Nutritional Support for Patients with Advanced/End-Stage Dementia - Essay Example

NUTRITIONAL SUPPORT FOR PATIENTS WITH ADVANCED/END STAGE DEMENTIA INTRODUCTION The essence of this essay is to address the role ofthe nurse in the nutritional care for patients with advanced dementia. The essay will start be giving a background of dementia as a health condition before analyzing a case presented in the study. Dementia is one of the single most critical health complications that can bedevil a human being. Patients with advanced or end death stage dementia are the most delicate in the sense that balancing between their nutritional wellbeing and their health is a tricky affair. One of the single most critical issues that people with dementia have to deal with that has to do with the feeding of the patients. Care of dementia patients is of essence while taking into consideration about their nutritional wellbeing. Malnutrition is a problem that face dementia patients. However, it should be noted that refusing to eat is part of the disease problem; hence the malnutrition might be expected to some degree. In a number of health facilities, doctors use the tubes to help feed the patients. The tubes are used to ease the eating process. Burns notes that when the patients do not eat, the final analysis becomes the problem of malnutrition (Burns & Winblad, 2006 p. 205). Malnutrition is one of the single most critical problems that patients with dementia have to contend with. A number of researches have been carried out to establish the usefulness of tubes in providing nutrition to the patients (National Collaborating Centre for Acute Care, 2006). To some extent, the tubes are helpful, but the patient sometimes must take up a personal initiative to eat some food to ensure that the problem of malnutrition is dealt with appropriately. Glaucia states that soar found in the mouth prove to be a serious challenge to the dementia patients (Glaucia et al. 2012 p. 12). Nurses are a great resource for patients with dementia. Case in point is that patients with dementia require constant health care to the extent that someone has to be available to ensure that the necessary role is provided. The effort and dedication of nurses in taking care of patients with dementia cannot be over emphasized. BACKGROUND Burns notes that dementia affects parts the brain, resulting in cognitive impairment (Burns & Winblad, 2006). Some of the features of dementia include memory loss and communication problems. Dementia is more likely in the older people that those in their young age (Amella 2004, p. 16). Dementia patients have problems of oral hygiene that potentially bring about soars in the mouth (The Royal College of Physicians 2010, p. 45). Due to malnutrition, dementia patients become underweight due to the fact they are not able to consume their foods (Faull et al. 2012, p. 23). Dementia patients do not eat or drink for a number of reasons. Case in point is that dementia patients are sometimes not able to talk and in this sense one cannot know if they are thirsty or angry. On the other hand, depression can cause a dementia patient to loss of appetite (Korczyn et al 2009, p. 12). During the late stage dementia, patients are largely dependent on nursing care. Dementia patients in late stage begin to get frail and become unsteady while walking. On the final analysis the patient gets confined to a bed or a support item such as a wheel chair (Korczyn et al 2009, p. 12). At the late stage, dementia patients have a problem with eating and to some extent find it difficult to swallow (Faull et al 2012, p. 23). Dementia patients in late stage also have a problem with weight loss. On the other hand, incontinence and loss of speech in a gradual manner are some of the problems faced by dementia patients at a later stage (Korczyn et al. 2009, p. 89). CASE STUDY A 79-year-old Singa Love (pseudonym- for confidentiality (NMC 2008) was diagnosed with a severe dementia and was admitted due to a fall. The staff at the nursing home where she resided reported that Ms Love’s mobility continued to deteriorate with countless chest and urinary tract infection (UTI), significant weight lost due to reduced appetite and refusal to eat. The severe nature of her case increased her risk of malnutrition. While in the hospital, Ms. Love refused to eat or drink and this worsened her malnutrition status. During her time of admission, she had a ‘This is me’ document that revealed a brief history about her. The document revealed that. Ms Love did not like the idea of being fed using spoons neither did she like foods that are chewable and she enjoys listening to music as she have her meals, and so was provided with a small radio. She managed to eat one or two spoonful while listening to music, but would refuse any form of fluids. Subcutaneous infusion (SI) was administered to keep her hydrated. Every time the nurses inserted the SI, she removed. Ms. Love had a one-to-one healthcare assistant to stop her from harming herself while pulling out the SI device. The multidisciplinary team (MDT) decided she was for palliation.  ANALYSIS The initial assessment was complex and was undertaken by the nurse. Of all the necessary initial assessments taken and recorded, malnutrition flagged out. The ‘Malnutrition Universal Screening Tool’ (MUST) (Pender 2009, p. 268) was appropriated to assess her level of malnutrition. MUST is a screening tool to identify adults who are at low to high risk malnutrition and who are malnourished (Pender 2009, p. 268), consequently aiding appropriate plan of care. MUST is a five-step tool which includes (Pender 2009, p. 268): step 1 - height, weight and ‘Body Mass Index’ BMI, scoring from 0-2. However, the score of zero (BMI >20 (> 30 obese) does not rule out malnutrition, as BMI > 30 is obese. Ms Love scored 2 as her BMI was below 18.5. Step 2 and 3 measured respectively, unplanned weight loss and weight loss due to acute illness/disease. Step 4 sums up the overall risk of malnutrition and step 5 provide appropriate management. Chest problems and UTI can cause confusion tendencies in dementia patients such as in the case of Ms. Love (Burton 2010, p. 156). Patients with dementia are bound to have symptoms coming up on short notices. Under these circumstances, there is need to have a professional who is quite able to note the various symptoms and take appropriate action. This can only happen when there is a person designated to perform such an action. Hughes notes that loss of appetite is another problem that faces the dementia patients (Hughes et al, 2010 p. 45). Loss of appetite is one of the single most root causes of malnutrition. In the case of Ms Love, it was reported that she was not able to eat her food at some point and eventually loses the desire to eat. Lack of desire to eat was as a result of bad oral hygiene together with the soars that proved to be painful. This lowered significantly the desire to eat. Some of the oral problems that dementia patients can experience include gum complications and decay. These problems can be dealt with by ensuring that proper dental care is ensured. The nurse was to aid the patient brush her death as appropriate to reduce oral disorder. Even though eating may be a problem under the circumstances provided, it is critical that fluid materials are consumed. Fluids act as nutritional alternatives, especially when the patients find discomfort in eating due to loss of appetite (The Royal College of Physicians 2010, p. 45). Food supplements may also be necessary. Palliation care to a large extent ensures that the life of the patient is improved (Faull 2012, p. 13). For Ms Love, her problem had already become dire and needed close examination and overseeing. The multidisciplinary team (MDT) came up with a decision to ensure that the patient had direct a one on one care at all times. (Holzmueller & Pronovost 2012). The role of the nurse as advocate come to play as nurses are likely to know their patients well (Martin & Sabbagh 2010), as they spend a considerable amount of time with them (Martin & Sabbagh 2010). The decision by the team was the most appropriate at the time. Palliative care was the best under the given circumstances due to the patient’s condition. The patient was mul-nutritioned with varied complications ranging from UTI to chest problems; hence, needed close care to ensure quality life. The decision to put the patient under one on one care was one of the most critical decisions made by the team. Palliation care that was proposed by the team was best for the situation at that time. The nature of this care required highly specialized personnel who could handle the professionally (Martin & Sabbagh, 2010 p. 13). A dementia case that is advanced cannot be left for new recruits or people with less experience to handle the case. The patient in her case required well-trained personnel to make sure that she is kept at bay insofar as her behaviors were concerned. Consequently, the skilled person who was to care for the patient would appropriately return the SI in the event that it was pulled off. Moreover, the patient could have been explained to the dangers of pulling the SI midstream when medication was in progress (Martin & Sabbagh, 2010 p. 56). The decision to have the patient under palliative care involved a number of issues (Faull 2012, p. 34). Case in point is that the decision was to include the patient, the medical practitioners, together with the members of the family. The patient’s sister was taken through the essence of the decision made and the various implications of the program. This provided a baseline for coming up with a conclusive decision. This was to ensure that everyone played an active role in ensuring that the patient received the much-needed care. Consequently, when there are professionals present, treatment is made effective (The Royal College of Physicians 2010, p. 45). The doctor is able to give some expert opinion on some of the most critical issues. The doctor also helps in providing expert opinion to the team based how best treatment is to take place. The decision by the team to offer palliation care of the team was the most well thought program (National Collaborating Centre for Acute Care 2006, p. 12). CHANGE IN FOCUS OF CARE Palliative care is where medical practitioners have to give care to patients who have critical health complications (Gillick 2000). The decision to employ palliative care was established when it was noted that her complication was end-stage dementia. There are a number of features related to the end stage dementia. Drowsiness, memory loss, confusion and bladder problems are some the features of end stage dementia. Swallowing is a problem for dementia patients and the condition is referred dysphagia (Stratton & Elia 2007, p. 12). For instance, it was found out that she could sometimes remove the SI (Stratton & Elia 2007, p. 12). The patient was mul-nutritioned and some necessary mealtime interventions need to be instituted. As mealtime intervention measures, there should be less destruction, serving one food at a time, helping the patient to eat while out of the bed and lastly encourages the patient to eat through own intervention (Philip et al 2011, p. 313). It is for this reason that palliative care was introduced. The role of the nurse at this stage of care was to minimize discomfort, maintain dignity, ensure safety, prevent falls, and encourage oral food and fluid intake to improve quality of life (Simmons, 2010 p. 15). The team should have focused on both sides or give each treatment prominence. It should however be noted that both of the areas needed equal concentration. Dementia at the advanced stage requires that every part be treated as equally important. For instance, the palliation care as it is known provides a collectivized care to the patient. In this case it requires that everyone who is supposed to take some part is involved. Tubes have been found to be very effective to some extent in providing health care to dementia patients. Medical practitioners have argued that have argued that providing nutritional foods to the patients is critical to the point that it should be given much prominence (National Collaborating Centre for Acute Care, 2006 p. 25). Malnutrition and dehydration affect so much the patients with dementia. Health professionals have always insisted that there should be hydration procedures together with programs that ensure that there is nutritional balance of the patients (Prince et al, 2014 p. 11). The error could have been corrected from the outset. The team should have introduced other means and ways through which different nutritious foods could have been introduced into the care pattern to ensure that the patient was well taken care of (Prince et al, 2014 p. 11). Some of the nurses were not well conversant with the mealtime care for patients for dementia patients and most instances; it was a gamble as to the food to give to the patient. In this case, the team could have provided the best scenario to ensure that the patient receives the best necessary care. Soft nutritious foods should be introduced during the meal time. Consequently, nutritious fluids should have been introduced as an alternative to food in different occasions. It is expected that the team should have realized the error of omission and acted appropriately to the issue. Care was also necessary to ensure that there was some bare maximum achieved (Sachs 2004 p. 10). MAINTAINING SAFETY One of the nursing roles was maintenance for safety. Some of the safety measures necessary include proper arrangement of furniture, ensuring that hot things are out of reach, sharp objects be stored in cupboards and ensuring that drugs are well kept (Volicer 2005, p. 20). The revelations that Ms Love used to remove the SI were a serious breach of her safety. It was critical that some safety be maintained around the patient to ensure that Ms Love was secure. The SI can be very dangerous when not handled with proper care, as it is required. The palliation care was meant to correct the unfortunate issue. In the event that Ms Love was put under 24/7 surveillance, it would have been possible to check on her as appropriate to ensure that she did not remove the SI (Volicer 2005, p. 20). Delirium is a confusional condition caused by UTI. For this condition, Ms. Love was given antibiotics and some pain relievers to help her out of the condition. This in turn would help the confusional state. An intervention for fall protocol was dealt with by ensuring that the patient was supported every time to help her gain her balance. Ms Love, at her age and due to her medical condition, an element of weakness was expected. It, therefore, required that she was to be cared for at all instances. The safety of every patient is of the essence (Zhu & Zhou 2014, p. 165). NURSING ROLES The role of a nurse in taking care of dementia patients is very critical. Hughes notes that patients with dementia require nurses almost all the time to ensure patient safety, maintain dignity, deliver high standard care and help improve normality (Hughes et al, 2010 p. 32). To ensure that the patient’s nutrition was improved, the nurses were to ensure that nutritious fluids and soft foods were provided at during the meal times and at different intervals within the day. Walsh notes that it is critical for dementia patients attain healthcare when at home (Walsh 2006, p. 67). The nurse can be able to educate and provide evidential research to the members of the family of the patient. This is important because it provides the family members with information that could help in taking care of the patient while at home (Walsh 2006, p. 21). On the other hand, the nurse’s intervention could help in providing insights for decision-making. Nurses are well equipped and highly skilled in assessing and identifying psychosocial needs (The Royal College of Physicians 2010, p. 20). It is well known that depression is prevalent in people with dementia (Agronin 2008, p34). Another role the nurses assumed was holistically assessing the patient, identifying depression amongst others and Ms Love was treated as appropriate. The nurses also provide the patient with emotional support (Walsh 2006, p. 67) to help motivate the patient in order to restore her self-esteem. FINAL ANALYSIS By the time of winding up the nursing role during the palliative care, the all the nurses had gained significant knowledge, especially on how to deal with dementia patients (Sachs 2004, p. 30). One of the things that were learned during this process was to identify nutritious foods for the dementia patients. Fluids were also found to be an important nutritional source for the patients. The best aspects about the care were that the patient was very cooperative and gave the practitioners easy time to attend to her. The nurses through their professional knowledge correctly determined that the patient’s case was at an advanced stage. It was a prudent idea to treat the patient at the nursing home because it would be possible for the medics to attend to her as and when it is necessary. Over and above, the treatment the patient got was above board and it is recommended that anyone who is at an advanced stage should seek palliative care in a nursing home as an alternative to receiving proper medical care (Martin & Sabbagh 2010). CONCLUSION The health care issues that surround dementia patients cannot be over emphasized. Dementia patients are often less able to operate actively and therefore, requires constant help to enable them operate normally. There are a number of care practices that can be invoked to help the patients get quality life. Palliation is an important care system that requires that patients be put under constant monitoring. This monitoring requires a team of palliation personnel not to mention medical specialists. Dementia patients require palliation to enhance the quality of their life. Even though palliation care maybe necessary, the nutritional wellbeing of the patients should not be underestimated. Consequently, the role of nurses in providing care should be noted as essential. BIBLIOGRAPHIES: Agronin, M. E., & Agronin, M. E. (2008). Alzheimer disease and other dementias: A practical guide. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Amella E J. (2004). Feeding and hydration issues for older adults with dementia. 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