Diploma of Nursing: Care Plan Report for Mr. John Woods

This report presents a comprehensive care plan for Mr. John Woods, an 85-year-old male diagnosed with Alzheimer's dementia and urinary incontinence, along with a history of other medical conditions. The report begins with a detailed medical diagnosis, including the patient's history of myocardial infarction, hypertension, osteoarthritis, anxiety, and depression. It then applies the activity theory of aging to Mr. Woods' case, explaining how social isolation and poor engagement in social activities have contributed to his current health state. The report delves into the physiology of aging, highlighting its impact on various body systems, particularly the cardiovascular and nervous systems, which are relevant to Mr. Woods' conditions. It identifies primary health services suitable for managing his dementia and incontinence, including dementia support specialists and community services. Furthermore, the report outlines effective strategies and interventions for addressing Mr. Woods' challenging behaviors, such as wandering, pain, social withdrawal, and low appetite, emphasizing the importance of reorientation, communication, and nutritional interventions. The report also addresses oral hygiene needs, detailing assessment and care strategies. Finally, it considers pain management strategies, including assessment tools and complementary therapies like music and massage therapy to improve the patient's overall well-being.

Running head: CARE PLAN
Care plan
Name of the student:
Name of the University:
Author’s note

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Part A:
Medical diagnosis:
Mr. John Woods is an 85 years old male who has been more recently diagnosed with
Alzheimer’s dementia and urinary incontinence. His past medical history includes myocardial
infarction (MI) diagnosed 8 years ago, hypertension, osteoarthritis and gout in the knee and
anxiety and depression diagnosed 2 years ago. All these conditions can have various effects on
patient. For example, history of osteoarthritis can affect his ability to walk and lead to frequent
episodes of pain, stiffness and loss of function of the knees. This may lead to more dependence
in walking, stair climbing and doing task involving lower extremity. Thus, Mr. John is likely to
require more support in this area in the future. He has been taking Voltaren Emulgel daily for his
left knee and long-term use of NSAID medications may lead to gastrointestinal and renal
complications (Charlesworth et al., 2019). His history of MI is highly linked to long history of
hypertension. In older adults, hypertension leads to stiffening of the arteries and these changes is
responsible for incidence of MI (Ferri, Ferri & Desideri, 2017). Moreover, his history of
depression may affect the patient’s ability to rehabilitate and further deteriorate his health (Gallo
et al., 2013).
Theory of ageing:
Mr. John’s current state is linked to the activity theory of ageing. This theory proposed
that successful ageing in dependent on older adult’s ability to stay active and maintain social
interactions. The main assumption is that successful ageing can take place only when older
adults remain socially active. This can improve quality of life of elderly. Hence, the theory
assumes that positive relation exists between level of social activities and satisfaction with life.

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The theory is also known as low theory of ageing or the implicit theory of aging (Fitzpatrick,
2018). The main rationale for finding this theory to be appropriate for Mr. John is that
deterioration in his current health has occurred because of social isolation and poor engagement
in social activities. The case study has revealed several examples of his social disengagement.
For instance, after his sister’s death, he became more socially isolated and he had contact with
his brother only after every three months. During his stay at the residential unit too, he rarely
attended any social activities with other residents. Due to the benefit of social engagement on his
overall health, the staffs at the residential aged care encouraged him to attend social activities
too. Douglas, Georgiou and Westbrook (2017) supports too that improving social participation of
older adults is crucial for successful ageing. Thus, the relation between the activity theory and
the condition of Mr. John is clear from the above explanation.
Physiology of ageing:
Ageing is a phenomenon associated with progressive and heterogenous decline in
functions of all vital organs of the body. Ageing is linked to physiological decline in most of the
organs of the human body. The human body ability to repair is reduced and the risk of loss of
functional reserved is further exacerbated by the presence of co-existing disease. It adversely
affects function of different body system such as cardiovascular system, nervous system,
respiratory system, gastrointestinal system, immune system, endocrine system and other systems.
Some effects of ageing on the cardiovascular system include changes in arterial wall thickening,
vascular wall matrix and stiffening of arterial blood vessels (Navaratnarajah & Jackson, 2017).
Thus, such changes increase the risk of elevated systolic arterial blood pressure. Similar effect of
ageing was found for Mr. John Woods too as he had history of hypertension and MI because of
the physiological effect of ageing. In addition, ageing is associated with serious changes in the

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nervous system which affects transmission of signals to the brain and increase in risk of
neurological disorders like Alzheimer’s dementia (Amarya, Singh & Sabharwal, 2018). Thus,
Mr. Wood’s current diagnosis of Azheimer’s dementia is an effect of ageing too. This disease
leads to cognitive impairment, change in behaviour and decline in activities of elderly. Similar
type of effect was found for Mr. John too.
Primary health services:
Two main health issues that is leading to major problem for Mr. John current are his loss
of orientation and symptoms of confusion due to dementia and urinary continence. Two primary
health service that would be appropriate to manage Mr. John’s condition include dementia
support related specialist and community services that can provide clinical support to deal with
dementia (Victoria State Government, 2015) and hospital services that can support him
addressing continence related problems like impaired cognition, under-nutrition, frailty and
cognition related support. Community based dementia care services are effective in assessing the
patient and engage in short-term care management (Victoria State Government, 2017).
Strategies and interventions for dementia/challenging behaviours:
In response to the issue of dementia, four interventions would be effective in managing
his unusual behaviours:
1. As John is suffering from poor orientation issues and he wander around the facility, he is
at risk of harm and injury. Waking up at night and wandering is also a challenging
behaviour which could harm Mr. Woods. This is because he may go to a place which is
not appropriate for him. Thus, to manage this, it is necessary to frequently orient him to
his surroundings. This can be done making his contact with familiar objects such as clock

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and calendar so that he is aware of the time. As part of reorientation strategy, it will also
be necessary to adjust the environment around Mr. Woods. This is because patient with
dementia find hard to adjust to a new environment or they get irritated with any
unfamiliarity. Thus, changes such as maintain good lighting and signage can be done so
that even when Mr. Woods start wandering, he could come back to his room without any
harm. Communication with patient can help to modify the temperature of his room as per
his preference. This strategy would help to control his challenging behaviour
(Krishnamoorthy & Anderson, 2011).
2. Another problem was that he was suffering from pain triggers. However, due to his
confusion, he could not give details about his pain. This is occurring because of the effect
of dementia on his concentration level. This issue can be managed by patient centred
communication during which the staff can educate him about the cause of his current pain
and the way to identify the location of the pain. The use of communication strategies like
reassurance, empathizing and reflection can help to protect the client from psychological
harm. Reassurance technique will help to develop sense of safety and familiarity and
address feelings of restlessness in client. Empathizing involves using appropriate non-
verbal gestures like hand touch and active listening to understand client’s concern. This
will help to find out how main concerns of the client and develop positive relationship
with him (Riachi, 2017). Krishnamoorthy & Anderson (2011) argues that as dementia is
associated with language impairment, staffs should ensure that they speak clearly in short
sentence, avoid confrontation and use communication aids while community with
dementia patient.

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3. Another challenging behaviour for Mr. John is his social withdrawal which can further
deteriorate his symptoms. Thus, there is a need to implement intervention that can
address his level of social connectedness and minimize his resistance in taking part in
social activities. This will involve arranging social activities that allow him to tap into his
current or previous habits or roles. For Example, as Mr. John was a hair stylist and he
took pride in his personal style and appearance. Hence, activities related to this previous
role could be arranged to foster engagement in activities. The interest in social activities
can be enhanced by adapting technique like praise statements that increases the social
demand of the activity (Trahan et al., 2014).
4. Another challenging behaviour is his low of appetite as he has been found eating less and
he has recently suffered from weight loss too. If this is not managed on time, it will lead
to malnutrition. Thus, to manage this challenging behaviour, it will be necessary to
implement nutritional intervention that modify food and eating pattern of Mr. John by
providing him assistance with eating, meeting his nutritional requirements. To promote
his interest in eating, environmental modifications during mealtimes such as changing
eating location, food presentation, music and ambient sounds could be done to promote
his interest in eating. This form of meal time assistance intervention can reduce risk and
promote well-being for patient (Murphy, Holmes & Brooks, 2017).
Oral hygiene:
From the analysis of Mr. John’s case study, it has been found that he is at risk of oral health
issues because currently he is dependent on other staffs for his dental care. As he has full lower
and partial dentures, there is a possibility that he is at higher risk of oral health issues. As he has
less number of natural teeth, he is at high risk of caries and untreated lesions. Due to decline in

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cognition, the patient may forget to remove his prostheses thus leading to deposition of food
debris and dental biofilms on the dentures (Pynn & Kolic, 2014). In response to this issue, the
following strategies will be necessary to meet his oral hygiene needs:
1. Firstly, it will be necessary to engage in routine oral assessment and care of Mr. Jones on
a daily basis. Soft and hard tissue oral examination will be necessary to identify any risk
too.
2. Following oral care assessment, it will be necessary for staffs assisting Mr. John to
mechanically remove debris using toothbrush or floss. The patient must be encouraged to
rinse his denture after eating food and removing dentures before sleeping. The staff needs
to monitor and remind about this to him as he is currently suffering from reorientation
issues (Mohammadi, Franks & Hines, 2015).
3. As good oral health is vital for overall well-being, the staff should take special precaution
in cleaning his dentures. They can assist John in cleaning his dentures twice daily. While
using brush for cleaning, care can be taken to use soft-bristled brush. Communication
with others staff is important too so that all staffs are aware that he is wearing a denture.
Looking for signs of discomfort is important too and this signs may involve making faces
and grimacing during brushing. If any of these signs are found for John, then he will be
referred to a dentist too (Mohammadi, Franks & Hines, 2015).
Pain:
From the case analysis of Mr. John, it has been found that the patient has complained
about pain in his left knees. He was found to be wandering at night, suffering from anxiety and
restlessness. These behaviour might also be a sign that he might be suffering from pain.

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Evidence has revealed that the pain is positively associated with these behaviours (Herr,
Zwakhalen & Swafford, 2017).. Thus, there is a possibility that proper management of his pain
can reduce wandering. The first strategy necessary to manage his pain is to first conduct proper
assessment of his pain. However, as he is not able to give details regarding the location and
frequency of his pain, there is a need to use other methods to assess his pain. This can be done by
the use of tools like Non-communicative Patient's Pain Assessment Instrument (NOPPAIN),
which is an evidence based pain assessment tool for dementia. Opioid analgesic may be
continued in the case of Mr. John so that his pain symptoms are addressed. If pain is not
managed by opioid, then adjuvant analgesic can be provided so that his pain symptoms are
addressed. Another important consideration while giving this intervention is that low dose of
opioid should be started first considering the age of Mr. John (Malotte & McPherson, 2016).
Complementary therapies:
Apart from pharmacological and educational intervention, other alternative therapy that
could benefit Mr. John includes music therapy and massage therapy. The advantage of music
therapy is that it can relax the patient and promote health using music experiences. Research
study has shown effectiveness of music therapy in leading to positive effect on cognitive skills,
social and emotional functions and behavioural symptoms. As Mr. John is having social
withdrawal and emotional issues, he may benefit from this therapy (Cho, 2018). In addition, the
advantage of massage therapy it can improve symptom of anxiety in Mr. John and increase his
alertness level. Massage can also alleviate feelings of social isolation. It can reduce anxiety as
well as his stress level (Zhao, Gu & Zhang, 2020).

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Part B:
Look: During analysis of the condition of Mr. John Woods, it was found that he had been
diagnosed with Alzheimer’s dementia and urinary incontinence. Other medical history includes
history of MI, hypertension, osteoarthritis and anxiety and depression.
Collect: While collecting data on his current symptoms and health problem, it was found
that Mr. John is suffering from anxiety and social isolation. He is also dependent on mobility and
needs assistance in his daily personal care. Another major problem is that he is found to wander
at night and sleep during the day. Pain in the knees is also an issue for him currently. He lost
interest in eating food and lost weight too.
Process: From the analysis of subjective and objective data of patient, it has been found
that night wandering and reorientation issue is a challenging behaviour as this may increase his
risk for fall and injury. Hence, focusing on addressing this symptom is important. As the patient
was awake at 3:00 hrs despite giving analgesic, it is a sign that his pain has not been managed.
Hence, this needs to be prioritized first too.
Decide and Plan: Based on analysis of Mr. Woods current and immediate health needs, it
has been identified that two actual problem or issue for Mr. Wood is presence of challenging
behavior like wandering and presence of pain. Thus, these two issues need to be addressed first.
Two other potential issues for Mr. Jones is risk of self-harm because of social isolation and
history of depression and risk of malnutrition due to loss of appetite.
Act: To ensure that night wandering is reduced, it is necessary to provide
pharmacological intervention like NSAID drugs to improve his symptoms. In addition,
environmental modification will be necessary too so that his condition is managed well. In

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addition, to address the issue of persistent pain evidenced by restlessness, adjuvant analgesic
treatment can be provided to patient. This can be followed by regular assessment of pain
(Achterberg et al., 2020).
In addition, for potential risk of suicide or self-harm, it will be necessary to engage
patient in social activities that provokes his past interest. Possibilities like rewards or
appreciation should be incorporated in the activities too so that Mr. John develops interest in
taking part in this activities. This can address his feelings of social isolation (Scales, Zimmerman
& Miller, 2018). In addition, his dietary issues can be managed by providing nutritional
supplements.
Evaluate: The effectiveness of pharmacological intervention will be done by assessment
of dementia symptoms. Absent of wandering and improvement in anxiety will be a sign that
therapeutic effect has been achieved. In addition, evidence based pain assessment and observing
of patient’s behaviour such absence of restlessness can show that his pain symptoms has been
manage. Signs of resolution of his potential risk may include increased participation in social
activities and weight gain.
Reflect: To conclude, this experience revealed that management of dementia requires not
just management of physical symptoms, but also engaging in holistic management by focusing
on their social and emotional health too.

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