Question

A male in his 80s was referred for an evaluation. He had previously been diagnosed with Alzheimer’s dementia. At the time of evaluation, he was living at home with assistance from his family and caregiver. He is now unable to learn most any new information, and long-term memories are also weak (sometimes forgetting who his wife and children are). He is sometimes hard to understand due to slurring of words, and he appears to see people who are not in the room. He is needing help in bathing, dressing, cutting his own food and using of toilet. Due to falls, he is usually transported via wheelchair.

During the evaluation, he was unable to state his age, the current month, the current year, and the city where he’s located. He can read a list of 3 words but could not remember any of them after just 1 minute.

Cholinesterase inhibitors and Memantine are administered. His family noted that they are struggling to provide care to him, and they asked whether it would be appropriate to consider moving him to a residence with a memory care unit.

1. Create 3 Nursing Diagnosis, with Nursing Intervention and Expected outcomes based on the case scenario.

Answer 1

Answer =

* Nursing Diagnosis =

1. Risk for injury due to loss of cognitive abilities .

2. Insomnia and mentally disturbance to disease process.

3. Caregiver role strain related to physical needs and behaviour menifestations of the disease process.

* Nursing Intervention =

a - Improving cognitive response = Simplify the environment - reduce the noice and social interaction with patient.

- Maintain a structured routinne and use the picture for understanding the patient activities.

- Encourage active participation in care as tolerated and provide positive feedback for task that are finsihed.

b. Preventing injury =

- Avoid restraints but maintain observation of the patient as necessary .

- Provide for adequate lighting to avoid misinterpretation of the environment.

- Remove unneeded furniture and equipment from the room.

c. Ensuring Adequate Rest =

- Attempt to limit the use of medication that act on CNS such as anxiolytic and antipsychotic tablets.

- Provide periods of physical exercise to expend energy.

- Support normal sleep habits and bedtimes rituals .

- Maintain quiet, relaxing environment to avoid confusion and agitation.

d. Supporting Caregiver =

- Encourage caregiver to discuss feeling .

- Enncourage caregiver to maintain own health and emotional well being.

- Stress the need for relaxation time or respite care .

- Support the patient and place the patient in long term care facility.

* Evaluation and Expected outcome =

-Remains the patient free from injury .

- Participates in activity of daily living without any resistance .

- Sleep the patient for 6-8 hour in night and 1-2 hour in a day time.

- Record the patient activity and also report for community resources .