Providing Nursing Care for Patients with Dementia - Case Study Example

Case Study: Clinical Reasoning Client Report Student’s Name: Course Code and Name: University: Date Assignment is due: Part A One of the issues that are a priority for Mrs. Archer in terms of providing nursing care is dementia. It is important for patients with dementia to receive nursing care owing to the adverse effects that the condition has on their health and functioning. According to the information provided on Mrs. Archer, the dementia has already affected other areas of her life causing a chain reaction of effects to follow this. According to Amella (2007, p. 1) older patients who are suffering from dementia have a higher likelihood of losing their abilities to take care of their selves including self feeding, which results in inadequate intake of fluids and food. Consequently, the patient is likely to suffer from malnutrition, delirium, skin breakdown and dehydration (Amealla 2007, p. 1). Mrs. Archer had paper thin skin, pulls back on her walking frame and was not eating well indicating that her dementia was getting worse. One of the best practices that have been identified is for the patient to receive individualized care provided by a certified nursing assistant. Nursing care is therefore a good idea in Mrs. Archer’s case. People with dementia have a higher vulnerability to negative outcome in life quality and health. Medicines Advisory Committee (2007, p. 1) point out that these vulnerability issues can be averted if the patients receive appropriate nursing care. This is because nursing practitioners will be in a better position to access and use facilities available to them to care for Mrs. Archer as opposed to her daughter. Older individuals with dementia need to be provided with care of the highest quality that is informed by research (Fletcher 2012). Professional nurses have access to this information and they can use it effectively. Receiving nursing care will ensure that Mrs. Archer receives holistic care that will care for her ADLs (activities of daily living) as well as her behavioral and psychiatric symptoms (Fletcher 2012). ADLs are constituent of physiological needs such as drinking, eating, hygiene and going to the toilet. While Mrs. Archer’s daughter may have been able to help her mother to do most of her ADLs, psychological needs and problems are more complicated and so are the ways of managing them. Another issue that should be given priority for Mrs. Archer is the frequent urinary tract infections (UTIs). UTIs are among the most common causes for hospitalization due to infectious diseases. This is more severe in individuals who are over the age of 65 (Juthani-Mehta 2009, p. 2). As such, it is important for an individual with this condition recurring to get nursing care. It is also costlier and more resource intensive while treating. Nursing care would be more appropriate so as to avoid the recurrence of the UTI and quick treatment in case there is an infection. There is a very high possibility that Mrs. Archer will get UTIs. In older women, it is associated with declining levels of oestrogen (Juthani-Mehta 2009, p. 2). The fact That Mrs. Archer has not been taking enough liquids also puts her at risk. Thus, it would be better if she were under nursing care to help in focusing the care she is receiving on prevention. Older women have a relatively higher risk owing to combinations of factors including insufficient intake of fluids. In addition, when the patient also has back pain, there is an increased probability that they have UUTI (upper urinary tract infection). Mrs. Archer has been displaying symptoms that are similar to this since her daughter reported that she tends to pull back on her walking frame and, she is also unsteady on her feet. This indicates that she has back pain. Research shows that UTIs are the cause of septicaemia in older individuals and, it has an 80% mortality rate for these individuals (Juthani-Mehta 2009, p. 2). It is important for Mrs. Archer to receive care from a trained healthcare practitioner who will assist her in case of an emergency and prevent further progression. Trained professionals will be in a better position to identify symptoms associated with UTIs. It is a great challenge to diagnose UTI older individuals because most of the common symptoms and signs are absent. According to the Medicine Advisory Committee of Oxford Radcliffe Hospitals, older individuals present symptoms such as decreased mobility (Juthani-Mehta 2009, p. 2). Mrs. Archer’s daughter reported that she has been having issues when walking and her frame is altered when she walks. This indicates that the older woman needs to be taken care of by a professional because her symptoms are beyond what her daughter can manage when caring for her at home. Part B Goals, actions and interventions The goal in the case of dementia is to ensure that Mrs. Archer gets treatment and care that will enable her to live a relatively high quality of life. Another goal is to ensure that she has someone there to help her with her eating and her diet to combat the issues with her skin and associated conditions (Fletcher 2012). Some of the strategies/actions that can be used to achieve these goals include monitoring the patient to get knowledge on the potential side effects as well as effectiveness of the medication given to them for dementia (Amella 2004, p. 607-623). In addition, nursing care will provide the patient with appropriate techniques that will enhance their cognitive functions and actions in social engagement. Adequate rest, comfort measures, fluids, pain control and sleep will be ensured. Pharmacologic and physical restraints will not be avoided and functional capacity will be maximized as much as it can be. Assistance with ADL will be given in a graded manner (Fletcher 2012). Toileting schedules will be made to help the patient in sticking to the times set for ADLs. Behavioral issues that may be triggering actions by the patient will be made; these are meant to reassure the patient. Eating is an issue with the patient and certain actions will be taken to ensure that she eats more and effectively. Distractions should be reduced to enhance eating. Distractions include the television or being in a room that people keep leaving and entering. The patient should eat while out of bed as much as possible because comfort and posture will be promoted. Use verbal reassurances and words to encourage the patient to eat such as ‘eat’, ‘swallow’. This can be enhanced by motions. Motions of eating will encourage the patient to try and eat as well. These actions will be evaluated by looking at a number of outcomes that encompass the patient, the caregiver/nurse and the institution Mrs. Archer will be associated with. In terms of the patient outcome, the patient should be as functional and as independent as they can be within the context of their lives only if for they possibly can. Complete dependency on others should be postponed. The comorbid conditions the patient may have experienced should be managed effectively. Since Mrs. Archer is old, any of the symptoms of distress, the sick person may experience mainly at the end of life should be controlled or minimized efficiently. The caregiver should be able to access as well as use resources obtainable to them effectively. In addition, they will show that they are able to give care sufficiently and they will have reported few burdens in their care giving endeavors (Fletcher 2012). The caregiver will also be evaluated by their knowledge of resources available to them such as research work. In addition, the nurse should display the capability to be flexible to the wants of the patient. This is especially so with the eating behavior as well as general demeanor. The institution should be able to provide the patient with a welcoming and enabling context. Eating will be evaluated by monitoring if the patient is increasing the volumes of food intake and if their health is improving. In terms of the UTI, the goal would be to ensure that the current infection is treated effectively and completely (symptoms relieved and infection eradicated). In addition, preventive measures should be taken to avoid recurrence and complications. Actions taken include giving the patient medication which will include antibiotics like Trimethoprim, which is given for three days. Analgesia can be considered for the back pain and in order o help the patient in improving her walking (Medicines Advisory Committee 2007, p. 1). Other actions suggested by research include older patients carrying out a urinary dipstick for the purpose of evaluation. Since there is a high chance that Mrs. Archer may have a UTI because of the numerous risk factors, the evaluation will help in monitoring to know if there is a recurrence. This is useful especially since visible symptoms are rare in adults. Mrs. Archer needs more fluids in her body to help her in preventing the UTI from recurring (Medicines Advisory Committee 2007, p. 1). Consequently, another action taken would be to increase the patient’s fluid intake. These actions will be evaluated by checking to see if the symptoms have been relieved and the infections have been eradicated. In addition, the complications and recurrence should have been prevented. One can check to see if there are more recurrences which will shed light on whether the prevention strategies and actions that have been taken are working. List of References Amella, EJ 2007, Eating and Feeding Issues in Older Adults with Dementia: Part II: Interventions, Issue 11.2, viewed 31 August 2012, http://consultgerirn.org/uploads/File/trythis/try_this_d11_2.pdf. Amella, E. J 2004, Feeding and hydration issues for older adults with dementia. In M. Mezey, E. Capezuti, & T. Fulmer (Eds.), Care of Older Adults: Nursing Clinics of North America, vol. 39, no. 3, pp. 607-623 Fletcher, K 2012, Dementia Nursing Standard of Practice Protocol: Recognition and Management of Dementia, Hartford Institute for Geriatric Nursing, viewed 31 August 2012, http://consultgerirn.org/topics/dementia/want_to_know_more. Juthani-Mehta, M 2009, Chapter 32: Urinary Tract Infections in Elderly Persons, American Society of Nephrology, viewed 31 August 2012, http://www.asn-online.org/education_and_meetings/distancelearning/curricula/geriatrics/Chapter32.pdf. Medicines Advisory Committee 2007, Treatment of Urinary Tract Infections in the Older Person, Oxford Radcliffe Hospitals, vol. 4, no. 11 viewed 31 August 2012, http://weblearn.ox.ac.uk/site/medsci/undergrad/medicine/year4/threads/therape/therap/theraptools/UTI%20treatment%20in%20the%20older%20person.pdf. Read More