Read the case study and answer the questions that follow. Mrs Maria Monticello is 89 years old and lives with her husband Ernie (90 years) in their beloved home of 60 years. Maria has two children, a daughter who died six years ago and a son, Jim who lives interstate. She has two granddaughters who live some distance away, one of whom is a nurse. They are only able to provide limited support and visit once a month, which Maria enjoys enormously.Maria has been diagnosed with Pagets disease which affects her mobility and causes a lot of pain in her joints. She uses a stick to walk around the house and is no longer able to do shopping or other household tasks like cleaning and laundry. Maria has had five falls over the past two years; has undergone surgery for bowel cancer; has lost consciousness on four occasions; and been hospitalised five times. She also suffers with significant pain from arthritis meaning that she can no longer do knitting, a past time she used to love.Maria relies hugely on Ernie. Ernie does all of the cleaning, laundry, gardening, financial management and other home maintenance. Ernie is physically fit, but is starting to experience dementia symptoms. He is no longer able to drive any distance because he has become lost several times. He also leaves the gas burner of the stove on regularly; has stopped taking walks because he has become confused; and has short term memory loss.Maria has to step over a bath to have a shower and there are steps to navigate at the entry to their home. Maria is also moderately incontinent of urine. She uses continence pads but is very self-conscious. Maria takes a number of medications and often becomes confused about what she should be taking and when. Both Maria and Ernie are quite isolated. Maria is often bored and does little else but sit in her chair watching television or reading. Reading has also become difficult due to her failing eyesight. She regularly expresses dissatisfaction about her life, the pain she experiences and her inability to do the things she used to enjoy. Maria has told her family that Ernie is often grumpy with her because he has to do everything around the house and she has become useless.Questions1. Identify the physiological and psychological changes that Maria is experiencing as a result of the ageing process. Identify 4 physiological/psysical changes and 4 psychological changes.2. Identify the 4 indicators that Ernie is experiencing dementia.3. As a care worker in Maria and Ernie’s home, what should you do in response to their following needs:Maria’s signs of depressionModificaions in Maria’s homeErnie’s signs of cognitive impairmentMaria’s pain4. Identify 2 strategies you could suggest to support Maria to become more socially engaged.5. You are the personal support worker who will be providing showering assistance to Maria. Answer the following questions.List 4 things you should do before you provide showering assistance to MariaList 2 types of personal protective equipment you should use when providing showering assistance to MariaList 2 types of equipment or aids you may need to use when assisting with showeringList 5 things you should remember when showering a person6. As part of the assessment of Ernie and Maria’s needs, it has been suggested that they would benefit from shopping assistance, transport, meal preparation and gardening. It is clear that all of these activities could be risky for them. However, Ernie refuses these services because he doesn’t want strangers in the house and he feels he can do these activities himself. What needs to be done so that the care organisation meets its duty of care obligations while at the same time respecting Ernie’s right to dignity of risk?
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