Nursing Case Study Dementia

Question: Discuss about theNursing Case Studyfor Dementia. Answer: Introduction Dementia is a progressive degenerative brain disorder that is characterized by memory loss, impaired thinking, significant behavior as well as emotional changes (Mandel, 2013). The common causes of the dementia are the genetic and environmental factors that lead to increased destruction of brain cells such as excessive use of alcohol, substance abuse, depression, medication side effects, thyroid problems and vitamin deficiencies. Other conditions associated with dementia including Alzheimers disease, vascular dementia and Fronto-Temporal Lobar Degeneration, Parkinsons disease, dementia with Lewy bodies, Huntingtons disease, Korsakoffs syndrome, AIDS-related dementia, Creutzfeldt-Jakob disease among others (Cavanaugh Blanchard-Fields, 2015). These degenerative diseases affect various parts of the brain and thus interfering with the ability of the affected parts functioning in an expected manner. Alzheimers disease is highly implicated in the establishment of dementia.It develops duri ng the increased degeneration of brain cells that causes shrinking, the disappearance of some cells and plaque formation leading to disruption of transmission in the brain and therefore the functions and abilities of the affected brain part are lost (Mandel, 2013). The signs and symptoms of dementia often depend on the underlying condition that causes it and the extent of progression of the disease. However, the general signs and symptoms of dementia include progressive and frequent memory loss, disorientation to time and place, personality change, withdrawal and loss of ability to perform activities of daily living. In some instances, there may be a loss of mobility and appetite especially in the late stages of dementia. Speech impairment and speech impairment or difficulty finding words as well as depression, bowel, and bladder incontinence are symptoms that are more common in the later stages of dementia (Cavanaugh Blanchard-Fields, 2015). Dementia associated problems are physical aggression, agitation, apathy, delusion and apathy and other relationship problems such as communication inabilities. Physical aggression may be due to various triggers such as the invasion of personal space, cultural inappropriateness, noise, hallucinations and unmet physical needs which make the affected individual feel they can no longer cope. They are also at increased risk of injuries due to the wandering experienced as the disease progresses. These experiences may be distressful to the family, isolating them from the society. The Mini Mentals examination of the patient stipulated the following indicators. Criteria Possible score Score Description Orientation to time 5 2 The client is oriented to year and month but not oriented to season, date and time Orientation to place 5 2 The client is oriented to country and town but not oriented to immediate place and room Registry of words 3 3 The client can repeat three unrelated words in a sequence Attention and calculation 5 3 The client was unable to perform calculations but can reverse-spell the word world as dlorw Recall 3 2 The client could recall the previously provided words but missing one of them Language 2 1 The client can name various objects presented to him but could not write a sentence as instructed be able to Repetition 1 1 The client can speak back a stated phrase correctly Complex commands 6 4 The client can draw an intersecting pentagon, move an object from right to left, and perform various commands given except the one for reading a phrase and doing what it means close your eyes. The Mini Mentals examination score is 18 indicating a mild cognitive impairment. The reason for choosing this tool in the assessment of the patient is because it is the one that can be used to determine and diagnose cognitive impairment of the client effectively. Therefore, appropriate interventional measures can be selected and implemented to curb the problem. The tool does not require specialized equipment or training for administration. On the other hand, its reliability and validity are high as well as its short duration of administration and therefore it can be readily used in the clinical area for initial clinical assessment (Kelly, McCabe, Innes Andrews, 2012). Assessment Nursing diagnosis Expected outcomes Interventions Rationale Evaluation 1.The client is not oriented to time a and place 2. mild memory impairment 3. unable to effectively follow commands and aggression Acute confusion related to an underlying mental condition as evidenced by disorientation to time and place By the end of 12 hours, the patient will be oriented to time and place with a significant improvement in the MMSE score 1.Assessment of any underlying trigger factor and intervene according to the particular findings 2. Allow the patient to move freely within a safe environment while engaging them in a therapeutic conversation (Low Fletcher, 2015). 1.Assessment enables a health care provider to determine the cause and select the most appropriate intervention for the patient 2. To orient the client to time, place and person Specific communication strategies can be employed to relieve distress, aggression, and challenging behaviors. Validation therapy which involves entering the clients reality rather than ones own enables development of trust and a sense of security as well as maintaining a high level of self-esteem and dignity. According to Low and Fletcher (2015), a quiet environment should be chosen for communication with the client since noise can be one of the triggers of aggression. Sensitive communication should be conducted in a private but safe environment in which the client is comfortable. Voice should be kept calm and clear while communicating with the client and questions should be asked one at a time and repeated if necessary to avoid further confusion of the patient. Facial expression, body language, and eye contact should be kept relatively Reminiscence reflection of the past events can be used to communicate to the patient as the memories may bring pleasure to them and cause a distracti on, hence reducing anxiety and aggressive behaviors. The client can be provided with opportunities that promote autonomy and independence. T As stipulated by Nay, Garratt, and Fetherstonhaugh (2014), the patient should be given a chance to perform the activities he enjoys most such as building toys and helping in the garden. The performance of these activities makes the patient maintain their motor skills and still maintain their self-worth since they can perform them independently. Moreover, physical exercises are necessary for the client to keep muscles healthy and functional as the condition progresses and make technical activities easier. The client can join a support group with the same or similar condition to share experiences and learn from each other on how to cope through self-reliance. Furthermore, the client can be trained and encouraged to keep track of planned activities in a diary as a reminder. The available community services to support the patient are local community health center where frequent checkups can be done, appropriate measures taken and any necessary referrals made. The client and relatives can also use the national dementia helpline for consultation about any concern (Australia Siewert, 2014). Furthermore, consultation of cognitive dementia and memory service clinics throughout the country can be made to receive the required services that address the special needs of the patient. They also provide counseling alternatives and necessary support to the client besides empowering them and their families on how to live positively with the condition. As identified by Preedy and Watson (2010), the condition can have various social and economic impacts on the family and other close associates such as relatives and friends. As the clients cognitive abilities including memory deteriorate, his social interaction and relationships change. They may develop challenging behaviors such as aggression, wandering and other socially unacceptable behaviors which may lead to social isolation by other members of the society. Furthermore, dementia patients become more dependent on the family members to carry out most of the activities of daily living hence increasing the burden of care on the family. Additionally, the medical attention and services may cause financial strain to the family, relatives and friends considering that the productivity of the individual with the condition significantly reduces. Changes in behavior and personality of the patient may cause stress and frustration to family and other as they try to adapt their emotional and p hysical relationship with the patient and therefore having detrimental effects on their psychological and physical health. References Australia, Siewert, R 2014,Care and management of younger and older Australians living with dementia and behavioral and psychiatric symptoms of dementia (BPSD), ACT Community Affairs References Committee, Canberra. Cavanaugh, J, C Blanchard-Fields, F 2015,Adult development and aging, Cengage Learning, Australia. Kelly, F, McCabe, L, Innes, A Andrews, J 2012,Key issues in evolving dementia care: International theory-based policy and practice, Jessica Kingsley Publishers, London. Low, L, F Fletcher, J 2015, Models of home care services for persons with dementia: a narrative review,International Psychogeriatrics,27,10, 1593-600. Mandel, S 2013,Neurodegenerative diseases: Integrative PPPM approach as the medicine of the future, Springer, Dordrecht. Nay, R, Garratt, S Fetherstonhaugh, D 2014,Older people: Issues and innovations in care, Churchill Livingstone/Elsevier, Sydney. Preedy, V, R, Watson, R, R 2010,Handbook of disease burdens and quality of life measures, Springer, New York.