Caring for Alzheimer’s disease PatientPlacement Case Scenario

UNIT:
DATE:
NAME:

Caring for Alzheimer’s disease Patient-
Placement Case Scenario
Alzheimer’s disease is a life-long mental illness that requires person centred nursing care.
Alzheimer’s disease is a common type of dementia and is defined as neurological disorder that
causes cognitive decline and memory loss (Rustenhoven et al., 2018). Alzheimer’s disease is
characterised with continuous decline in thinking, social and behavioural skills that interferes
with the ability of a person to function independently (Hartz, Shen, Ding, & Bauer, 2018). To
effectively care for a patient with Alzheimer’s disease, nurses need to conduct comprehensive
mental status examination and used evidence based literature and research to plan for person
centred nursing care. The following essay is a discussion of a patient that had Alzheimer disease
that a student nurse cared for while on placement. The discussion involves a comprehensive
nursing assessment of the patient and the care plan to attain person centred care and ensure
challenging behaviours are managed to meet Nursing Council of New Zealand (2016)
competences 3.1 and 3.2 of Domain 3 Competencies for registered nurses.
The patient name was X who is a 90 years old lady who was born in a family of five
sisters and two brothers from European Country. X has been married for sixty year and has three
children. She was a nurse for many years trained in Scotland and moved in New Zealand to her
career in nursing and midwifery. X also has six grandchildren and lives in a single storeyed 5
bedroom home in semi rural area. X has Alzheimer’s disease, cerebrovascular disease diagnosed
12 years ago left side hemiplegic, bilateral cataract and permanent cardiac pacemaker. She is
moderately impaired in daily decision making and can express her needs and wants such as
deciding to go dining, bed or stay in her room. X is able to respond adequately to simple direct
communication. X is not able to recall three words given for instance pen, paper, and ball. She
can also not remember the names of her children. X can be physically aggressive toward staff
when being assisted with personal care and she is bed and chair bound. X likes porridge and
orange juice for breakfast and eats whatever is in the menu for lunch and dinner. Another
noticeable behaviour is that X does not participate in any activity and never interacts with other
residents.

Comprehensive nursing assessment is the first step to providing person centred care.
Mental status examination (MSE) is an important tool for undertaking comprehensive nursing
assessment for mental patients (Jackman, & Beatty, 2015). The MSE will examine appearance,
behaviour, speech, mood, insight, motor activity and intelligence. X appearance is an elderly 90
years female from a European Country. She is both chair and bed bound. The X’s behaviour
shows both aggression and apathy. She gets physically aggressive toward staff when assisted
with personal care. She wants a staff to be around her all time, persistently wants attention, does
not adapt easily to a change of staff and routine. X does not participate in any activities or
interact with other residents. X’s motor activity level is agitation. She bangs the wall with bare
hands, slides her lazyboy, bangs cups, spoons and call bell, throws food around and pours her
drink on the floor. X’s speech can express what she wants and express displeasure by screaming.
She can communicate what she wants such as if she wants to go to her room or take meals at the
dining room. X’s mood is apprehensive. She fears to be left alone. The thoughts stream of X
indicates poverty of thought. She believes she is going to fall off the floor and request the bed to
be placed on the floor. X’s thoughts form is circumstantial. The thinking is disordered and
responds to only simple direct communication. The X’s thoughts contents indicated phobia. She
has excessive fear of falling. The level of consciousness of X is alert. She enjoys watching
movies. The cognitive orientation showed that she is aware of current setting and familiar people
and resists change in staff and inability to adapt change in routine. X is not able to pay attention
and poor memory. She can’t pay attention or repeat simple words. For example she cannot repeat
three words; pen, paper and ball and she cannot remember her children’s names. X has poor
insights and impaired judgments. She cannot decide on what is of the best interest to her. She
complains when assisted with personal care.
X has challenging behaviours that need to be incorporated in the nursing care to achieve
person centred care that is with cultural safety principles. X’s Alzheimer’s disease is
accompanied by several challenging behaviours that nurses or care givers need to prepare to
handle. The disease changes a person’s personality is manifested in a totally change of behaviour
that is both challenging to the patient and nurse (Brooke et al. 2019). Challenging behaviours are
behavioural problems, changes, concerns, difficult, disruptive, symptoms and inappropriate
behaviours that are as a result of dementia (Stokes, 2017). X was a nurse for many years until her
retirement that indicates she was a modest lady who understands decency and practices for