Question

A 94-year-old widow who is a resident of an assisted care facility was diagnosed with Alzheimer’s dementia a year ago shortly after admission to the care facility. Her memory was slowly declining over the past 5 years. She was no longer able to balance her checkbook, forgetting to turn the stove off, forgetting where things were placed and waking up after a nap terrified stating she could not remember where she was. The patient has also demonstrated a gradual decline in activities of daily living (ADLs). For example, she cannot remember how to feed herself, how to comb her hair, how to clean herself after using the toilet. She becomes disoriented at the facility and cannot remember the number to her room. There is an increase in sun-downing behavior over the past 4 months with difficulty falling asleep and restlessness. The patient takes Calcium supplements 1000mg/day after having a parathyroidectomy 5 years ago. The patient’s daughter manages her finances and has been designated as the patient’s health care advocate. The patient recently fell 3 weeks ago and was found on the floor after rolling off of the couch. She has increasingly had bouts of crying, restlessness, and agitation. Nine months ago she was placed on hospice. Xanax was prescribed for anxiety with the dose gradually increased from .50 mg to 1mg 4x/day. Tramadol was prescribed for shoulder pain due to chronic arthritis.

1. What signs and symptoms of Alzheimer’s dementia can you identify in this patient?
2. Identify two nursing diagnoses for the patient, prioritizing the diagnoses. The nursing diagnosis should include what the problem is related to and evidence that supports the chosen diagnosis.
3. Identify two outcomes that are patient-centered and include specific time frames for evaluation.
4. Create two nursing interventions that are evidence-based and include rationales.
5. How would you evaluate the effectiveness of your nursing care?
6. What are your suggestions to the assisted care facility staff for patient safety and health promotion?
7. What supportive resources would you provide the patient's daughter?

Answer 1

Q. No. 1. Answer :

Signs and symptoms of Alzheimers dementia in this patient :

* Cognitive :

Memory declining,

forgetfulness,

inability to recognize common things,

disorientation,

Mental decline ect

* Behavioural :

Difficulty in self care like feeding self, combing, cleaning her self after using toilet ect.

* psychological and Mood :

Difficulty in falling asleep,

Agitation

Rest less ness ect.

These are the signs and symptoms of Alzheimers dementia we can observe in these patient.

Q. No. 2. Answer :

Nursing diagnosis 1.

Disturbed sleeping pattern related to sensory changes as evidenced by patient inability to sleep properly and fall in sleep.

Nursing diagnosis 2.

Self care deficit related to memory impairment or neuromuscular impairment as evidenced by patient can not able to maintain daily living activities like eating, grooming, cleaning ect.

Nursing diagnosis 3.

Risk for injury related to inability to identify hazards in the environment.

Q. No. 3. Answer :

Two outcomes :

* To improve sleeping pattern of the client.

* To improve self care activities by helping or assisting with patient.

* To prevent injuries by taking precautions.

Q. No. 4. Answer :

Interventions :

* provide calm and quiet environment,

* provide psychological support and emotional support to feel comfortable.

* assist the patient in daily living activities.

* use alarm system to attend needs of client.

* repeatedly tell the things to the client to remember.

* avoid all the unnecessary equipments surroundings of the client to prevent injuries.

* arrange all the needed articles near to client.

* provide bed side cummods, or bed pans if needed.

Q. No. 5. Answer :

Evaluation of effective ness of nursing care :

By seeing improvement levels of the client we can evaluate the nursing care.

Through structure, process, outcome model we can evaluate.