The client [referred to as Rose in the case file] is an adolescent girl with some mild learning difficulties managing independent care.
The client was born with the genetic condition Noonan Syndrome. The characteristics of this syndrome include heart defects, facial features including drooping eyelids, large downward slanting eyes, widely spaced eyes, flat nasal bridge, short neck, low hairline, low set ears with frontal lobe rotation and short stature in correct proportion.
Due to her severe birth heart defects she had a heart transplant at nine months old. She currently attends the Cardiology Clinic at the General Infirmary every three months and the Cardiology Clinic at London, yearly. The transplant is currently working well. Apart from the side effects of some of the immunosuppressant medication she needs to take. She is closely monitored at the Renal Unit because the immunosuppressant medication she takes can cause renal problems. The client is hearing impaired in both ears and normally wears hearing aids.
She is now well into adolescence and is becoming quite aware of the differences between her facial features and those of her peers. Her grandparents, who she lives with, and the school are becoming increasingly concerned that she is showing signs of depression and low self esteem. She has made such statements as ‘why does everyone have to be nasty to me’, ‘one day I will kill myself’, ‘what is the point in being alive’. In addition to these negative thoughts, she seems to be showing some of the physical symptoms of depression in that she is sleeping very poorly and goes through bouts of either eating or not eating. Currently she feels that she is too fat. Seen by the child psychiatrist who prescribes the anti-depressant Dothiepin to which she responds very well.
The story concludes with a visit to the plastic surgeon who offers Rose a choice between extensive facial reconstructive surgery or less invasive surgery to ‘pin back her ears.’ She initially rejects any of the surgery offered and is asked to think about what she wants and given a follow up appointment in three months.
Profile of Learning Disability Case 01-095
Client with undefined learning difficulties and mental health problems
The client’s health fluctuates. he lives alone and he suffers with regular colds and chests. he has problems with eczema on his legs and scalp and he will scratch and make it sore. he regularly visits his GP for his depot injection on a three-weekly basis. He did suffer from epilepsy, but has not had a seizure for a number of years. He is in receipt of the higher rate of mobility. He attends outpatient clinic on a six-monthly basis and his medication is administered by dosette box on a weekly basis by the GP’s wife. and this appears to work well for him. He is only on anti-convulsants medication at this time.
The client is quite an able gentleman. He enjoys reading Shakespeare, poetry and local history. However, he is deemed extremely vulnerable in other areas particularly around mental health needs and requires a lot of support with daily living activities. He very rarely goes out apart from shopping independently or if he goes out with his support worker.
Defining feature of his care relates to supportive care required to remain in the community.
Profile of Learning Disability Case 01-096
Client [referred to Mary throughout the case notes] with moderate learning difficulties, depression and schizophrenia.
The story begins with reports of Mary taking five overdoses within the past week thought to be ‘copy cat’ of her boyfriend. Appears to be impressionable and dominated by her boyfriend. Lives relatively independently with support from community sister and medical input. Appears to have difficulty sustaining relationships and is in counselling for this. Episodes of ‘drunkenness’ resulting in falls and injuries requiring attendance at A&E department remorseful following such incidents.
A central theme is documentation around an alleged rape requiring multi agency input and police involvement. Evidence surrounding alleged rape not clear with Mary having difficulty constructing exactly what occurred and with concepts such as ‘penetration’ and ‘ejaculation.’ Removed to a place of safety and investigated by the police. Prone to tell anyone she meet about the alleged rape and the identity and location of the person who carried out the alleged rape. Appears not to be able to bring closure to the incident and it is not clear from the records what actions were taken by the police and prosecuting authorities.
The story concludes with Mary feeling low and tearful/emotional remembering her son whose birthday it is this week.
Profile of Learning Disability Case 01-097
Client with moderate learning disability and a complex range of physical and mental health problems, which also have impact on his psychological health. He has the following diagnoses:
· Congenital blindness
· Liver cirrhosis - portal hypertension and ascites
· Anti-thrombin III deficiency with a history of recurrent DVT
· Previous varicele bleeds therefore not anticoagulant (varices)
· Diabetes Mellitus
These complex health problems necessitate the staff caring for him to have an understanding of his health problems and how they present, especially in emergency situations. The client needs a care plan which reflects his on-going monitoring needs, what to do if there are concerns about his health and how to manage emergency situations. There also needs to be a smooth transition from current services, GP, Consultant Physician and hospital services.
A feature of his demeanour is non compliance with medications, treatment regimes, appointments with health care professionals etc. Known to abuse alcohol which accounts for many of his health problems and contributes to his non compliance.
The story concludes with him developing diabetes mellitus controlled initially with diet and medication but progressing to insulin replacement.