Question

An 88-year-old woman has been in a Memory Care unit of a long-term care facility for the past two years due to advanced Alzheimer’s disease. She does not recognize her family and stopped communicating or providing self-care about 6 months ago. Last week she developed a urinary tract infection and was transferred to the skilled unit in the same facility for IV antibiotics. She has a durable power of attorney for health care (her daughter) and living will, which her family supports. For the past two days, the resident has refused to drink or eat anything. She is barely responsive when the staff attempts to arouse her, but moans at times.

QUESTIONS (10 POINTS TOTAL)

1. Why is the resident receiving antibiotic therapy in view of the fact that Alzheimer’s disease is considered a terminal health problem? (2 POINTS)

2. List two NANDA potential/”risk for” nursing diagnoses for this patient. Discuss why did you select those diagnoses? (2 POINTS)

3. What members of the interprofessional team will you consult and why?

(2 POINTS)

4. Is the resident a candidate for hospice at this time? Why or why not?

(2 POINTS)

5. What symptoms of distress do you anticipate that she may have based on your clinical judgment? (2 POINTS)

A 73-year-old patient who is being managed for viral cardiomyopathy with heart failure is going home today after an acute exacerbation of his heart failure. He has been taking furosemide 40 mg orally daily, rivaroxaban 20 mg orally daily, lisinopril 5 mg orally daily, and carvedilol 25 mg orally twice daily. He is now being prescribed to also take magnesium 500 mg orally once daily. He tells you that he understands why he is to continue to take the previously prescribed drugs but wants to know how the magnesium will help him. Your responsibility is to help him become a partner in his therapy to prevent worsening heart failure.

Questions (10 POINTS TOTAL)

1. Is this patient at risk for dehydration or fluid overload? Explain this risk.

(2 POINTS)

2. What parameters will you teach him to self-monitor at home for indications of needing to see the health care provider? Provide a rationale for your selection.

(2 POINTS)

3. What electrolytes are most likely to be disturbed by his drug therapy? Explain your selections and the directions of the potential disturbances. (2 POINTS)

4. What will you tell him about the magnesium? (2 POINTS)

5. What members of the interprofessional team would be most helpful in this patient’s management and why? (2 POINTS)

Answer 1

1, UTI is a common infection for the old age group. When a patient with advanced memory impairment there may be an infection that can occur. UTI can develop severe confusion, agitation, withdrawal. It can be treated with the right antibiotics before it leads to a complication.
2, Impaired social interaction
due to irritability, confusion and lack of confidence.
  Urinary and bowel elimination
due to loss of neurological function, muscle tone, inability to identify the bathroom and needs.
3, Nursing staff, physician, social workers, psychologist, physical and occupational therapist, pharmacist are the interprofessional team need to consult the patient.
4, A dementia patient needs to meet the hospice eligibility criteria. For patient with dementia the candidate's physical condition begins to decline, her life expectancy should be less than six months. This patient became a candidate for hospice at this time because her health condition began to decline with advanced Alzheimer's disease. she has all withdrawal, irritability, slow response symptoms, an infection that indicates the patient is in an advanced stage.
5, Inability to communicate, moaning symptoms shows patient with severe Alzheimer's disease, completely depend on others,there is a pneumonia symptom like not taking any foods and liquids.