CASE STUDY TWO
Julia McGraw
N309 Nursing of the Gerontological Client
Lakeview College of Nursing
May 29, 2011
Case Study Two
     Some potential challenges for communicating with Mrs. Schmidt are her fears of change relating to leaving the acute care facility and the removal of her medical devices.  She is also extremely upset and not remembering what was said to her the night before, so she may be suffering from delirium.
     I would talk to her about how she feels about going home and the need for her foley catheter, to determine if and what her fears entail.  I would also look back at her chart to see if she has a history of memory loss or it came on suddenly.  I would talk with her about any problems she may be worried about.
     She may be fearful of the big changes that are about to occur in her life and is not coping well.  Also, she was not given much time to deal with the fact that she was going home the next day, as well as, being told she would be on a ventilator for the rest of her life.  This could cause major emotional problems, resulting in delirium.  Thus, she did not remember short term and is extremely upset.
     She should have been told upon her admittance to the facility an approximation of time of being there.  She should have been told an approximate number of weaning attempts and what was considered progress to continue the weaning off of the vent.  Also, she should have been told in advance about attempts coming to an end.  She should have 
CASE STUDY TWO
also been told that she was leaving in an appropriate time frame.  Someone should have discussed the consequences of keeping the foley catheter inserted.
     Her miraculous weaning could have been from her fears of leaving the facility.  She felt comfortable there and she was not worried about having difficulty breathing.  Also, she felt secure and was use to her mechanical ventilator, so she did not want anything to change.  She did not want to live everyday life with a ventilator, so she made up her mind she would breath on her own.
     She was use to it being there.  Also, everything was happening at once and removing the catheter was one more change in her life.  She could also be worried about not making it to the bathroom in time.

CASE STUDY TWO
References
Gillis, A., & MacDonald, B. (2006). Unmasking delirium: nurses can play a key role in 
     the prevention, detection and treatment of delirium in older adults. Canadian Nurse, 
     102(9), 18-24. Retrieved from EBSCOhost.
Mauk, K. L. (Ed.). (2010). Gerontological nursing: Competencies for care (2nd ed.). 
     Sudbury,  MA: Jones and Bartlett.
Ouldred, E. E., & Bryant, C. C. (2011). Delirium: prevention, clinical features and 
     management. Nursing Standard, 25(28), 47-56. Retrieved from EBSCOhost.