Dawn

This case study is an example of specialist knowledge and intervention by Ruth O'Regan, Norfolk and Norwich.

Dawn has secondary progressive MS. She requires twenty-four hour care and lives with her husband, who is also disabled.

• Dawn has now been classed as palliative for four to five years and has had frequent hospitalisations for pneumonia.
• She is fed with a feeding tube and requires a hoist to move. She has ongoing issues with pressure sores and significantly reduced cough power.
• Her husband who is also disabled, often feels isolated and anxious whilst managing Dawn's situation.
• Dawn has had no neuro-nurse or consultant review for four years because she is housebound.

• Dawn is only able to sit out of bed for short periods due to a pressure sore. However the AMSC noted that her breathing was much clearer when she was sitting compared to lying down.
• Breathing exercises were introduced for the patient and a referral to Specialist Respiratory Physiotherapy was made.
• The AMSC taught carers how to do a manual cough assist to help clear Dawn's lungs and encouraged daily sitting.
• Dawn's breathing was also improved when she lay on her side in bed, so the AMSC demonstrated how pillows could help to support her when in bed.
• Dawn's ankle muscles were weakening due to prolonged periods in bed, so the AMSC taught the carers how to complete ankle stretches and advised on positioning.
• The AMSC identified that Dawn might have oral thrush, she advised the carers to contact the GP about this.

• Cough assist machine has been provided and carers trained in use. There have been no hospital admissions for pneumonia since.
• Received a neurological review in accordance with NICE (National Institute for Health and Care Excellence) guidelines and has a contact number for specialist support as needed.
• Provision of a suction machine has been provided ongoing, along with training for new carers.