Palliative Care in Dementia - Coursework Example

Running Head: Nursing in the Old Palliative Care in Dementia Name Institution Date Dementia is neurodegenerative but constantly progressing disease that tend to lower the survival of the affected patiet.Patients with dementia lack the ability to communicate effectively, they are also limited or enable to conduct daily living activities and meeting of their personal needs. The patients are therefore reliant on the care givers in terms of receiving care to meet their needs. Palliative care would entail the giving of total care to the patients who are having dementia that is now not responsive to the treatment that is being given. The goal of palliative care is to achieve quality as well as better life for both the patient and their respective families (Miller et al, 2005). The older people in the society need care as much as the other people in the society. The patients who have dementia would specifically require to receive quality care when they are dying. Palliative care that is available to this patients and the natural history of the advanced form of the disease also being limited. This is because most of the dementia patients tend to be admitted as an unplanned emergency to the acute hospital and hence most of them would tend to pass away just below the sixth month. The patients with dementia require complex needs and most of the times would lack the general capacity to make their wishes in terms of care to be known to the acre givers (Mitchell et al, 2004). There are various designs or methods which have been designed to help in giving quality care to dementia patients. This interventions are formulated basing on the complex intervention framework which gives a bottom up approach in the development of interventions for the patients that are having advanced dementia .in this intervention, the care givers aim is to be able to have a good definition of the end of life care for both the patient and also the one who is going to provide the care, be able to have a palliative care intervention in mind which will be effected and finally to be able to come up with a frame work to be used in planning of advanced care for the patients (Hamel et al, 2004). Palliative care would entail the management of pain and symptom relief. Dementia is a neurodegenerative disease and is characterized by pain. The pain increases with the increase of in the severity of the disease inquiry by asking the patient to rate the pain from one to ten or simply the patient will use an equivalent analog to be able to show the severity of the pain he or she is experiencing. The dementia patients tend to have pain and thus the control of pain to tolerable levels will be of importance. The pain must be assessed for frequently and this will involve conducting a direct the intensity of the pain will be assessed when the mini mental state exam is conducted. The assessment of pain will require one to have assessment skills for pain and also the knowledge of the therapeutic approaches. The patients are managed for pain following the three opioids step hierarchy for drugs that relieve pain. The use of drugs would range from non opioids such as aspirin or paracetamol, the mild opioids such as codeine and finally the use of strong opioids such as morphine. The non pharmacological management methods for pain would include massage especially in an anxious patient or one who has heads aches. The application of heat and cold could also be used especially when one has muscle spams.The patient will also be encouraged to meditate or have other relaxation techniques to help in the management of the pain (Mitchell et al, 2004). People with advanced dementia are more predisposed to getting infections more easily. This is because their immunity is greatly impared and also due to their immobility. This makes them to be more prone especially to intercurrent infections. Pneumonia still remains the top most infection to those who have dementia. The use of antibiotics is thus recommended in the management of the infections. The difficulty in swallowing and the incontinence will greatly predispose them to respiratory tract infections and urinary tract infections respectively. The use of antibiotics will be mainly targeted at reducing the circulating proteins that would normally lead to the worsening of dementia by enhancing rapid progression of the disease. The presence of infections simply causes worsens the severity of the disease in dementia patients (Shega et al, 2003). Artificial nutrition rehydration is essential in dementia patients because they would have problems with feeding. The worsening progresses even more with the severity of the disease. In dementia the patients tend to have a loss of appetite and also lack the enjoyment of food. They would also exhibit the loss of the feeling and experience for hubnger.They also have dyspraxia and sequencing problems and thus there will be need for them to be on a routine of regular meals. They also tend to exhibit swallowing problems and hence they are more predisposed to develop aspiration pneumonia. This risk for aspiration pneumonia is eliminated through the use of the percutaneous endoscopic gastrostomy tubes .the feeding will end up preventing malnutrition among the patients with dementia .the risks of infection is also lowered by the use of the percutaneous endoscopic gastrostomy tubes while feeding. The feeding will generally slow down the progression of dementia due to it boosting the immunity of the dementia patient from acquiring intercurrent infections (Morris, 2001). In some cases cardiopulmonary resuscitation is necessary in patients with dementia especially in the end stage of the disease. Cardiopulmonary resuscitation is conducted in the patients who are frail and rare compromised. The cardiopulmonary resuscitation will employ the use of the ABC’s which includes (airway ,breathing ,circulation)in the airway one would check whether the patient has a patent airway and if the airways are obstructed, the obstruction element is removed from the airway. The clearance for the blocked airway is done by performing a head tilt or a jaw thrust and clearance of the removal of the blocking agent or material is done. Breathing would involve the use of mouth to mouth breathing. Circulation would be enhanced by the starting of chest compressions while conducting resuscitation procedure. The compression of the chest creates a positive pressure inside the chest and the oxygenated blood will be pushed through the arteries to the brain and other body organs. And when one releases, the blood is forced into the veins from the heart. The resuscitation is only done after the surrogates give a go ahead for the process to be carried out since it usually a painful process and not many of the patients make it out alive after it has been done then they would be denied the chance of a dignified death of their patient (Campbell et al, 2004). Psychological and behavioral symptoms that the dementia patient exhibits will require day to day care of the patient. They could exhibit agitation, they will also seem to be wandering and having inappropriate sexual behaviours.They could also present with delusions, depression or even hallucinations. The plan of care is made after taking a comprehensive history and being able to identify any derangements in the patient and this will involve the identification of the behavioral and psychological symptoms with their frequency as well as their severity and impact they will have on the patient. This will be mainly centered on the decreasing of the psychological or behavioral symptoms (Campbell et al, 2004). The management of this could either be pharmacological or non pharmacological. The pharmarmacological interventions will involve the use of the drugs such as the selective serotonin reuptake inhibitors which are safe and effective as well. In some patients however the placebos can also be applied.choleneterases as well as neuroepileptics such as carbamazepine could also be used in the management of the symptoms. A stroke prophylaxis should also be instituted especially for the patients who have vascular and mixed dementias (Campbell et al, 2004). Non pharmacological interventions will mainly have an aim of rechanneling the behavior or altering the consequences of problems behavior disorder which have been identified. The non pharmacological management is mainly useful in the patients who have moderate dementia. The non pharmacological management will include sessions of music therapy, the provision of bright lighting .this patients would also require help in their carrying out of daily activities such as dressing, feeding, bathing, bladder and bowel emptying. On the other hand, Spiritual care will provide an internal resource that will enable the patient to be able to sustain and be able to motivate the patient in the period of having the illness (Mitchell et al, 2004). In conclusion, many decisions concerning the care of the patient with dementia will be mainly made by the surrogates due to the patients having dementia not having the capacity to demand for the kind of care they would like to be given to them. The care given to the dementia patients should therefore be holistic ,and should have longevity in that the care should be able to cover the entire lifespan of the dementia patient or until the patient has a dignified death (Hamel et al, 2004). References Miller SC. et al, (2005).A national study of the location of death for older persons with dementia, J Am Geriatr Soc. Mitchell SL et al, (2004). Terminal care for persons with advanced dementia in the nursing home and home care settings, Journal of Palliative Medicine. Hamel MB et al, (2004).Dying with advanced dementia in the nursing home, Arch Intern Med. Shega JW et al, (2003). Palliative Excellence in Alzheimer Care Efforts (PEACE) , a program description, Journal of Palliative Medicine. Bunch TJ et al, (2004). Impact of age on long-term survival and quality of life following our-of hospital cardiac arrest, Critical Care Medicine. Campbell ML et al, (2004). A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia,Care Med. Morris J, (2001). Nutritional management of individuals with Alzheimer's disease and other progressive dementias, Nutrition in Clinical Care Read More