CHRONIC ILLNESS DEMENTIA (FRONTOTEMPORAL)

Running Head: CHRONIC ILLNESS DEMENTIA (FRONTOTEMPORAL)
CHRONIC ILLNESS DEMENTIA (FRONTOTEMPORAL)
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Frontotemporal dementia is classified as a type of insidious neurodegenerative clinical
disorder where it is further characterized with the progression (Tábuas-Pereira, Santana &
Santo, 2017) in the deficits of traits that include behavior, language and executive function. The
disorder is one of the most common form of dementia that is seen to affect all the age groups
and are ranked third after Alzheimer’s disease and Lewy bodied dementia, which is referred to
as the beginning stage of dementia. Due to the various sets of similarities of the frontotemporal
dementia (Bang, Spina & Miller, 2015) with the patients suffering from psychiatric disorders, the
early diagnosis of the said disease become quite a bit of a challenge. The paper below
discusses about the chronic disease frontotemporal dementia in details and showcases an
interview session with an old aged patient named Mr. Jon Moss. The paper projects light on
how the said disorder had impacted the life of Mr. Moss and his family while dealing with the
disorder. With the application of Roger, Logan & Tierney model (2008) as a framework for the
senior nurse to practice has been incorporated in the paper. The first five stages of the Levett-
Jones clinical reasoning cycle had been applied as well to help the nurse and the reader
understand and identify the criteria for providing care that need to prioritize on urgent basis.
Lastly, the paper discusses and charts out a nursing care plan for Mr. Jon Moss and aims to
provide him with optimal care.
Background:
The paper deals with the case Mr. Jon Moss, a 65-year-old man born and residing in
Australia. On further interviewing the patient and his family, it was revealed that Mr. Jon Moss
worked as an accountant and had to retire early due to facing continuous health issues. Mr.
Moss was a widower and resided in the suburbs of Australia. His family consists of two adult
children and four grandchildren who resided in another city. On speaking to his son, it was

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revealed that last month Mr. Moss was brought to the emergency room (ER) to assess his
suicidal ideations and bipolar behavior. The case stated that Mr. Moss was observed to indulge
in frequent verbal arguments with every person and mentioned the fact repeatedly, that he did
not have any desire to live and might chose overdosing himself with medicines to end his life.
Moreover, he was seen to put on weight rapidly over the last few weeks and was facing problem
while trying to sleep. On being asked whether he feels depressed or not, he completely denied
the possibility of him being depressed. Based on initial assessment, his short-term memory and
long-term memory was found to be intact, however he was diagnosed with major depression
and was recommended to get started on melatonin and sertraline. Within a few days of him
being discharged, Mr. Moss was again admitted following the same complains of acting
depressed and sad, along with feeling suicidal. Post admission, he was further sent for a
reassessment, where it was projected that the actions and the behavior posed by Mr. Moss was
not at all normal and had been completely out of his character. Behavioral changes such as
throwing stuff at his own grandchildren whom he loved and adored so much, irritability towards
any discussion, lack of judging skills and not being able to concentrate on any situation and
inability to take any decision or have any say in any discussion was particularly noteworthy. The
medical history was also checked where no incidences of any stroke, seizures or head injury
were stated. All the above symptoms and the computed tomography that was conducted on Mr.
Moss indicated towards frontotemporal dementia. Recent researches that have been conducted
have been focusing mainly on understanding the mechanisms that are involved in this kind of
neurodegenerative diseases. Frontotemporal dementia is observed to be caused by the clumps
of abnormal protein that are observed to form inside the brain cells. These in turn damage the
cells and make them stop working completely. The protein are seen to build up in the frontal and
the temporal lobes of the brain, specifically in the frontal sides and the sides of the brain. These
sides are mainly the ones that control the language skills, ability to endure pain, behavior and
organizing skills. The studies conducted mentions that there is a genetical connect and that

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every 1 in 8 people who suffer from frontotemporal dementia are found to have relatives
suffering from the same condition. Post diagnosis Mr. Moss was taken under immediate
treatment and was prescribed with antidepressant, citalopram (Celexa) 40 mg daily for six
straight weeks. This helped in reducing the behavioral issues due to frontotemporal dementia.
The drug was antipsychotic and had been proved to be much more effective in cases dealing
with frontotemporal dementia. The drug helps in restoring the balance of serotonin in the brain.
Although, the drug have been reported to portray side effects such as nausea, drowsiness,
confusion, and anorexia. However, due to the drug being more effective in nature while treating
frontotemporal dementia, they are administered as an alternative to antipsychotic drugs.
Discussion:
Application of Clinical Reasoning Cycle to determine the case:
Investigation was done based on conducting mini-mental status examination (MMSE)
and clock-drawing test, where the results showed that he had scored well. Complete blood
count, thyroid-stimulating hormone (TSH), vitamin B12, comprehensive metabolic panel (CMP)
and folate levels were checked and were found at normal level. Lastly, a computed tomography
(CT) scan was obtained (Archer et al, 2015) and the results showed prominent frontal atrophy
for her age. Post discussing the case further with Mr. Moss’s family and following the
investigation and application of the clinical reason cycle model, Mr. Moss was diagnosed with
frontotemporal dementia. Moreover, the whole case, including the diagnosis, prognosis and the
symptoms displayed by Mr. Moss was reviewed infront of him. The case was completely
discussed in details with Mr. Moss and he was made to understand the status of his condition
along with the consequences of the disorder in the later stages. On hearing this part, he
panicked first but eventually he calmed down and accepted his condition sensibly. Additionally,
he was further referred to neuropsychological examination in order to further assess the
neurocognitive status of MR. Moss.

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Incorporation of 12 steps of Roper-Logan-Tierney Model for Nursing in
assessing Mr. Moss’ case:
The Roper-Logan-Tierney Model for Nursing is one of the acclaimed theory that are
based on the activities of daily living of the patient. It helps in assessing the patient’s condition
throughout the term of their intervention that are being applied. The nurses are found to check
the patient’s relative and potential independence while performing their daily activities. While
assessing Mr. Moss on the basis of the interview that was conducted, the information gathered
stated that Mr. Moss was a widow and he used to stay alone. This helped in understanding that
the deteriorating condition and the changed in behavior as such irritability was caused due the
feeling of abandonment. Assessing the interview questions, Mr. Moss was found to be facing
problem with communication. He was not able to freely state his issues and was confused about
his degrading condition. Though, there was no mention of any episode of feeling
breathlessness, Mr. Moss felt depressed and had eating irregularities. There were many
mentions of instances, where Mr. Moss’s son had stated of him skipping out on his meals.
There was no mention of in taking of any alcohol or smoking. The factor eliminating helped in
determining the faecal output of the patient. Through the assessment, it can be stated that no
difference was observed in the medical charts of Mr. Moss. However, he had suffered from
irritable bowel syndrome regularly before being admitted. Mr. Moss stated about feeling
lethargic to move or go to visit any place. The feeling of communicating with his grandchildren
by working and playing with them started being a burden to him. This gradually became the
increasing reason of his irritability and he started having arguments with his son. One particular
incident was mentioned where Mr. Moss had a pretty bad heated argument with his sons, which
further lead to the throwing of things towards them. He mentioned in the rage of anger that his
level of frustration was getting beyond control and that he wanted to end his life by overdosing

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on his medications. The changes mentioned in the behavior and the lack of sleep all indicated
and confirmed that the condition diagnosed here was frontotemporal dementia.
Care Priorities and Goal Setting:
Studies that have been performed assessing the struggle of the dementia affected
patient have projected that one of the prime problem faced by a dementia patient is their fight to
maintain their identity. The feeling of being under confident with oneself is one of the biggest
hindrance faced by the patients as well as the nursing caregivers (Doenges, Moorhouse & Murr,
2019). While assessing, Mr. Moss’s case it was seen that though he had initially accepted his
condition but gradually he was observed to lose confidence while performing everyday task.
Even before the diagnosis, he was found to completely withdraw himself from the social
activities, which in turn had broken his self esteem and relationships. Dealing with the situation,
the family (Caceres et al, 2016) can incorporated as informal carers. The main responsibility of
the nurses is to place Mr. Moss in a safe and encouraging environment where he does not feel
that he is inadequate of staying in the society. The nurses are observed to ask Mr. Moss’s
family, specifically his sons to act and encourage their father in different daily activities. The
nurses also are found to assess Mr. Moss’s needs and regardless of any financial status the
care needs to be provided. The assessment further helps in checking for the change in the
factors that range from the psychosocial to psychological distress. Following the individual
therapy (Massimo, Evans & Grossman, 2014), that is being incorporated helps in supporting Mr.
Moss to reduce the psychological stresses and counsel him on focusing on the recovery of his
condition (Roche et al, 2015).
The goals incorporated here included the aim to have Mr. Moss maintain his mental and
psychological function as long as possible. The family member are made to understand the
need of required care towards him. The care plan also aimed at helping Mr. Moss to improve

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their throught process and make him aware of the reality and that with the proper
implementation of the interventions his condition would improve. Lastly, the care plan involved
in identifying the behavioral problems. This would further help and encourage him to control the
irritability quotient as much as possible.
Conclusion:
Frontotemporal dementia (FTD) is one of the most frequently encountered form of
primary degenerative dementia that are seen to occur maximum amongst the middle-aged
individuals. The paper describes the case study of an Australian born, 65 year old man who was
diagnosed with frontotemporal dementia. The case study portrays changes in the patient’s
gradual behavior as well as his eating habits. On being further investigated he was diagnosed
with frontotemporal dementia. The paper deals with the application of clinical reasoning cycle
while dealing with the patient to understand the case study and ultimately provide him with
optimal care. Moreover, with the application of Roper-Logan-Tierney model of nursing, Mr.
Moss’ changes in the lifestyle activities were also assessed. This helped in the proper
evaluation of the case study and helped in providing perfect care plan. The care plan
incorporated, also helped in increasing Mr. Moss’s self-confidence and helped him reconnect
with his family.

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References:
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