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    Case Study of a Patient Dementia

    Introduction

    A nurse associate is responsible to provide adequate medical care to the dementia patients so that they get optimal well-being. This essay highlights the case of a dementia patient who is suffering from health issues due to sleep disorders, hallucinations and short-term memory loss. Dementia is the deterioration of the cortex region of the brain and cause abnormalities in the sensorimotor cortical regions.  In order to maintain the patient's confidentiality, the patient is named as Mrs. X as per NMC (2018). The responsibilities of a nurse associate are outlined sharply that helps a dementia patient to lead an independent and healthy life with the ability to overcome or face barriers and challenges. Hence, through the implementation of adequate medical care and effective social services, a dementia patient can be encouraged to feel motivated to live a healthy life.       

    Discussion

    Mrs. X is an eighty-four years old woman. She lives with husband and two daughters. Her professional career states that, she used to be a lawyer and enjoyed writing and reading books. Five years ago, she was diagnosed with vascular dementia. Due to this, she faces short-term memory loss, anxiety, depression, and loss of appetite. Mrs. X was suffering from reduced mobility as dementia has significant impact mobility at later stage of her life. The dementia report of 2014 stated, "more than 79.3% of people having dementia feel depressed and anxious” (T O'Brien and Thomas, 2015, pp. 1698). According to the dementia report of 2014, around 34% of all kinds of dementia are expected to occur due to vascular dysfunction. Mrs. X was diagnosed with delirium and that delirium is considered as a co-factor or early detection agent for dementia (Dewing and Dijk, 2016, pp. 107).

    When Mrs. X was admitted to a hospital having extreme urinary tract infection and severe agitation, delirium was diagnosed, as proven by the 4AT screening tool. Due to the disturbed sleep patterns, she used to feel agitated and anxious, which brought a feeling of apprehension and fear. This had a significant impact on the emotional, mental and psychological well-being of Mrs. X. As stated by Alzheimer’s society (2018), dementia is a progressive and long-term condition that destroys the brain cells of the patient. It leads to memory loss and the symptoms are seen to get worse with emerging time (Livingston et al. 2017, pp. 504). Through the development of an effective therapeutic approach, a healthy relationship was built with Mrs. X. Thus, the rationale behind the essay is to evaluate the usual causes of delirium that has affected the well-being of Mrs. X. As Mrs. X faced abnormal drowsiness due to delirium, she showed less eagerness in her interview.

    The case study of Mrs. X revealed the adversities of Dementia like anxiety, short-term memory loss, and its potential impact on the well-being of the patient (Jönsson et al. 2019, pp. 3). Additionally, anxiety and depression have made her secluded from all other social activities. She used to remain confused between the time and place. Due to excessive disruption in the brain functioning, Mrs. X faced communication difficulties. Besides this, Mrs. X also faced reduced mobility. The medical reports of Mrs. X suggest that the progression of vascular dementia has a significant impact on the swallowing function of Mrs. X. Furthermore, this caused severe dehydration and additional weight loss. Thus, Mrs. X was provided with nursing aid so that she can take her regular nutritional intake by getting adequate nutrition support (Kontos et al. 2017, pp. 183).

     The extreme impact of dementia caused Mrs. X to have communication difficulties. Therefore, use of simple words, low voice tone and utilization of verbal cues helped her to decode the information (Fazio et al. 2018, pp. S11). The nurses were given the responsibility to monitor the crucial signs of hourly-basis. This is because due to short-term memory loss or frequent drowsiness, the patients’ skip their medicines. Additionally, she was treated with antibiotics to prevent additional health issues besides dementia (Latham and Brooker 2017, pp. 504). In this regard, diagnostic tests and screening methodologies can help diagnose people with dementia for early detection (Alzheimer's society, 2018).  A nurse must be responsible to support a dementia patient with adequate care. In the case of Mrs. X, the nurse was provided the task to aid Mrs. X with reassurance and empathy. This has also helped her to reduce fears and anxieties. Additionally, the role of the nurse was to promote her autonomy. The code of practice was maintained throughout the treatment phase of Mrs. X so that it can emphasize the best interest to generate effective decisions about the care of patients. A calm environment was given to Mrs. X so that she gets a peaceful sleep by avoiding noise (Corey 2017, pp. 575). Additionally, a pressure mattress was given to Mrs. X so that she can avoid pressure sores. Moreover, the integrity of the pressure skin was maintained in Mrs. X, as she was vulnerable to excessive illness due to poor nutritional intake. The role of the nurse was to carry out a urine dip stick to identify UTIs. Effective communication was done with Mrs. X so that the nurse can understand her problem effectively. Moreover, the nurse performed an effective role in maintaining the well-being of Mrs. X through continuous monitoring and hourly observations of her vital signs. This will help the physicians to monitor her health progress. Furthermore, the tasks of the nurse were to check her well-being to make sure that Mrs. X remained well-nourished, hydrated and sufficiently oxygenated, so that episodes of delirium were reduced. Additionally, the nurse associate was provided the responsibility to record fluid and food balance charts. Assessment of nutritional dietary intake acts to be an efficient intervention in dementia patients because lack of coordination between neurons affects their senses of hunger (Jones et al. 2016, pp. 280). Furthermore, the nurse associate assisted the dieticians with the regular monitoring reports so that an accurate nutritional balance is developed and the nurse associate can provide on-time nutritional content to Mrs. X.   As Mrs. X was suffering from malnutrition (as evident from case study), it was necessary to monitor her diet charts to keep her healthy. Besides all these, the nurse associate was given the responsibility to monitor MUST (Malnutrition Universal Screening Tool) and Waterloo scale, and care plan was evaluated weekly. In comparison to this, intervention is a necessary element that will support the meal choices, drinking and eating habits of people suffering from dementia (Surr et al. 2016, pp. 145).                       

    Several assisted activities were provided to Mrs. X so that she can lead her daily live independently. Numerous new symptoms restlessness, moaning, etc. came into effect due to the severe impact of delirium (Latham and Brooker 2017, pp. 506). This was difficult for Mrs. X and her family to cope with the situation. Personal centered care plan and discharge planning were designed based on the medical background and history. The alignment with effective medical care, provision of care package was formulated that supports Mrs. X’s daily activities at her home. Occupational therapists and physiotherapists encouraged Mrs. X’s behavior so that she becomes independent to carry out her daily exercises and other activities. This enhanced her confidence and she started to carry out her daily activities of living independently. Additionally, NHS England (2012) outlined the significance of supporting patients to re-gain their independence. A MTD (Multidisciplinary team) involved Mrs. X to plan her care and to highlight the importance of efficient delirium management. Additionally, health care promotional events have proven to be helpful for both Mrs. X and her husband to deal with a happy and healthy life. Thus, it helped to raise awareness regarding dehydration and UTIs. Mrs. X was able to eat and drink efficiently, which improved her nutrition intake. Mr. X was involved in numerous therapeutic activities and enjoyed listening to her favorite music. This enhanced her stimulation to live life happily, thereby reducing depression. Social services evaluated the potential needs for Mrs. X and numerous local authorities collaborated to meet the demands of her emotional, social and financial needs to promote independnce. The voluntary services that were provided to Mrs. X made her feel listened to and valued by other individuals.  Hence, it had a positive impact on her mental health and well-being.                   

    Conclusion

    This essay has explored dementia and the impact of a UTI on dementia patients and the competency of the nurse associates to carry out their responsibilities efficiently. From the study, it is evident that Mrs. X is suffering from dementia for the past five years. Due to this, she has faced hallucination, memory loss, and other health issues. In this phase, a nurse associate must develop effective communication with a dementia patient so that she can express her needs through verbal cues, simple words and other means of communication. Thus, the importance of nurse associates to impose effective strategies will help a dementia patient to lead a happy, independent healthy life.    

     

     

    References

    Alzheimer's society (2018) Dementia UK: The full report. London: Alzheimer’s Society

    Corey, T, (2017). Genetic and environment factor associated with delirium severity in older adults with dementia: International journal of Geriatrics psychiatry. Vol. 32(5), pp,574-581.

    Dewing, J. and Dijk, S., (2016). What is the current state of care for older people with dementia in general hospitals? A literature review. Dementia15(1), pp.106-124.

    Fazio, S., Pace, D., Flinner, J. and Kallmyer, B., (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist58(suppl_1), pp. S10-S19.

    T O'Brien, J. and Thomas, A., 2015. Vascular dementia. The Lancet386(10004), pp.1698-1706.

    Jones, L., Candy, B., Davis, S., Elliott, M., Gola, A., Harrington, J., Kupeli, N., Lord, K., Moore, K., Scott, S. and Vickerstaff, V., (2016). Development of a model for integrated care at the end of life in advanced dementia: a whole systems UK-wide approach. Palliative medicine30(3), pp.279-295.

    Jönsson, K.E., Ornstein, K., Christensen, J. and Eriksson, J., (2019), June. A reminder system for independence in dementia care: a case study in an assisted living facility. In Proceedings of the 12th ACM International Conference on PErvasive Technologies Related to Assistive Environments (pp. 176-185). ACM.

    Kontos, P., Miller, K.L. and Kontos, A.P., (2017). Relational citizenship: supporting embodied selfhood and relationality in dementia care. Sociology of Health & Illness39(2), pp.182-198.

    Latham, I. and Brooker, D., (2017). Reducing anti-psychotic prescribing for care home residents with dementia. Nurse Prescribing15(10), pp.504-511.

    Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S.G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J. and Cooper, C., (2017). Dementia prevention, intervention, and care. The Lancet390(10113), pp.2673-2734.

    NHS England (2012). 6Cs of Nursing Standards. British Medical Journal. Accessed December 2011, Vol. 343.

    Nursing and Midwifery Council (NMC, 2018). The Code. London: Nursing and Midwifery Council.

    Surr, C.A., Smith, S.J., Crossland, J. and Robins, J., 2016. Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study. International journal of nursing studies53, pp.144-151.

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