CASE STUDY 1

Case Study

CASE STUDY 2

Case Study

CASE STUDY 3

Ms. J is a woman with mild developmental disability, diagnosed with type 2 diabetes, recurrent major depression, and PTSD. She lives in a residential facility. Her diabetes is treated with some success with oral agents, although she is noncompliant with diet restrictions. Her recurrent depression and PTSD are treated with an antidepressant and a mood stabilizer. Ms. J's weight remains around 185 lbs, and she has fat folds below her breasts and in the groin area. Direct care staff members report that Ms. J does not shower daily and often goes five to six days without a shower. The nursing staff notes when doing weekly skin audits that Ms. J has excoriated areas in the fat folds and she is complaining of discomfort. The nursing staff has explained to Ms. J the need to shower and dry the area well each day and that topical medication will then be applied to heal the area. Ms. J continues to refuse to shower regularly, and it is determined that it is a necessity for her own well-being that she do so. The case manager discusses this with Ms. J and sets up a program in which she will receive a portion of her weekly allowance on a daily basis, but only after she has showered for the day and allowed the nurse to apply the medication. Ms. J and her advocate agree to this arrangement, and the information is shared with the facilities human rights committee to obtain permission for a rights restriction. After a few weeks, the skin areas begin to heal, and Ms. J is complying with showers on most days. It is determined by the multidisciplinary team to continue the behavior modification strategy with a review on a quarterly basis by the human rights committee.