Nursing Care Plan for Dementia - Essay Example

Nursing Care Plan for Dementia and Analysis Assignment A: Holistic Nursing Care Plan for Bill The Case Study under consideration is about Bill who has been diagnosed with Alzheimer’s disease. His condition is even aggravated with the development of dementia which is typical in older people with Alzheimer’s disease. Being the admitting registered nurse of the residential facility in which Bill will be staying, the following holistic nursing care plan is developed which will serve as guide for the employment of appropriate treatment or intervention. The key target of the plan is to help the patient with Dementia to address his needs through quality care and proper attention from the professional health care giver. It will be the primary objective that the patient be assessed with utmost scrutiny in regards his physical, mental, and behavioural conditions. In this way, the health care giver will know the key areas of concern and be able to supply adequate attention and intervention. In the development of a holistic nursing care plan, the locus of attention is not only the person with dementia. It caters to the family and the institutional care givers as well, because there evolves a complex interplay of roles among these components of the triad. A holistic approach in intervention conveys the need to apply a variety of dementia approaches to ensure better treatment of the signs and symptoms associated with Dementia and Alzheimer’s disease. Medical history is important in the clinical diagnosis. After gathering the medical records of the patient, social and environment factors including his family will also be part of the assessment in order to inquire about the patient’s physical, psychological and behavioural manifestations during the time when Bill is under their custody of care. All information obtained from the evaluations will help the nurse practitioner to assess the patient’s current functional state and ability and therefore determine the best treatment or intervention. Likewise, assessment of the patient’s incontinence which includes his urine and bowel elimination is important as this is one of the key areas of concern. Bill has been incontinent of urine since 2006 and incontinent of faeces in 2007. Through employment of regular toileting, the patient would be able to maintain skin integrity and with the establishment of such pattern, reduction of faecal incontinence and anxiety manifestation may be obtained. Daily charting and documentation of the patient’s skin integrity and bowel movement would be developed. Second, Nutrition is also assessed, by obtaining Bill’s weight and body mass index or BMI and checking skin turgor for hydration. Problem involved is that the patient’s admission in a residential facility would likely result to less mobility and less fluid intake. Thus, the nurse needs to ensure the patient’s appropriate body weight is maintained, low fat high fibre diet is given, and encourage the patient to drink adequate amount of fluids to avoid dehydration, and lessen incidences of constipation or accrued urinary tract infection (UTI). In this regard, the charting of bowel movement and documentation of sudden changes in behaviour ought to be developed. Third, activities of daily living (ADL) are vital also in the assessment process. By observing the patient’s appearance and general level of hygiene, including acquired input from family regarding Bill’s compliance with ADL, the nurse practitioner would know the functional state or ability of the patient to perform the ADL on his own. It is highly important that the patient be encouraged for independence in terms of caring for himself. Assistance is given only in areas that need it to avoid infections or other problems related to poor hygiene. In this case, regular visual assessment of skin integrity, dental hygiene and overall grooming is encouraged. Another key factor for assessment would be identification of falls risk. The nurse practitioner need to observe the patient’s mobility and gait. Likewise ensure that the facility is free from any obstacles or barriers that might result to fall incidents. Safety of the patients during their stay in the residential facility is very important. Through assessment of the patient’s mobility and gait, the nurse may opt to give the patient with adequate mobility aids to ensure safety and reduce falls risk. Communication is indeed significant too in the assessment of the patient’s needs. The family may provide the nurse with adequate input regarding the patient’s ability to communicate and comprehend. Through information obtained, the nurse practitioner would gain insights about the patient’s communication and comprehension level and abilities. To help the patient reduce agitation, frustration and anxiety due to impaired comprehension and communication, the nurse may opt to give the patient proper communication tools such as eyeglasses and hearing aids. Evaluation of any episodes of anxiety or frustration, including incidence of aggression toward health care staff would also help in the assessment procedures. Finally, a patient with Alzheimer’s disease and exhibiting signs and symptoms of dementia commonly manifests episodes of wandering or expressed an intention to do so. In this regard, safety of the residential facility is important to keep the patient safe and away from possible harm. Regular visual observation of the patient’s whereabouts and activities is essential. Likewise, the patient needs to be constantly reminded and reoriented of the new environment to avoid confusion and thoughts of wandering. Ensuring the facilities’ gates and doors are always locked and providing patient’s with wrist monitors is a must. Subsequently, reports coming from personal care giver may help in the assessment to prevent any incidences of wandering by patients. Assignment B: Written Analysis of Care Plan Developed Alzheimer’s disease is the most common cause of Dementia (Korvath et al, 1989). Dementia is characterized by a progressive failure of various cerebral functions (Adams and Moyle, 2007) which affects the individual’s memory, attention, language and judgment (Dettmore et al, 2009). In Bill’s case, clinical features and manifestations associated with Dementia were gradually exhibited by the patient throughout 2003. The year after his twin brother died. This incident resulted to so much depression for Bill which later caused him to be confused, forgetful and disoriented. In 2006, he lost continence of urine and later bowel continence also in 2007. From here, he was brought to geriatrics for assessment and he was diagnosed with Alzheimer’s Disease. In Australia, the prevalence rate of people with Dementia is expected to increase significantly over time as a consequence of burgeoning number of ‘baby boomers’ or those who are in the retirement age. Albeit record that shows a small number of people (about 1 percent) with age range of 60-64 who manifests signs of dementia, this increases to about 12 percent by age 80-84. Moreover, a higher percentile rate of about 40 for people aged over 94. Higher prevalence of dementia is likely among women than men in the Australian region. An estimated 40, 000 people with dementia are currently assessed compared to 2002 which projects a nearly 25 percent surge in dementia prevalence (Australian Health Ministers Conference, 2006). Often, long-term care associated with Dementia is very expensive, and serves as an additional financial burden that family of the patient’s need to shoulder (Moyle et al, 2002). In the same way that national government is also concerned with its ageing population due to increasing impact on its expenditure relating to health care of demented people (Australian Health Ministers Conference, 2006) Due to overlapping features of delirium, depression and dementia, the latter cannot be easily identified as it is. Accurate evaluation is important because appropriate treatment to be employed is determined by the patient’s diagnosis. In comparison of the three D’s: Delirium, Depression and Dementia, the following are the significant similarities and differences that might help in the proper evaluation of the nursing practitioner. First, delirium is said to be the most acute of all the 3 D’s. It is a syndrome which is distinguished by symptoms associated with either of the following causes: serious medical condition or withdrawal from a medication. There exists global impairment of cognitive functions similar to dementia. And these imply huge impact on the entire individual’s performance. Second, Depression on the other hand, is referred to as an extreme or prolonged sadness which is treatable. This is typical in older people due to series of losses incurred in this stage such as diminishing functional abilities and skills, memory loss, death in the family, etc. Its cognitive impairment may be similar with Dementia such as forgetfulness, visual and spatial relationship problems, as well as declining executive functioning. Yet, it differs with dementia in the sense that cognitive confusion associated with it is specific rather than global. Lastly, Dementia differs with both delirium and depression because its symptoms aren’t usually reversible. Signs and symptoms manifests in gradual state. Later stage of Dementia results to other cognitive difficulties including aphasia and agnosia (Arnold, 2005). In the case of Bill, he did manifest behaviour changes and cognitive impairment affecting all aspects of his supposed normal functioning after the death of his twin brother. Thus, the impact of the incident is believed to cause him depression as well but with the manifestation of other clinical features of Dementia the condition of the patient is more accurately evaluated as Alzheimer’s Disease. This is the most common cause of Dementia (Korvath et al, 1989; Adams and Moyle, 2007; ACCESS, 2006). After the assessment of the real condition of the patient, the nursing care plan developed will directly target the person’s needs as an Alzheimer’s patient with dementia. Based on literature, there are various approaches to deal with demented people. Person-centred care by Kirtwood (1997), highlights the inner subjective needs of the patients with Dementia, implying their sense of personhood. Other approach deals with the complex roles that interplay among the patient with dementia, the family, and the health and social care givers (Dementia care triads) (Nolan et al, 2004). In this regard, the assessment used in the development of nursing care plan for Bill was a holistic one. For it involves the integration of a variety of aspects taken from the two mentioned approaches. As argued by Adams (2008), there is a need to consider a wider perspective in terms of social, psychological and biological aspects to help establish a better picture of the needs of the patient with Dementia. Based on the nursing care plan, the incontinence of the urine and faecal movement of the patient is included in the assessment, as well as his safety, communication, nutrition, activities of daily living (ADL), and falls risk. All these constitute the needs that a demented individual would convey to his caregiver but could hardly do so because of impaired language or communication skills. Sometimes, aggression is their way of communicating to other people (Dettmore et al, 2009; Mitty and Flores, 2007). Therefore, deep understanding of these needs is a prerequisite to reduce or avoid aggressive tendencies of patients. A holistic approach of intervention also involves the family or the informal caregiver of the patient. In which case, Sylvia, Bill’s wife, is also affected by the turn-out of events. Thus, she also voiced out her need for psychological help and counseling. Intervention for Dementia is not only focus on the patient himself. It also involves the emotional consequences that such illness brings to the family including the financial burden associated with the long term of health care for their affected member of the family (Adams and Moyle, 2007). Education and counseling through peer support is an effective treatment tool for the family (First and Tasman, 2004). In the case of Bill and Sylvia, the latter sought for support from Alzheimer’s Australia Group to gain knowledge and understanding about the disease. By sharing experiences and grief with other people in the same situation would nevertheless help in the process of accepting the reality about his husband’s condition. Yet, she still opted to reside in the same facility as Bill’s for she believes she also needs more care and support and by knowing that being together again albeit the situation, brings her more peace and a positive attitude toward the condition. As stated in the study of First and Tasman (2004), family of the patient with Alzheimer ’s disease is also a victim for they are also affected greatly by the impact of the disease to them in regards emotional burden. Likewise, a holistic approach for intervention is appropriate as a solution for treating the disease. Through this, the patient with dementia or AD and their family are involved in the management of care as this brings strength to them for they could see their role in the care setting positively (Adams and Moyle, 2007). 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