Question

Mrs. Williams is a 68-year-old wife and mother who has diabetes, hypertension and is suffering from advanced Alzheimer’s disease. Her 70-year-old husband, a retired pastry chef, is her main caregiver. She has gradually lost weight, often refuses to eat and requires a great deal of assistance to move from bed to chair. Mr. Williams does have the assistance of his daughter, but she has a family with school-age children who require her time as well. The physician has suggested that a feeding tube would be a consideration at this time. Mr. Williams is anxious and uncertain as to what to do.

1. If she didn't have Alzheimer's, could Mrs. Williams be experiencing a form of dementia or delirium? Please describe the difference between the two.

2. What additional data would you focus on obtaining when you are assigned this patient?

3. What legal and ethical issues do you need to consider in this situation and how would you be an advocate for the couple?

4. You're realizing a multi-discipline conference is necessary. Which disciplines would you invite to attend?

Answer 1

1.She may have experienced age related delirium and often reversible with treatment. The difference between Alzheimer's and dementia are

Alzheimer's disease	Dementia
neurodegenerative disease Cannot be cured Memory loss,confusion ,delusion,hallucination, aggressive, anger ,mood changes, It has seven stages psychological disturbances	not neurodegenerative Can be cured if underlying problem is treated Insomnia,hallucinations, combative behaviour, moaning ,forgetting It has three stages

2.The additional data which can be asked are

• Her daily routine to make a schedue
• Her past surgical history ,any infections or diseases,etc.,
• Her medication history
• Any allergies (food and drug)
• Her favourites and dislikes
• Her bowel and bladder pattern to plan for care

3.The ethical issue is doing a procedure without patient knowledge  due to disease condition and intentionally causing some physical disturbances  to save her.

The legal concern been doing a procedure without patients consent

The couple can be advocated on the benefits of the procedure, clearing all their doubts and queries and getting consented

4.A multidisciplinary team is needed here for making a firm decision .The team can include a physician,psychiatrist,social workers, gastroenterologist, neurologist, nursing processional to plan for the care and the treatment regimen