CASE STUDY RESIDENT WITH SENILE DEMENTIA

Transcription

1 CASE STUDY RESIDENT WITH SENILE DEMENTIA INFORMATION COLLECTION Mr. Frank Miller, 72 years old Occupation: Has recently worked for the building authority Social situation: widowed, recently he lived with a partner She is now 68 years old and visits Mr. Miller regularly. History: Mr. Miller was already several times in the geriatric psychiatry clinic, he has been suffering from Alzheimer's disease for 8 years. The disease began with memory loss and withdrawal tendencies. From the transition report you get the following information: At the last admission, the disease was at an advanced stage with disorientation, he is disoriented towards time, place, and person and he jumps in the times. Mr. Miller was responsible for structural damage at the building authority. This is still reflected today in his behavior. It is often observed, that he monitors the structural conditions and rants about possible structural damage and botched work. His mood fluctuates greatly. Mr. Miller was already married once. His first wife has been dead for 15 years. There is a son and a daughter from his first marriage. But there is no contact to the two children since Mr. Miller has found his new partner in life. The late wife is buried on the cemetery near the institution. Mr. Miller shows tendency to run away, then he often can be found at the grave of his late wife. He shows psychomotoric restlessness and activity, can hardly sit still and focus on something. Mr. Miller has memory impairments. He can not remember, for example, to have eaten shortly after breakfast. According to the stories of his partner, Mr. Miller was a funny person and liked playing the harmonica and accordion with friends. Mr. Miller spent many vacations with his partner in the area of Germany in recent years. He is very close to nature and always worked in the garden and house. Current nursing situation: The resident is dependent in the activities of daily living and needs support especially in personal hygiene. During washing Mr. Miller has developed stereotypical washing movements lasting for several minutes. The sequence of personal hygiene is not known. Also, the sequence of dressing does not make sense. He is unable to put in the denture independently, he can not handle the adhesive cream, but needs it, because otherwise the denture is loose. Mr. Miller also needs support in shaving, he does not know what to do with the shaver and the hand has to be guided first before the resident is able to continue shaving. Also, independent food intake is not possible, he repeatedly needs activating stimuli and the food must be prepared bite-sized. Without request for fluid intake Mr. Miller would not drink anything. During food intake it turns out that the situation of food intake is often misunderstood. The resident often does not know what to do with objects such as cutlery and the food on the plate. If he is given food and liquid, he accepts it and then starts partially to eat on his own. Mr. Miller can also only decide between simple offers with difficulty. He is awake very early, walks around in pajamas in the living area, walks into other rooms and looks for structural damage. Mr. Miller goes to the bathroom independently, although he often goes to the bathrooms of other residents. Sometimes he does not find the bathroom in time and wets himself. He is unable to establish contact with other residents, during group offers in the living area he can only pay attention on one activity for short periods of time, he often stands up and walks around in the living area. The interaction is severely impaired by slurred speech and inappropriate contents. He withdraws from social events and there is the risk of isolation. He can barely follow conversations and avoids contact with fellow residents. An independent daily structure is not possible.

2 Nursing Classification ENP Version 2.9, 2014 The resident is unable to organize personal hygiene independently due to being disorientated Characteristics/Symptoms: Is unable to use articles necessary for personal hygiene adequately/independently; Inability to carry out body hygiene independently and organized ; Altered orientation to place/time The resident wears dentures and is unable to carry out mouth/denture care independently Characteristics/Symptoms: Sequence of dental care is not known Changes caused by dementia The resident is restricted in carrying out shaving/beard grooming independently Characteristics/Symptoms: Sequence of shaving is unknown Disorientated The resident is restricted in dressing and undressing due to apraxia Characteristics/Symptoms: Is unable to put on clothes in the correct order The resident is at risk of malnutrition due to cognitive impairment Characteristics/Symptoms: Lacking stimulus for food intake; Forgets food intake Eating situation is misinterpreted The resident is at risk of fluid/electrolyte deficit Characteristics/Symptoms: Drinks very little, Independent oral fluid intake is not possible The resident is unable to avoid urine loss with an intact urogenital tract (functional urinary incontinence) Characteristics/Symptoms: Is unable to find the way to the toilet ; Dementia with disorientation to place The resident demonstrates a tendency to run away, there is a risk of self-harm Characteristics/Symptoms: Activity and psychomotor states of restlessness Impaired environmental interpretation syndrome The resident is impaired in the independent daily organization/organization of life due to dementia Characteristics/Symptoms: Is unable to make decisions in every day life, Restricted orientation, Mood swings, Motor restlessness The resident is impaired in the daily organization/organization of life due to memory disorders Characteristics/Symptoms: Is unable to remember carried out activities any longer, Is no longer able to focus The resident is impaired in the daily organization/organization of life due to a thought disorder Characteristics/Symptoms: Thought slowdown, Cognitive functional alterations, Is easily distracted, Limited ability to make decisions The resident withdraws from social events, there is a risk of social isolation Characteristics/Symptoms: Hardly approaches others The resident has difficulties concentrating on discussions, an impaired interaction exists Characteristics/Symptoms: Attention is divided, Answer is not adequate to the topic/flow of conversation Lack of concentration, Changes caused by dementia The resident is restricted in communication due to a language disorder Characteristics/Symptoms: Slurring Language attrition in dementia

3 Nursing Classification NANDA-I Bathing Self-Care Deficit Dressing Self-Care Deficit Feeding Self-Care Deficit Inability to access bathroom, Inability to dry body, Inability to get bath supplies Impaired ability to fasten clothing Inability to handle utensils, Inability to ingest sufficient food Risk for Deficient Fluid Volume Risk Factors: Deviations affecting intake of fluids Functional Urinary Incontinence Impaired Enviromental Interpretation Syndrome Wandering Ineffective Activity Planning Impaired Memory Risk for Loneliness Risk Factors: Chronic Confusion Impaired Social Interaction Impaired Verbal Communication able to complete empty bladder, Loss of urine before reaching toilet, senses need to void Impaired cognition Chronic confusional states, Loss of social functioning Dementia Frequent movement from place to place, Hapharzad locomotion, Locomotion into unauthorized/private spaces, Locomotion resulting in unintendend leaving of a premises (e.g., memory and recall deficits, disorientation, poor Disorientation, poor visuoconstructive or visuospatial ability, language defects) Lack of Plan Unrealistic Perception of Events Inability to perform a previously learned skill, Inability to recall events Neurological disturbances Social Isolation Altered Interpretation, Altered personality, Impaired long-term memory, Impaired short-term memory, Impaired Socialization, Progressive cognitive impairment Alzheimer s disease Dysfunctional interaction with others, Inability to communicate a satisfying sense of social engagement (e.g., belonging, caring, interest, shared history) Disturbed thought processes Difficulty in selective attending, Disorientated to space, Disorientated to time, Slurring Alteration of central nervous system

4 Nursing Classification ICNP The Words due to / during / and are additional and not a component of the ICNP. The Terms / / Time / / Action / Appraisal are referring to the Axes from which the Terms/Concepts were chosen from. Impaired Ability to Perform Hygiene [due to] Dementia Impaired Ability to Groom [due to] Dementia Impaired Ability to Dress [due to] Dementia Impaired Low Nutritional Intake [due to] Dementia Impaired Fluid Intake [due to] Self Performing Act, negative judged state Appraisal Functional Incontinence [due to] Ability to Perform Self Toileting, negative judged state Appraisal Elopement [due to] Dementia Dementia [to due] Self Performing Act, negative judges state Appraisal Dementia [due to] Ability to Perform Diversional Activity, negative judged state Appraisal Slurred Speech [due to] Dementia Distorted Thinking Process [due to] Dementia Attention, negative judged state Appraisal Contacting [and] Relating, negative judged state Action Action Appraisal Disorientation [due to] Dementia Wandering [during] Hyperactivity [due to] Dementia

5 Nursing Classification ICF Washing body parts Caring for teeth Caring for Fingernails Caring for Toenails Caring for Hair Drying oneself Dressing Eating Drinking Urinary continence Managing daily routine Applying knowledge, other specified and unspecified Communication with receiving nonverbal messages Speaking Basic interpersonal interactions Informal social relationships with co-inhabitants Formal relationship, other specified Memory functions Thought Functions Attention Functions Assessment Criteria ICF NO Difficulty 0-4 % MILD Difficulty 5-24 % MODERATE Difficulty % SEVERE Difficulty % Assessment Criteria ICF NO Difficulty COMPLETE 0-4 % Difficulty % MILD Difficulty 5-24 % MODERATE Difficulty % SEVERE Difficulty % COMPLETE Difficulty %