IPE involving healthcare students

1. Interprofessional
Education
University Hospital Kerry

2. Case Study
 Patient X
 74 year old, male patient
 Widowed, 4 children
 Retired Publican
 Non-smoker (quit 15 years ago)
 Uses walking stick
 Lives with daughter, good family support

3. Before meeting the patient
 Prepared list of questions (Physio, General, Mental)
 Agreed on 1 person ask questions, take notes
 If elaboration on given answer needed everyone can join in
 As Patient had Ultrasound done, catheter inserted we agreed to
assess/interview next day
 Shared workload (info gathering on Pneumonia, Diabetes, Septicaemia, DVT,
Parkinson’s Disease)

4. Reason for Admission
 Presented via South Doc in ED
 Reports shivering, couldn’t hold a glass (weakness)
 Confusion
 Pneumonia
 Temp. 40.8 C, Pulse 130, Resp. Rate 22, O2 Sat. 92%
 GCS 11/15
 Septicaemia
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5. Medical History
 Surgery for varicose veins (3 times)
 Diabetes (sees specialist, administers Insulin at home)
 Parkinson’s Disease (diagnosed 7-8 month ago, sees Neurologist, Medication,
no advancing of illness since then)
 Ultrasound in Hospital: Fatty liver
 Fall 2-3 weeks ago (slipped)
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6. Medication
 IV Fluids Novorapid
 Lyrica IV Vancomycin/Tazocin
 Amitriptyline
 Azilect
 Clexin
 Janumet
 Atrostatin
 Allupurinol
 Clopidogrel
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7. Treatment
 Catheter inserted (unable to pass urine)-monitor input/output
 Oxygen
 Antibiotics
 IV Fluids
 Physiotherapy
 Bedrest
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8. Mental State Examination
 Well groomed, 74 year old male patient, stable Consciousness, good short term memory
 Good eye contact, cooperative and open, alert and spontaneous response, but appears to
have difficulty to concentrate/focus
 Uses walking stick, good posture
 Talk active, normal and clear speech, coherent but easy to distract
 Subjective (Mood): feeling of anxiety and insecurity, fear of going home and being “left
alone”, fear of falling and dependency
 Objective (Affect): Slight confusion and avoiding questions regarding ED admission, death of
wife, memory lapse in ED, no delusions, suicidal thoughts or obsessions, reports no
alcohol intake (“not really”), but in conversation re Admission mentioned “hot whiskey”
 Patient understands reason for admission, aware of treatment and compliant
 Good family support, socialises in family owned Pub (everyday from lunch time till evening),
dependent on care through family
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9. Medical Examination
 Blood culture and sensitivities, lactic acid
 Ultrasound abdomen
 Observation of BP, RR, Temp, Pulse 3 hourly
 Check AVPU, GCS
 Check Blood sugar
 Input/output chart
 Assist with ADL’s
 Document
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10. Physiotherapy
 Initial assessment: ROM, Strength, Sensation, Neurological assessment for
Parkinson's, Respiratory assessment for pneumonia.
 Treatment: Mobilisation, ADL, Balance, Coordination and Strengthening
 Outcome measure: Berg Balance scale. 48/56. Deemed low falls risk

11. Discharge Planning
 Involve family/Medical professionals in holistic care for patient
 Involve Public Health Nurse
 Diabetes CareSpecialist
 Parkinson’s DiseaseNeurologist, GP
 OT?stair lift already installed, possibility to move bedroom downstairs?
 Physiotherapy: Berg Balance, can carry out ADLs, mobilisation independently
and chest is clear with stable SpO2 levels.
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12. Varicose veins
 Enlarged and twisted veins, usually in the leg
 more common in women than men
 Cause: heredity, pregnancy, obesity, menopause, aging, prolonged standing, leg
injury and abdominal straining. Varicose veins, less common post phlebitic
obstruction or incontinence, venous and arteriovenous malformations
 cosmetic problem, painful, especially when standing
 Severe long-standing varicose veins can lead to leg swelling, venous eczema, skin
thickening and ulceration
 Life-threatening complications uncommon
 Non-surgical treatments include sclerotherapy, elastic stockings, leg elevation and
exercise
 traditional surgical treatment: vein stripping to remove affected veins

13. Pneumonia
 Inflamed infection of the alveoli in one or both lungs.
 Alveoli filled with purulent material (bacteria, viruses, pus, fungi)
 CAP: Streptococcus Pneumoniae
 Symptoms: SOB, Cough with sputum, fever, chills and pleuritic chest pain.
 Smoking is a major risk factor
 Outcome measure: Pneumonia Severity Index or CRB-65

14. Parkinson’s Disease
 Progressive disorder of the nervous system
 Caused by breakdown of neurons in the brain.
 Dopamine levels decrease and cause abnormal brain activity leading to signs
of the disease
 In early stages: masked expression, slowed movement, shuffling gait,
impaired posture and balance.

15. Septicaemia
 Life threatening condition
 Immune response triggered by infection
 Signs: fever, increased HR, RR, Confusion
 Diagnosis: Blood test
 Treatment antibiotics, fluids, O2 take 3 and give 3

16. Diabetes
 Diabetes I and II
 Metabolic illness, either insulin deficiency or inability to use produced Insulin
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 Type I Diabetic Novorapid Bolus with Meals
 Bloodsugar levels checked with every meal (between 4-8 mmols)
 Controlled by diet and insulin
 Diabetic meals from kitchen
 Sees specialist in Bons Secours Hospital
 Monitor complication

17. Interprofessional Education Experience
 Difficult as we are not yet used to assess a patient unsupervised.
 MDT work very important as it can save time and is less stressful for patients
and care team involved.
 Good communication skills are necessary as well as a plan before assessing
the patient
 Difficult to gain all necessary information in 1 interview.
 Difficult to read Doctor notes, medication prescription chart, have access to
medical chart, patient etc..
 Working with peers at same point in training
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