Interacts with healthcare providers
     • Spends time alone with PSW while wife works and kids are at school
   • Health Services
     • Doctor located 30 km away
     • Nearest hospital located 30 km away
     • Limited access to home care due to rural location

3. Amyotrophic Lateral Sclerosis [ALS]

   • Progression
     • Symptoms
       • Difficulty breathing
       • Dysphagia
       • Weight loss
       • Loss of mobility
       • Loss of cognitive function
       • Insomnia
       • Progressive loss of the ability to speak
       • Fatigue
   • Treatment
     • Feeding tube (Late Stage)
     • Catheterization
     • Oxygen/Ventilation
       • Later stages, when breathing muscles are affected
     • Medication
       • Does not treat disease, treats symptoms only
       • Lengthens the appearance of symptoms
   • Prognosis
     • Death after 2-3 years
   • Diagnosis
     • Diagnosed between 40-70 Years old (Average age of 55)
     • Less common in younger people

4. Personal Meaning

   • Vision of the future
     • Care and treatment preferences
     • Do not resuscitate
     • Euthanasia
     • End of life wishes
     • Palliative care plan
   • Experience with Disease
     • Loss of independence
     • Coping with grief
     • Depression
     • Loneliness
     • Self perceived burden
   • Experience with Diagnosis
     • Anxiety
     • Fear
     • Stress
     • Sadness

5. Quality of Life

   • Facilitators
     • Church
       • Catholic
       • Supportive Community
       • Bible study
       • Prayer
     • Support from family and friends
     • Hobbies
       • Watching sports
       • Reading
       • Listening to music
     • Equipmments
       • Ramps
       • Wheelchair
       • Bathlifts
       • Hospital bed
     • ODSP
     • Access to hospital
   • Barriers
     • No cure for ALS
     • Dysrathia
     • Low income
     • Social Isolation
     • Limited Mobility
     • Home environment
     • Limited insurance coverage
     • Health worsens as Disease progresses

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