Nursing Assignment for Alzheimer's Dementia Patient

The nursing assignment presents a critical analysis of the medical condition of an eighty nine year old female who has been diagnosed with Alzheimer’s Dementia. The paper outlines the medical history of the patient along with the theory and physiology of ageing. The paper further suggests primary health services that can be referred to for the support and care of the patient. The paper also highlights strategies and interventions for managing challenging behaviours, oral hygiene and pain. Finally, an appropriate nursing plan has been designed that highlights two actual problems and two potential problems along with the intervention strategies.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Part A:
Introduction:
The case study presents facts that must be critically considered while proceeding with
the designing of an appropriate care plan. The case study mentions the client to be an eighty
nine year old female who at present is residing in the Minnows Aged Care facility. Apart
from her medical complications, the patient has recently been diagnosed with Alzheimer’s
Dementia. Research studies show that the Dementia is a common mental illness that
manifests itself with advancing age. It should further be noted in this regard that Dementia
cannot be categorized as a specific physical health condition but is marked by a group of
conditions. The disease condition primarily affects two major functioning areas of the brain
that includes memory retention and lack of judgement (Scher & Hsu, 2013). Some of the
common symptoms include, forgetfulness, limited social adjustment and thinking ability
along with fragile physical health (McLaren et al., 2013). The patients often require
assistance with the activities of daily living. It should also be noted in this context that the
medical condition cannot be completely cured but the symptoms can be managed so as to
enhance the standard of living of the elderly patients.
This paper intends to devise an appropriate nursing plan for the client. It would
critically consider a number of aspects with respect to ageing in section A, so as to formulate
an appropriate plan.
Medical Diagnosis:
In order to proceed with the critical designing of an appropriate care plan, it is
important to consider the past medical history of the client. Miss Alice Jones (the client) had
been diagnosed with Myocardial Infarct 10 years ago. She had also been diagnosed with

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Hypertension 10 years ago. She has also been diagnosed with Osteoarthritis in her right knee.
In addition to this, it should also be noted that, Miss Alice Jones has been diagnosed with
mental health conditions that include Anxiety and Depression almost two years ago. Miss
Jones has recently been diagnosed with Alzheimer’s Dementia and Urinary incontinence and
ambulates with the help of a 4-wheeled frame. She has recently encountered two episodes of
fall but that resulted in no injuries. She requires assistance with her activities of daily living
and has lost weight. She is often found confused and wandering to other areas of the care
home. She has to be redirected to her ward with assistance. Her present medication routine
comprises of the following:
Prn Panadol 1grm tds
Voltaren Emulgel daily to right knee
Tramadol 50mg PRN
Atenolol 100 mg mane
Therefore on the basis of the medical history of the patient it can be predicted that the
condition of the patient is worsening and the medical condition of Alzheimer’s Dementia is
rapidly progressing. Also, on evaluating the cognitive score of the patient along with the
DSM-V Dementia criteria, it can be said the patient is susceptible to develop severe forms of
sleep apnoea, eating disorders and complete cognitive impairment. Based on the recent
medical health condition, it can be said that the client already has developed mild forms of
these medical conditions.
Theory of Ageing:
According to Bratic and Larsson (2013), ageing has been defined as a universal,
continuous and a deleterious process which advances with age and cannot be voluntarily

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controlled. In close association with the case study, it must be mentioned that that the
programmed theory of ageing can be used to explain the worsening condition of the client.
According to Bractic and Larsson (2013), the programmed theory of ageing suggests that
ageing is controlled by the changes in genetic expression that is governed by the biological
timetable. The alterations in the genetic expression affects the ability of the body to perform
functions of repair, regenerate and maintain defence responses. Research studies have
suggested that advancing age leads to brain damage and deterioration in the normal
functioning of the neuronal cytoskeleton (Scher & Hsu, 2013). Senescence also damages the
mitochondria which further diminish the neuronal energy. In addition to this, researchers
have also suggested that the impact of the external environment also determines the
progression of ageing (Bratic & Larsson, 2013). Therefore, in this context, the advancing age
of the client is responsible for the normal physiological functioning of her body. This can be
verified through the medical history of the client which presents diagnosis of Alzheimer’s
dementia and Dementia 2 years ago.
Physiology of Ageing:
The process of ageing is primarily governed by two factors which include, genetic
ageing and environmental influence. Ageing refers to perpetual deterioration of all the major
organ systems of the body (Scher & Hsu, 2013). This includes weakening of the
integumentary system, immune system, cardiovascular system, nervous system, respiratory
system, Digestive system, Urinary system, Endocrine system and skeletal system. Ageing
causes reduction in the bone density, reduction in perception ability and responsiveness to
stimuli. It further affects the endocrine system and hampers the hormone synthesis
mechanism (Richardson et al., 2013). Hence, it can be said that patient’s present medical
condition is characterized by the deterioration of the major organ systems within the body.

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Primary health services:
Considering the present medical health condition of the client, it should be suggested
that the client would be referred to primary health service providers for support and care. As
the client is experiencing the rapid progression of Alzheimer’s dementia, it would be feasible
to recommend a Dementia care nurse to offer assistance to the client. The rationale behind the
recommendation of a Dementia care nurse would facilitate the client to remember vital
information and manage activities of daily living. According to research studies, it has been
mentioned that effective management of the symptoms of Dementia involve slowing the
progression of the symptoms and preventing the severity of the disorder (Richardson et al.,
2013). The dementia care nursing professional would offer complete assistance to the client
so as to effectively help her in managing cognitive functioning and activities of daily living
that would include helping the client managing toilet continence, washing, and grooming.
Further, the carer would also emphasise on the psychological well-being of the subject and
would instil confidence in her so as to motivate her and make her socially active.
The second primary carer who would be appointed for providing assistance to the
client would include a dietician. As has already been mentioned in the case study, the client
has lost appetite and invariably forgets to consume her every day diet. It has further been
highlighted that the client has lost weight. Hence, in order to ensure that the client is taking a
balanced diet, it is important to appoint a dietician. The dietician would ensure that the client
is taking the meals at the proper time and would keep a track on the water intake of the client.
In order to deal with the weakness of the body, it is exceedingly important that the client
consumes proper meals at the correct timings of the day in order to gain energy and stay fit.
Therefore, the rationale of referring a dietician would facilitate proper dietary intake and
constant body-weight monitoring of the client so as to accelerate the recovery process.

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Strategies and interventions for dementia/ challenging behaviours:
Dementia is associated with a number of complex behaviours that are challenging for
both the patient as well as the care providers. In close association with the case study, it
should be clearly noted that the client presents a number of challenging behaviours that must
be managed appropriately in order to avoid further worsening of the health condition. In this
section, four major challenging behaviours would be outlined and along with the same,
appropriate interventions would be suggested that would serve as guidelines to manage the
challenging behaviour of the patient.
The first set of challenging behaviour that has been identified is the aimless
wandering of the client. According to research studies, it has been mentioned that clueless
wandering is a common problem witnessed in Dementia patients. In order to proceed with an
effective intervention, it is essential to first identify the cause of wandering. Wandering can
be an outcome of multiple reasons that include, need for food, water, toileting and exercise.
The managing strategies would include, maintenance of security and companionship (Payne,
2017). Equipping the patient with alarm and bells so that the patient can ask for assistance
whenever in need. Proper handing over of nursing notes at the end of the shift so as to clearly
direct the next carer to assist the patient in an appropriate manner (Mioshi et al.,2013) .
The second set of challenging behaviour would include managing the aggressive
behaviour of the patient. In order to develop an effective strategy to manage the problem
related with anxiety, the first step would involve identifying the problem that is causing the
anxiety and accordingly manipulating the environment to reduce the negative impact.
Strategies such as effective communication and using the reminiscence therapy can help in
managing the anxious behaviour of the client (Lima et al., 2016).

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The third set of challenging behaviour would include effectively directing the patient
to manage and improve urinary continence. Administration of pelvic muscle exercises in
combination with the administration of antimuscarinic drug can help in improving the
problem of urinary incontinence (Huang et al.,2013) .
The fourth set of challenging behaviour would include effectively managing the
cognitive functioning of the client. This would be done through administration of Hormonal
therapies and monitoring cognitive training (Edwards, 2015). In addition to this, the
maintenance of a safe environment would help in the prevention of cognitive impairment.
Oral hygiene:
The client has been reported to be non-cooperative with the healthcare professionals.
It has also been mentioned that the client needs complete assistance with the activities of
daily living. The client is dazzled and confused and often forgets things that she has done or
either needs to do. On many occasions the client forgets taking her meals and hence, it is
obvious that the minimal oral hygiene requirements of the client would remain unmet. On
account of the forgetfulness the client cannot communicate appropriately with the nursing
professionals and hence it can be assumed that her oral hygiene routine might be overlooked.
In order to ensure that the oral hygiene is maintained on a regular basis, a helper nurse would
be appointed who would brush the teeth of the client during morning and night. The carer
would ensure that a soft brush is used for the brushing procedure along with a Fluoride paste.
Care would be taken to make sure that there is no bacterial infection within the oral cavity
and chlorhexidine would be applied to manage the bacterial infection (Drazenka et al., 2014).
The client would be fed on a low sugar diet to ensure that there is no microbial flora
flourishing inside the oral cavity and the mouth would be kept moist through hydration. In

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order to assist the client with oral hygiene the client would be made comfortable within a
caring environment and treated with respect to promote healthy recovery.
Pain:
The client has continuously complained to experience pain in the right knee. In order
to assist the client with pain relief, the first step that would be performed would include a
pain assessment. On the basis of the pain score collected after the successful pain assessment
pharmacological intervention would be devised. At the same time, it would be made sure that
the client is comfortable in the presence of the carer and is able to communicate effectively
(Drazenka et al., 2014). Through the process of counselling, the information about the
psychological status of the client would also be estimated that would help in understanding
whether the sensation is physical or emotional. The personal pain might be caused on account
of loneliness and isolation from the family members, separation from her sister due to her
demise. The personal pain management would be done through continuous counselling.
Complementary Therapies:
In addition to the above mentioned therapies, devising mindfulness based therapy
such as meditation and assisting music therapy can help the patient with a faster recovery.
The administration of mindfulness based therapy would help in effectively taking care of the
spiritual needs of the patient and at the same time facilitate composure over the pertinent
anxious behaviour of the client. Further, music therapy would help the client in gaining relief
from the continuous sensation of pain (Chiao,Wu &Hsiao, 2015).

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Part B:
Nursing Plan:
In order to effectively assist the patient with the recovery process, an appropriate
nursing plan would be designed which would highlight two actual problems and the two
potential problems. Along with the problems, the intervention strategies would also be
highlighted in order to design an effective care plan for the client. It is expected that the client
would slowly recover, however the process would extend over a considerable period of time
and must be continued so as to ensure positive recovery.
A. Two actual problems/ Issues: B. Two potential problems/ Issues:
Two actual problems that can be identified
in relation to the case study would include:
 Increased susceptibility to fall and
related injuries die to aimless
wandering: On account of the aimless
wandering of the client during odd hours
of the day, the patient is susceptible to
accidental falls and injuries.
 Intervention: In order to prevent the
risks associated with accidental falls and
injuries, appropriate care would be taken
to monitor the whereabouts of the client
and maintenance of a safe and risk free
environment (Brown et al., 2016).
 Increased weight-loss and
Two potential problems that can be
identified in relation to the case study
would include:
 Exhibition of violent behaviour towards
caring professionals on account of
pertinent anxiety: On account of anxiety
the client might be exhibiting violent
expression towards the carers.
 Intervention: Pertinent counselling and
maintaining effective communication with
the client would help in providing
assurance to the client. It would also help
in the maintenance of composure of
behaviour.
 Complete seclusion and isolation from

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deterioration of body strength: The
medical reports has already revealed
weight-loss of the client.
 Intervention: It should be made sure
that the client is properly assisted by a
dietician and constant monitoring of the
food and water intake of the client would
help in effective maintenance of body
weight.
social circle on account of depression:
The case study has also mentioned that
the client often looks for her deceased
sister and has no family members as her
immediate care providers. With the
advancing age, the client is bound to feel
insecure and depressed.
 Intervention: Administration of spiritual
therapy and inclusion in social activities
can help the client feel positive (Adelman
et al., 2014).
Conclusion:
Therefore to conclude, it can be said that old-age patients placed under Dementia care
are extremely vulnerable. The patients are susceptible to vulnerability both in terms of
physical health deterioration as well as mental health instability. Caring for the aged patients
who do not have an immediate care provider is even more challenging as it involves dealing
with complex challenging behaviours. Carers must be extremely polite and sensitive towards
the patients. Critical consideration of the medical history of the patients along with the proper
assessment of environmental risk factors can help in devising an appropriate care plan. While
devising the care plan it is also important to critically consider the preferences of the client
along with the consideration of the ethnic, religious and cultural background. This is
important to ensure a culturally safe intervention plan and promote positive patient outcome.

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References:
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burden: a clinical review. Jama, 311(10), 1052-1060.
Brown, K. W., Coogle, C. L., & Wegelin, J. (2016). A pilot randomized controlled trial of
mindfulness-based stress reduction for caregivers of family members with
dementia. Aging & mental health, 20(11), 1157-1166.
Chiao, C. Y., Wu, H. S., & Hsiao, C. Y. (2015). Caregiver burden for informal caregivers of
patients with dementia: a systematic review. International nursing review, 62(3), 340-
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Draženka, O., Domagoj, V., Ana, B., Petrana, B., & Vlado, J. (2014). Prevalence of Anxiety
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