The activities of living listed in the Roper-Logan-Tierney Model of Nursing are:
1. Maintaining Safe Environment
Anna is dependent on staff to keep her safe. She exhibits bodily movements which interfere with normal safe eating and drinking. On occasions these erratic movements are so extreme as to put her at increased risk of physical injury. She can cause small wounds to her face, limbs and torso due to her repetitive stereotypical hand and arm movements. During the period of her erratic and uncontrolled movements put her at risk of aspiration and chocking. The uncontrolled movement can also cause lose some of her medication which is very essential for her physical wellbeing.
When she settle after a seizure she is more likely to sleepy. During this time excessive production of saliva can affect her breathing / blocking the airway.
Both Anna and staff are at risk of injury due to her flailing arms and legs. Also it is not safe to do the manual handling. When she displaying extreme body movements it not safe to transport her which can affect her attendance at day services.
Anna’s dysphasia can increase the risk of aspiration and may can cause chest infection.

Communicating

Anna has no formalised system of communication through which to make her need/wishes known and is totally reliant on others to anticipate her needs. Even though she has very good eye contact. She has no active say regarding any aspect of her life. She is open to speech and Language Therapy services but this mainly for dysphasia. Communication and sensory integration assessment have been done in the past with very limited success (2011-12)

Breathing

Anna has abnormal breathing patterns which is common in Rett syndrome. Anna will show signs of shortness of breath which is causing her distress and/ or pain. Shortness of breath can lead to cyanosis. This most likely to occur after a prolonged seizure or when she has chest infection. If her oxygen saturation levels are reading below the usual baseline ie 93% or less Her range is 94-97%) oxygen is administrated as per prescribed.

Eating and Drinking

Anna has no functional use of her hand and she is fully depending on others to assist with her eating and drinking. She does eat and drink well, it seems she enjoy her meal. She has been assessed by the Speech and Language Therapy to be at the risk of aspiration. Anna has liquidised food and thickened drink. Anna has dysphasia which can contribute to an increased risk of coughing , chocking, aspiration and recurring respiratory tract infections

Elimination

Anna is unable to take herself to the toilet and has no formalised system of communication to alert others of her need to go to the toilet. Anna is incontinent of both urine and faeces with an associated potential for skin breakdown. Anna is prone to constipation.

Personal Cleansing and Dressing

Anna is unable to do her personal hygiene independently due to her complex health needs. Due to her erratic movements she cannot be bathed conventionally. She has had recent urinary tract infection, which may have been the result of faecal contamination of the vaginal area. At present Anna has the bed bath everyday with Aqueous cream (soap substitute) to help with her dry skin. Diprobase moisturiser is available as PRN for dry skin to prevent the risk of skin breakdown.
Anna is unable to independently manage her oral hygiene needs and requires full support in this aspect of her care in order to maintain healthy teeth gums. Anna’s oral hygiene is maintained daily. Her positioning during and after oral hygiene procedures are important in order to minimise the risk of aspiration including silent aspiration.

Controlling Body Temperature

Anna’s normal temperature range for observations is 36-37.5*C. Anna can experience difficulty in maintaining an even body temperature and it is prone to becoming suddenly cold or hot. She prefers moderations in temperature. Staff need to be able to recognise when Anna is becoming too hot. Staff recognise breathing difficulties and cyanosis during prolonged seizures and use the prescribed oxygen via a face mask if necessary.

Mobilising

Anna is non-ambulant. She is unable to stand or support her own weight but she can hold head up when alert. She requires a back rest and bilateral support to be able to maintain an upright seated position. She has a full range of movement in all her limbs. Anna’s preferred positioning of her legs is to hold her knees tightly in flexion. Anna has apraxia and is unable to perform controlled motor movements.

Working and Playing

Anna attends day services for three full days a week. Attendance at day service is depending on her health and safety in transporting (i.e. when displaying extreme body movements it is not safe to transport her).

Expressing Sexuality

Anna’s physical / sexual body development is normal. Anna does not appear to show any interest of a sexual nature with the same or opposite sex.

Sleeping

Anna has several opportunities to rest in her day chair or in her bed. However, she is likely to drop off to sleep. She can take longer time go to sleep at night and normally has several interruptions in sleep throughout the night.

Dying

As Anna is stable at the movement her parents are not mentally ready to talk about her end of life. It will be done in the future when required.