Running head: CASE STUDY II	

Case Study II
Mbinglo Peter
Lakeview College of Nursing
N309, Nursing of the Gerontological Client
 May, 25, 2011

CASE STUDY II
Case Study II		
	Mrs. Schmidt appears to have memory issue relating to the fact that she had already forgotten what her doctor told her about leaving the facility. She has chronic obstructive pulmonary disease which means a reduction in the amount of oxygen to her brain over the years. With regards to the weaning, she sounds like she is hearing about vacating the premises from the nurse for the first time. It is therefore apparent that she has problems with her short term memory. Some of the challenges with communicating with Mrs. Schmidt would be information processing speed, and divided attention. Most of all, she might be facing some hearing problems already if she could not remember what the doctor told her, or she could just be pretending in an effect to continue staying on the mechanical ventilator. (Mauk, 2010)
	According to Jarvis (2008) there are ways that I can use to assess for some of the problems Mrs. Schmidt is having. To test for recent memory loss, I can ask her to do her 24-hour diet recall or I will ask questions that I can collaborate. Any make up answers to fill in the gaps will confirm memory loss. I can check for divided attention by noting her ability to wander, whether she can complete a thought without wandering. With information processing, I will test if I can follow what she is saying or find out if she thinks in a logical way. 
	The doctor in the vignette probably did not take time to explain why Mrs. Schmidt will be leaving the acute facility. This could have been due in part because the doctor thought that his/her message was well understood by Mrs. Schmidt, and thus no further explanation was necessary. Another problem was that, as my Foundation teacher said, “patients don’t always take time to ask doctors questions or ask doctors to explain things in greater detail”; they sit and listen to the doctors and nod their head as if understanding what the doctor is saying. When doctors 
CASE STUDY II
go out, they turn to the nurse and ask what the doctor was talking about. Mrs. Schmidt appears to fall in that category. She could have memory problems and may not remember that the doctor had told her that she would be leaving the facility. Hearing problems could have equally played a role here plus the choice of words that were used.
	There are a few things that should have been done differently because Mrs. Schmidt does have a catheter on and that alone possess a great risk for infection ((Taylor, Lillis, LeMone, & Lynn. 2011); it is important to take that into consideration when asking her to leave. That catheter shows that she is have continent problems which could likely come as a result of her immobility or from her brain confirming that she does have memory issues. It would have been nice if they told her  that each time she failed the weaning, it increases her chances of vacating the premises. In order words, they should have been indicating to her from the first attempt that staying in this facility requires that she passes the weaning test. No one, I guess, ever told her that. Finally the doctor walks in and tells her; sorry you have to leave because you failed the weaning test again. I can understand why she was so upset. It’s like the doctor is telling her that it is time to go to the world beyond. However with regards to the mechanical ventilator, there was not much that could have been changed.
	I think that her miraculous ability to wean is probably due to the fact that by staying on the mechanical ventilator, some of the cells in her lungs could have been feed enough oxygen that they have recovered from their injury. Another probability is that the cells could have been so stress out because of her trying to get enough oxygen that the ventilator helped reduce the stress and these cells can now function. But most of all, I think that the mechanical ventilator 

CASE STUDY II
gave the cells enough time to produce news cells to pick up the breathing once she got off the mechanical ventilator.	
	The Foley catheter to her is the only thing she can hang onto. She had probably stayed so long on the mechanical ventilator that she thought it was part of her life. I guess she is equally thinking same about the Foley catheter. Nonetheless, having a catheter for more than 3 months is like her only way of discharging her urine. Any other option would not be welcomed by her. I think that the Foley catheter helped to save the energy she would have use to void; that energy is what she needs for breathing.  

CASE STUDY II
References
Jarvis, C. (2008). Physical examination & health assessment (5th Ed). St. Louis: MO. Saunders 	Elsevier.
Mauk, K. L. (2010). Gerontological nursing: Competencies for care (2nd Ed).Boston: Jones & 	Bartlett.
Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Foundation of nursing: The art and 	science of nursing care. Philadelphia: PA. Lippincott Williams & Wilkins.