Question

Case study

Margaret is a 75 year old woman living in an aged care facility for residents with low-care needs. Margaret had polio as a young child and has one shortened leg requiring a built-up shoe. She also now has arthritis in her hands, back, hips and knees, which is making movement, transfers and balance difficult and painful. Margaret also has emphysema and requires oxygen via nasal tubes, medication via a nebuliser, tablets for her arthritis and she receives injections.

Following is a list of supports outlined on Margaret’s care plan.

Washing: Margaret can sit on a shower chair and independently wash the top half of her body, including genital area. She requires assistance to wash feet, legs and hair.

Margaret must be supervised and may need direction when stepping in and out of shower and transferring in and out of the shower chair.

She needs full assistance with drying herself, as she becomes breathless.

Dressing / undressing: Margaret needs assistance with dressing and undressing as she has difficulty moving and becomes breathless with exertion. She must have a built-up shoe on her left foot.

Grooming: Margaret likes to direct her own grooming and can do her make-up independently. She needs assistance with drying and styling her hair.

Nail care: Margaret needs regular monitoring and treatment for ingrown toenails and corns. She takes care of her fingernails independently.

Oral hygiene: Margaret has upper dentures and requires assistance to clean these and to open lids of cleaning fluid and containers.

Mobility: Margaret uses a four-wheeled walker at all times.

Transfer: Margaret requires direction to use handrails and chair arms, to transfer in and out of chairs.

Toileting: Margaret can use the toilet independently but wears incontinence padding due to difficulty getting to the bathroom in time, which results in occasional leakage.

Eating and drinking: Margaret has all meals in the facility dining room. She requires modified large-handled cutlery due to arthritis in hands.

1. What are the risks for Margaret’s safety that need to be considered when using the equipment and/or aids?

2. What are the risks for a support worker’s safety that need to be made for use of this equipment, and what strategies should be employed to eliminate or reduce the risks?

3. What are the work health and safety risks associated with Margaret transferring in and out of the shower chair?

4. The left side handbrake on Margaret’s four-wheeled walker has a stretched cable and is not working effectively. What action is required to address this problem?

5. What infection control procedures should the support worker adopt in providing routine support for Margaret?

Answer 1

1) Risk of fall while transferring in and out of the wheel chair as she might not be able to position and maintain the gravity due to her limited balancing and pain. She might require sufficient energy to wheel as she is on oxygen and has rigidity due to pain which might limit her from moving in faster pace in case of any emergency.

2)Workers are prone to injure their neck, shoulder,back and wrists while assisting due to pulling, pushing, bending etc.

Factors causing injury are :

1) Poorly maintained wheelchair with no proper brakes, handles or wheels.

2)suitability of the wheelchair with the client.

3) The effort to move the wheel chair.

4)Pulling wheelchair over long distances.

5)Transferring in /out of the wheelchair.

6) Improper surfaces where the wheelchair needs to be pulled and unavailability of place to move the wheel chair freely.

Strategies to improve;

a)Proper teaching and guidance to how to move a wheelchair including patient transferring with the help of good body posture.

b)Fixing any faulty equipment to ease the movement of the wheelchair.

c)Plan strategies and place an agreement with client for proper equipment and seek options when the equipment needs to be maintained.

d)Maintain good surface in order to move the wheelchair with ease.

e) An assessment can be done on the risks and solutions before caring for the client.

3)Problems associated with transferring the patient in/out of the shower chair.Muscular, soft-tissue or skeletal injury to workers from incorrect movement, posture, repetitive bending, leaning or reaching, or a slip on wet surface.

4)Immediately fix the faulty equipment or replace it in order to prevent fall due to inability to apply brakes while moving in an inclined pave.

5)Infection control procedures;

Proper hand washing or hand hygiene before and after touching the client or coming in contact with body fluids.

Proper bath daily to prevent sores and infection.

Proper respiratory hygiene to prevent further chest infection.

Removing any wet or soiled linen on time.

Monitoring regular vital signs to observe for any signs of infection.