Nursing 1: Alzheimer's Dementia Case Study - Mrs. Walker's Care

This case study examines the care of Mrs. Walker, a 72-year-old woman with Alzheimer's dementia. The assignment details the importance of assessment tools, including safety and activities of daily living scales, in providing effective care. It addresses the use of restraints, types of physical and chemical interventions, and the role of the interdisciplinary team in their authorization. The case study also covers Mrs. Walker's physical disabilities, including a contracture of her right hand and weight loss, and the need for osteo assessment. Furthermore, the assignment explores the stages of dementia, palliative care, and end-of-life care considerations. Organizational policies regarding deceased clients and the importance of respecting patient wishes and family needs are also discussed. References to relevant literature are included.

Running Head: NURSING 1
ALZHEIMER DEMENTIA CASE STUDY
Student’s name
Professor’s name
Institution of affiliation
Date

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1c). Assessment tools are important for older people because they help to gather the
information that is useful during decision making that is reflected as the foundation of clinical
practice. The tools have several checkpoints to evaluate whether health impacts are likely great
enough to deserve additional analysis. Also, it assists health practitioners in identifying care
requirement and risks in order to determine the kind of treatment and care options (Patton, &
Henry, 2019).
The relevant assessment tools are a safety culture assessment tool and Activities of the daily
living scale assessment tool. Mental assessment to collect data about mind working abilities and
what can be done to cater to the patient need. Also, the patient has several health problems apart
from dementia-like weight loss and contracture of her right hand as well as refusing to eat;
hence, the general health assessment tool is crucial.
2a). Health questionnaires such as those that address recent travel and exposure risk assessment
tool that can assist in collecting data concerning language and cognitive functioning. Alzheimer
dementia is well known to diminish an individual’s ability to communicate. A quick assessment
is vital so that treatment can be administered after data collected is analyzed. The report should
be communicated to the doctor addressing the state of Mrs. Walker who has anxiety and
emotional as well and does not engage in any communication (Hills, Robinson, & Hungerford,
2019).
The communication skill tried to include non-verbal communication like the use of gestures and
signs to examine whether she is interested with any. Also, listening skill is tested but she seems
to lack concentration, and she is not friendly at all.

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3a) Restraint is a term that denotes an aversive practice, an action or object that interrupts a
person’s potential to come up with decisions or hinders an individual’s free movement. The
interdisciplinary team (ITD) are responsible for authorization of all type of restraint.
Nevertheless, if there is an emergency and the ITD is not instantly available the following staff
can authorize restraints:
1. A licensed physician or certified physician’s assistant;
2. Dentist for issues about dental
3. Qualified disability professional intellectually
4. advanced registered nurse professional
Types of restraint
Restraint is any restriction from one freedom to mobility, and they include (Wilson, Rouse, Rae,
& Kar Ray, 2018):
Physical restraint which entails holding of the patient body parts or the whole body to hinder the
person free mobility. Also, it encompasses all the accepted controlling maneuvers like
therapeutic choices holds. It does not involve brief holding, but the person held for support to
move safely from one location to another.
Chemical restraint which encompasses the use of psychoactive drugs by administering them to
the patient to limit or prevent perplexing behavior. The person is prevented from self-harm as
well as other peoples harm (Scheepmans, Casterle, Paquay, & Milisen, 2018).

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Physical intervention meaning is utilizing manual technique purposing to interfere or quit a
behavior from happening. Physical intervention is more of physical restraint since they are used
to escape danger or a situation that is likely dangerous.
Exclusionary time out detonating the removal of an individual from a state where positive
fortification is present to a location where it is not possible for a particular behavior to occur. In
this case, existing that location is prohibited. This type of restraint is authorized by the division
director.
Mechanical restraint comprises the use of an object or device that the individual is unable to
remove, to an individual’s body that hinders the person’s freedom to move. Nurses are
responsible for managing and monitoring the health condition of an individual in restraint (Mills,
Weinheimer, Polivy, & Herman, 2018).
4d) Mrs. Walker physical disability is her contracture hand that is an abnormal contraction of a
muscle; deformity caused by burns she received in her kitchen 11 months ago in the body and
sometimes it can permanent. Her contracture hand can be hindering her from performing daily
chores like cooking for herself. Thus she might have been feeding poorly. Also, she lives alone
and lacks support in case of any pain (van der Vet et al, 2019).
6) Osteo assessment should be conducted by the osteopathic physician who has specialized in the
field of osteocare or caring for the bones of the body. Study proves that women who have
attained the menopause age are likely to suffer osteoporosis due to bone weakening and brittle.
The allied health professional who would undertake the Osteo assessment is called Osteopath
(Salunke, Shah, Pandit, & Amin, 2018). Osteopath should be trained and familiar with the
thermometer, bladder scanner, speculum, eye charts, otoscope, penlight, stethoscope (bell and

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diaphragm), cardiac and blood pressure monitors, fetal doppler and extremity doppler, and
sphygmomanometer.
7a) Dementia refer to a disorder that attacks person’s mind and results to impairment of mental
functioning like thinking, recalling, reasoning and behavioral abilities to a point where, daily
living style of a person is affected and leads to abnormality (Semrau, & Sartorius, 2019). While
Alzheimer’s disease is a type of dementia that is either familial or sporadic and it person’s brain
causing the cortex to shrink. Cortex region is engaged in memory, judgment, and language and
when affected the personal communication skill is lost (Kupeli et al, 2018).
Dementia occurs in three stages namely the early, middle and late stage. The early stage is
marked by symptoms like being anxious, short-term memory loss, and a times confusion. The
middle stage is more advanced than the early stage, and symptoms include the person’s
maximized forgetfulness thus requiring more support. A person at this stage is mostly distressed
as well as angry (Alzheimer's Association, 2018).
The late stage is worse than the previous two about damage and the extent of infection effect.
The late stage is identified with traits like a problem in feeding, difficulties in identifying usual
things, frequent loss of speech, unable to recognize people and the environment. Further, the
person experiences incontinence, general body weakness, and the emergence of slow and
unsteady mobility (Birks, & Harvey, 2018).
7b) palliative care denotes care that aims at enlightening the quality of life as well as the quality
of care for patients who have life-frightening or off-putting life sickness. Their families via the
prevention and assistance, communication concerning the aim of care, and timely recognition

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and evaluation, treatment of agony and additional problems, psychosocial, physical and spiritual
(Abrams, Vandrevala, Samsi, & Manthorpe, 2018).
End-of-life care means care that happens in the last few months of the patient’s life, concerning
the existing diagnosis as well as clinical progress. It entails preparation for the termination of
life.
ASSESSMENT ONE PART B
1. Organizational policies and procedures when caring for the deceased client are: According to
the policy only the registered psychiatric, registered nurse, or licensed practical nurse can
pronounce death. Also, they are responsible for informing the most accountable physician of
patient death, and afterward the family physician is made aware (Unick, Bassuk, Richard, &
Paquette, 2019).
In case there is a claim that the death is not natural and information available cannot assist in
proving the issue, then the death is reported to a coroner. Any death that is not considered to be
coroners case a non-medicolegal autopsy is needed. When death is as a result of natural cause
such as disease the LPN/RN/RPN can allow the removal of the body either to the funeral home
for the burial of to the morgue (Björk, 019).
The health practitioner should follow the client’s wishes according to the policy. For instance,
the client would like to donate organs and tissues if the client body should be cremated or buried.
Verification of the death after which is done by the doctor as well as a registered nurse who is
qualified in verifying death.
Certification occurs when the respective medical officer has approved all issues. In all coroner’s
incidence movement of the disease is prohibited unless allowed by the coroner. Also, when death

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is coroner’s case or if an autopsy is needed, leave all martial tubes, catheters and drain in place.
Else, eliminate them properly.
One should be aware of all the infection the deceased client had and handle them with care and
wear gloves for protection and aprons. The care is supposed to occur within two to four hours of
death; this helps to maintain their appearance, dignity, and condition. At least two people are
recommended to offer care for a deceased client. Caring for the deceased client should be
continuous and should of high respect and dignity. Respect by the health worker extends to the
cultural practices and religious practices that are vital to them and family.
2. Respect, each death is different, and individuals react in an extremely distinct manner. In case
death occurs while the family members are present, the nurse should show respect to their needs.
When there is no one present either friend or family member, as a nurse you should ensure they
are aware as early as possible. A health practitioner must show a high level of professionalism
and be a good listener to all request made by the bereaved family to support them emotionally
(Tsui, Franzosa, Cribbs, & Baron, 2019).
Being informative, the people who are close to the deceased client like family member need to
know the type of bereavement services they can access. The health practitioner can support the
important people to the deceased by availing all the information vital to helping them prepare
and organize the funeral and payment of the hospital bill during the mourning period. The
support can also be spiritual where the health practitioner can encourage them through biblical
verse about death. Health practitioners are expected to condole with the bereaved family, and
they can even send a condolence letter to the family to be read during the funeral day (Makaroun
et al, 2018).

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References
Abrams, R., Vandrevala, T., Samsi, K., & Manthorpe, J. (2018). The need for flexibility when
negotiating professional boundaries in the context of home care, dementia and end of life.
Ageing & Society, 1-20
Alzheimer's Association. (2018). 2018 Alzheimer's disease facts and figures. Alzheimer's &
Dementia, 14(3), 367-429.
Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer's disease.
Cochrane Database of systematic reviews, (6).
Björk, A. (2019). Reconsidering critical appraisal in social work: choice, care and organization
in real-time treatment decisions. Nordic Social Work Research, 9(1), 42-54.
Hills, D., Hills, S., Robinson, T., & Hungerford, C. (2019). Mental health nurses supporting the
routine assessment of anxiety of older people in primary care settings: Insights from an
Australian study. Issues in mental health nursing, 1-6.
Kupeli, N., Leavey, G., Harrington, J., Lord, K., King, M., Nazareth, I., ... & Jones, L. (2018).
What are the barriers to care integration for those at the advanced stages of dementia

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living in care homes in the UK? Health care professional perspective. Dementia, 17(2),
164-179.
Makaroun, L. K., Teno, J. M., Freedman, V. A., Kasper, J. D., Gozalo, P., & Mor, V. (2018).
Late transitions and bereaved family member perceptions of quality of end‐of‐life care.
Journal of the American Geriatrics Society, 66(9), 1730-1736.
Mills, J. S., Weinheimer, L., Polivy, J., & Herman, C. P. (2018). Are there different types of
dieters? A review of personality and dietary restraint. Appetite, 125, 380-400.
Patton, S. K., & Henry, L. J. (2019). Nursing students’ experience with fall risk assessment in
older adults. Nursing & health sciences, 21(1), 21-27.
Salunke, A. A., Shah, J., Pandit, J., & Amin, P. (2018). Malignant Tumors of Foot: What are the
Outcomes?. Journal of Musculoskeletal Research, 21(02), 1850007.
Scheepmans, K., de Casterle, B. D., Paquay, L., & Milisen, K. (2018). Restraint use in older
adults in home care: A systematic review. International journal of nursing studies, 79,
122-136.
Semrau, M., & Sartorius, N. (2019). What is new within staging of care for people with
dementia? The IDEAL schedule and other recent work. Current opinion in psychiatry.
Tsui, E. K., Franzosa, E., Cribbs, K. A., & Baron, S. (2019). Home Care Workers’ Experiences
of Client Death and Disenfranchised Grief. Qualitative health research, 29(3), 382-392.
Unick, G. J., Bassuk, E. L., Richard, M. K., & Paquette, K. (2019). Organizational trauma-
informed care: Associations with individual and agency factors. Psychological services,
16(1), 134.

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van der Vet, P. C. R., Kusen, J. Q., Rohner-Spengler, M., Link, B. C., Houwert, R. M., Babst, R.,
... & Beeres, F. J. P. (2019). Secondary prevention of minor trauma fractures: the effects
of a tailored intervention—an observational study. Archives of Osteoporosis, 14(1), 44.
Wilson, C., Rouse, L., Rae, S., & Kar Ray, M. (2018). Mental health inpatients’ and staff
members’ suggestions for reducing physical restraint: A qualitative study. Journal of
psychiatric and mental health nursing, 25(3), 188-200.

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