The Gallaghers PUP 2224 Module Assessment Scenario

PLEASE NOTE

The Gallagher's have been developed for the sole

purpose of the PUP 2224 Module Assessment. All

scenarios are the work of the module team and are

fiction. The characters do NOT exist. Any resemblance to

persons living or dead is purely coincidental.

However, to ensure professionalism the PPT must only

be viewed by the student during the preparation of the

PUP 2224 module assignment in order to maintain

confidentiality.

All pictures used are Creative Commons Zero (CC0)

license. This means the pictures are completely free to

be used for any legal purpose.

PUP 2224 Assignment Question &Guidelines

Assignment Essay: 3500 words

Choose a member of the family and using the information given in the scenario, analyse the role of the nurse to promote independent living and self-care.

Guidelines

Choose ONE member of this family and, using the information given in the scenario, provide an individual health profile stating the health determinants that impact the condition. (LO1)

Provide an overview of the long term condition i.e. explain the altered physiology of the long term condition relating this to assessment of health needs. (LO2)

Analyse the lifestyle and the elements of this, that impact upon their condition and care.

How do their health choices affect them? (e.g. smoking & diet) How does their condition affect the individual holistically? (e.g. mobility, socialising etc.). (LO1 and 2)

Discuss the scope for collaborative working with patients living with a long-term condition, their families/carers across health, social and voluntary/private sector providers. Therefore, consider the initiatives (national and local) that are in place to support this individual, i.e. What agencies are involved in the care of the patient? (LO3)

Throughout your discussion be sure to analyse the role of the nurse in promoting independence and the management of the chosen long-term condition. (LO4).

The Gallagher’s Street and

Homes

Profile

The Gallagher family are well known to local health and social care services

as they are a family with complex long term health needs.

The Gallaghers live on the same street in four bedroom terraced housing

with small front and back gardens.

They have access to transport, local shops, a supermarket, play areas,

schools, a gymnasium and the area Health Care Centre .

Mary, Jack, Harry and Helen all left school at 16 with no qualifications.

Paul is a secondary mathematics teacher who was the first in the family to

go to university and gain a degree.

Zack is at university in his third year studying Computer Science

Sarah is due to do her A levels this year and is predicted to get good grades

Mary and Jack’s Annual Income= £27,000, they have 2 years left on their

mortgage and run a car.

Helen and Harry’s Annual Income= £30,000, they have paid off their

mortgage and run a car

Both Gladys and George receive state pensions and no longer live in their

own homes. Gladys stays with Mary and Jack and George stays with Helen

and Harry

Health Determinants

Helen GallagherAge 56 yearsOccupation

Unemployment

Stress and Hypertension

Helen Gallagher has been diagnosed as suffering with hypertension –

her last recorded blood pressure was 175/95mmHg and the time

before that it was 170/100mmHg on three separate occasions during

the past six months.

Helen reports that before this her B.P. was always around

110/65mmHG.

Helen describes herself as very stressed due being a full time carer to

her dad George whilst at the same time trying to cope with the

devastating news that her husband Harry has cancer.

Helen’s dad has ongoing health problems and has just been

diagnosed with Parkinson Disease which is making him very

frustrated and short tempered as he cannot do the things he would

like to do.

Helen is reluctant to express her concerns for fear of causing more

upset to the family – she does however divulge her worries to the

family priest who is worried that this is the cause of her stress which

is manifesting as severe bouts of breathlessness.

Health Profile

Harry GallagherAge 61

Occupation: Plumber

Bowel Cancer

Harry has just been diagnosed with cancer and is currently

undergoing chemotherapy at the regional cancer center each

week.

Harry is unable to maintain adequate nutrition and fluids due

to the side effects of the chemotherapy and is becoming

increasingly frustrated that he cannot enjoy everyday

activities.

As a result, of the need to have time off from work to receive

his chemotherapy treatment, Harry was made redundant from

his job. This has made him very angry as he wants something

in his life that helps him forget his illness.

Health Profile

Paul GallagherAge 31

Occupation School Teacher (Maths)

Motor Neuron Disease

Paul Gallagher lives opposite his mum Mary with his partner,

Raymond.

Paul works full time as a secondary school teacher, as well as

acting as the main carer for Raymond who has HIV.

Paul is hiding that he has Motor Neuron Disease which he is being

treated for at the specialist Regional Neurological Centre.

At the moment his symptoms are mild so he is able to hide them

from his family. His symptoms include fatigue, which manifest as

slight slurring of his speech & mild muscle weakness.

(Paul notes that on days that require more energy such as exercise

or illness such as the common cold, his symptoms occur )

Paul is very aware and understands what will happen to his body

as a result of having motor neuron disease. Therefore he has

decided to avoid planning his future and take each day as it comes

and will tell his family when he feels the time is right.

Health Profile

Raymond StanleyAge 30

Occupation Bar Staff

AIDS/HIV

Raymond is a 30-year-old man, he is newly diagnosed HIV positive. At present, he is asymptomatic and is currently being treated with Nucleoside/nucleotide reverse transcriptase inhibitors NRTs as well as attending the HIV specialist clinic for regular blood checks.

He is employed as bar staff in a busy city night club. Raymond met his partner Paul in the club 3 years ago, they have had an exclusive relationship during that time. Although initially very shocked and frightened, Raymond is trying to come to terms with his diagnosis and plan for the future.

Raymond does not feel ready to tell his family about his diagnosis, he is not sure how he could do this. He is worried they may not understand and reject him. He is also concerned that Paul may be at risk of contracting HIV from him.

Raymond understands the need to live a healthy lifestyle, however due to the nature of his work, he enjoys a smoke and several alcoholic drinks after his shift to help him unwind.

Raymond is also concerned that if becomes unwell or needs to attend hospital appointments he may lose his employment.

Health Profile

George GreyAge 81

A Retired Barber

Parkinson Disease

George is 81 and has lived with his daughter Helen and son in

law since the death of his wife 3 years ago.

George misses his wife as they had a very active social life and

enjoyed going on bus tour holidays several times a year .

Just recently George was diagnosed as having Parkinson

Disease and must take his medication on time to avoid

stiffness.

His main problems are stiffness which is causing poor mobility

and a slight tremor in both hands as well as a very poor sleep

pattern.

This has meant the George can’t get out and about like he

used to and is dependent on taking his medication which he

says can make him feel worse sometimes.

Health Profile

Philip Gallagher Age 75

Occupation Retired Factory Worker

Chronic Wound: Venous Leg Ulcer

Philip is a retired factory worker which during his 45 years of

working, demanded that he was on his feet for most of the

day. When he was 56 he suffered an injury at work, fracturing

his left ankle, which later compromised his mobility. As a

result, his ankle swells when standing, even for short periods

and aches most of the time which requires him to take pain

killers at night to help him get to sleep.

Philip has been diagnosed with Peripheral Vascular Disease

and has chronic venous hypertension which has resulted in a

venous ulcer on his left leg just above his ankle.

Philip is currently overweight BMI of 28 and wants to loose

weight as he feels this will help his mobility and ease the pain

he gets from his ankle. As a result, he is trying to cut down on

his carbohydrate intake which he loves so is finding this

difficult to do. Philip is a non smoker and enjoys going to the

local pub for a pint or two with his brother.

Philip’s Left Leg Status

http://legulcercharity.org/swollen-ankles-and-venous-leg-ulcers/

Mary Gallagher Age 58

Unemployed

Stress and Depression

Health Profile

Mary Gallagher BMI states that she is clinically obese (she is 5

feet and 2 inches tall and weighs 13 stones and 2 pounds).

Mary successfully gave up smoking 3 years ago and believes her

weight gain is due to this. Although is fighting the cravings to

start again.

Mary said that watching her mum-in-law Gladys gradually loss

her memory is a major worry that makes her feel helpless. She

worries about Jack’s who has COPD, that he won’t be able to

work.

Mary worries about Sarah that she will fall into the wrong crowd

and not do well at school to get onto the career ladder.

Last year Mary was diagnosed with clinical depression and is

being treated with an anti- depressant (an SSRI).

Mary is currently unemployed and feels that this and her lack of

success to find work, is adding to her depression

Health Profile

Jack GallagherAge 59

Occupation: Lorry Driver

COPD

Jack Gallagher, is employed as a long distance lorry driver (his work takes

him away from home at least 3 nights each week).

Jack is loosing weight and is being monitored at the local health center in

order to promote healthy eating and exercise. As well as monitor his

respiratory function.

Jack is also a very heavy smoker he confesses to smoking 20 a day. He has

tried several times to give up (using Nicotine replacement therapy) without

success, he would really like to try again in order to support Mary.

Jack was diagnosed as having COPD last year, which is being managed by

medication. Although Jack is noting that he is unable to do the things he

used to such as go for a brisk walk with the dog, without becoming

breathless. And that he feels exhausted, even after eating a meal and notes

that he needs to take his inhalers often to control his breathlessness.

Jack has confessed to the GP that he worries about his health because of

the breathlessness. As a result, he is loosing confidence to do things and is

worried that he will die suddenly.

Health Profile

Gladys GallagherAge 78

Retired School Dinner Lady

Dementia

Health Profile

Gladys Gallagher Jack’s mother, is 78 years old and has lived

with the family since her husband died 4 years ago.

Gladys has become increasingly forgetful over the past year,

and and had been displaying erratic behaviour for the past

three months.

As Gladys has been wandering the house during the night

stating that she is late for work. As well as talking about her

husband as though he is alive and living at home. She also

refers to her family as when they were children.

Initially this was thought to be related to her bereavement, but

the situation has worsened recently and has prompted further

investigation by her General Practitioner, who believes that she

has ‘brain softening’ and is displaying dementia possibly a

Alzheimer's Dementia

Health Profile

Sarah GallagherAge 17

6th Form School

Risky Health Behaviour

Since the age of 15, Sarah has been drinking with her friends at

the beach and has been brought home by the police on several

occasions. 6 months ago, she spend a night in the local A&E

department after drinking too much and passing out.

Following this event, Sarah confessed to her best friend that

she had unprotected sex.

Mary worries about the long term effect of her daughter’s

lifestyle and is worried that she is taking illegal substances as

she found evidence that Sarah maybe smoking cannabis.

She feels that Sarah has no idea just how dangerous the things

she is doing to her health and wants her to stop and do well at

school.

Sarah confesses that she that is only doing what is normal for a

teenager today as all her friends do it and they are healthy.

Health Profile

Zack GallagherAge 20

Full Time Undergraduate

Student

Asthma

Health Profile

Zack Gallagher, Jack and Mary’s 20 year old son, has suffered

from asthma since the age of 4.

Zack’s asthma is fairly well controlled on his inhaled

medication and his parents have always been careful not to

smoke around him.

Recently, he has experimented with smoking cigarettes and

has found that this has exacerbated his asthma. Mary his mum

is worried that this new habit will cause him to have frequent

asthma attacks which in turn will effect his studies and his

health .

Mary describes her son as a nervous kid who is keen to please

people but is worried that he could get in with the wrong

crowd and not do well at university as he is a bright pupil who

if he does the work will do well.

Health Profile

Sustaining Health

Long Term Conditions cannot be cured but can be treated

Long Term Conditions can cause unseen disabilities

Long Term Conditions demand extra energy through effort

from the body to get through the day

Long Term Conditions can cause fatigue and depression

Long Term Conditions puts strain on the immune system

Long Term Conditions can cause other illness and disease

Long term Conditions are not the cause of death

Points to Note

Reflect on your chosen Gallagher and consider all of the above in the context of their long term condition to help determine how the role of the nurse can help sustain their health.

References Further Reading

Nicol, J. (2015) Nursing adults with long term conditions. Available at: http://capitadiscovery.co.uk/edgehill/items/254260 (Accessed: 2 January 2017).

Presho, M. (2008) Managing long term conditions: A social model for community practice. Available at: http://capitadiscovery.co.uk/edgehill/items/79855 (Accessed: 2 January 2017).

Lorig, K. (2014) Self-management of long term health conditions: A handbook for people with chronic disease. Available at: http://capitadiscovery.co.uk/edgehill/items/81771 (Accessed: 2 January 2017).

Thornton, L. 2013, Whole person caring: an interprofessional model for healing and wellness, 1st edn, Sigma Theta Tau International, Indianapolis, Indiana.

McKenna, H.P., Pajnkihar, M. & Murphy, F. 2014, Fundamentals of Nursing Models, Theories and Practice, Second;2nd; edn, Wiley Blackwell, Chichester, West Sussex.

Kim, H.S. 2015, The essence of nursing practice: philosophy and perspective, Springer Publishing Company, New York, New York.

McKenna, H.P., Pankhihar, M. & Murphy, F. 2014, Fundamentals of Nursing Models, Theories and Practice, 2nd edn, Wiley Blackwell, Chichester, England.

Orem, D.E. 2001, Nursing: concepts of practice, 6th edn, Mosby, St. Louis, Mo;London;.

Rogers, K.M.A., Scott, W.N. & ebrary, I. 2011;2013;, Nurses! Test yourself in anatomy and physiology, McGraw-Hill/Open University Press, Berkshire, England.

Peate, I. & Nair, M. 2017, Fundamentals of Anatomy and Physiology for Nursing and Healthcare Students, 2nd edn, Wiley Blackwell, Chichester, West Sussex.

Waugh, A., Grant, A., Chambers, G., Ross, J.S. & Wilson, K.J.W. 2014, Ross and Wilson Anatomy & Physiology in Health and Illness, 12th edn, Churchill Livingstone, Edinburgh.

Journals

Orem, D.E., Renpenning, K.M., Taylor, S.G. & ebrary, I. 2003, Self-care theory in nursing: selected papers of Dorothea Orem, Springer Pub, New York.