Nursing Case Study: Advanced Stage Dementia

Mr. John Kelly,83 years old is admitted to a long term care centre of older adults due to his physical and psychological difficulties after death of his wife . After six months of his wife’s death ,he visited his GP and diagnosed depression and referred to a geriatrician .Also, John was diagnosed with Alzheimer’s disease and rheumatoid arthritis on prescribed medications. The aim of this case study is to explain and discuss the major nursing care of a 85 year old man who has recently been diagnosed with advanced stage dementia. This case study will express my knowledge and understanding of evidence based nursing practice whilst exhibiting my ability to outline a plan of care, which is based on this.

a)
Key priorities for John’s care
The nursing process wants the nurse to carry out a holistic assessment of clients needs of physical, social, psychological, and spiritual being in order to create an appropriate plan of care (Ken worthy et al, 2006).
As a nurse it is essential to identify the use of an advanced plan of care s would enable John, while he is in the nursing home, to write a statement which outlines the way in which care has been prioritised as it is appropriate to him.
Impaired physical mobility
Impaired physical mobility of Mr. John is due to neuro muscular damage and decreased Muscle tone and strength as evidenced by inability to perform activity of daily living. As Mr. John has dementia with his old age, he cannot interfere with his ability to care for himself. It is suggested that activities of daily living (ADL) are vital errands that one require to perform to survive. These include bathing, eating, toileting, and grooming. Mauk
(2008).

Imbalanced nutrition less than body requirement
Imbalanced nutrition less than body requirement is related to sensory changes as it is easy to forget by Mr. John. It has reported in a literature, diet and nutrition are significant attention in the valuable and evidence based concern of person who experiencing cognitive decline, particularly those experiencing Dementia and Alzheimer’s disease.Also,caloric control has been reported to improve memory performance of elderly people in order to decrease obesity.Martin.etl.2014(p.259)

Impaired Urinary and Bowel Elimination
Urinary and bowel elimination related to neurological function loss which leads inability to determine where the bathroom and identify needs. It is reported that Men with dementia sometimes urinate in corners and waste paper baskets. Alternatively, they may once have lived or worked where the hygienic preparations required them to urinate in a bucket, and may believe that what they are doing is appropriate. This can be tested by removing the basket and putting something disturbing in the wrong corner, such as a chair. Most importantly, nursing staff must take care of such problems to avoid smell and distress to others. Andrews J (2013)

Ineffective individual coping
Ineffective individual coping of Mr. John is related to recent loss of his wife as well as inability to resolve the issues, intellectual changes. Meine. E(2011) suggests that depressed older adults are always at the risk of inability to care themselves. Because of psychosocial mechanisms, together with emotional tension and unhappiness; loss of community, instrumental and material support (Nihtila & Martikainen, 2008, p. 1228)

Disturbed Sleep Pattern
As Mr. John has Alzheimer’s disease, and is associated with neurodegenerative disease resulting in disturbed sleeping pattern. Elder adults with dementia are more prone to strictly disturbed sleep due to injure in neuron pathways that obstruct homeostatic and circadian regularity processes. Fitzpatrick J (2012 page no252).

Risk for injury
Risk for injury to Mr. John is due to weaknesses, the inability to recognize and identify hazards in the environment. Prevention of fall is the primary strategy of a dementia patient. According to the author, the occurrence of dementia increases possibility for falls in double. Also ,it increases key injuries like fracture and traumatic brain injury related to falls. Older adults are at threat of traumatic brain Injury. Ebersole (2014 p.198)

Pain in dementia due to rheumatoid Arthritis
Although, pain management is very difficult in old age without any cognitive impairment, management of pain with dementia patients are extreme worse. Problems arise due to cognitive impairment of clients and pain make moving hard. Marshal (2004 p.no.211).

b) Pain in dementia due to rheumatoid Arthritis
As can be seen from the scenario, Mr.
John has been suffering from rheumatoid arthritis and it causes him to limit his mobility and he is using stick while walking as an assistive support and he is on pain management medication. It is evidenced by various studies management of pain is difficult for older patient with dementia.
To begin with, according to a demonstrated study, the strategies depicted are more paramount to caliber estimation, fragile more seasoned persons, a more-dependent number over those powerless one assembly mulled over. Measures of nature are meager to such groups, to some degree due to worries that caliber measures will not apply a result those profit starting with intercessions is thereabouts little for patients in the greater part weakened state thatquqlity indicators( QIs) are inapplicable. Solomon, 2003 p.no
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In addition to this, the study says that utilizing cautious analysis—akin of the graded methodology utilized by encountered clinicians in directing the consideration about patients to those limit about life— the consideration procedures that must be safeguarded and the individuals that may not a chance to be utilized make identifier. More than half about Assessing Care of VulnerableElders-3 (ACOVE-3) forethought techniques were held for provision should patients for notice and poor prognosis, demonstrating that proportionate consideration could make portrayed what is more clinicians could be held mindful will uphold norms from claiming personal satisfaction on treating patients to the end for term. Personal satisfaction of consideration could be measured and ought further bolstering to make normal to indeed going the large portion powerless patients. {Wenger, 2007 #9}
Furthermore, pain assessment and management in dementia patient is complicated for a nurse in order to assess pain.It is stated in Ford, (2015 page no.6) that to aid lessen pain in elder adults with dementia, it is essential that health care providers to be proactive while screening and assessing for probable pain in this particular inhabitants.

Studies evidence that “Although detecting arthritis as a disease may not substantially diminish the need for nursing home placement, it could be hypothesized that large-scale efforts to lessen the physical disability associated with arthritis would have a modest effect on placement” Guccione, A(1989). Generally, older adults with dementia are at major prone of having pain. Innovative interventions and programs are necessary to control pain adequately in this vulnerable populations, it is described by, Hunt,( 2015 p.no: 3).

Torment evaluation in people with cognitive difficulty depended with respect to behavioral observation,and the utilization of institutionalized torment evaluation instruments. In the non attendance of their capacity on self-report agony. Also,this study aim that, because of poor communication, the clinical abilities of the care takers will give coordinated comprehensive forethought and viable ache administration.This obliged medical caretakers to have additional information in regards to individuals for dementia, close by the utilization for suitable ache appraisal devices.This investigation additionally uncovered that absence of training.Therefore, there is a Compelling reason to create ache instruction programmes. Particularly intended for nurture looking after more seasoned kin for dementia, should enhance learning done. Those compelling appraisal should attain success, it will be prescribed that those methodologies for example, such that in-service preparation programmes,. Instructive facilitators, correspondence, templates. Also torment management rules need aid to be investigated further and received previously clinical practice. {Burns, 2015 #12}
Similarly, another study mentioned that continual pain is general among the aged and is connected with cognitive deficits in cross-sectional studies; the population-level involvement between chronic pain and longitudinal cognition is anonymous .Also, constant pain was related with accelerated remembrance turn down and amplified possibility of dementia. Whitlock, (2017 page no.5).
Conclusion
In conclusion, this essay has provided an explanation and discussion regarding key priorities the nursing care of a 85 year old man who has recently been diagnosed with advanced stage of dementia after loss of his wife Mr. John came to the attention of the nursing service following a referral from his GP for a full medical assessment by a geriatrician . These clinical task was completed and diagnosed with Alzheimer’s disease and Rheumatoid arthritis. Although he is on some medications,there is no evidence to prove that he was on it correctly at home. However, this case study has identified that there are many issues that can present when PHN is visiting regularly and assessing the patient. When providing a holistic nursing approach to individualized care,Mr.John to be admitted to a long term care setting,.
Throughout the assessment and involvement with Mr.John, it was observed that there is a complex set of needs and issues that require to maximise his health and the needs are prioritized as relevant.. This case study has demonstrated my knowledge and understanding of evidence based nursing practice and demonstrated my ability to utilize this in order to outline a plan of care