Comprehensive Case Study and Nursing Care Plan on Dementia: Patient A

This case study examines a 75-year-old patient, referred to as Patient A, residing in a residential care facility and diagnosed with dementia. The patient exhibits symptoms of memory loss, cognitive impairment, depression, and schizophrenia, along with tremors and incontinence, compounded by a history of substance abuse. The study delves into the patient's condition, exploring the potential causes, including Lewy body dementia, vitamin deficiencies, and the impact of aging based on the free radicals theory. The analysis covers the physiological processes of aging, such as neuronal loss, vitamin B deficiency, and mental health problems, and their relevance to Patient A's condition. The case study also references various research papers and studies to support the findings and provide a comprehensive overview of the patient's condition and potential care strategies.

Running head: CASE STUDY AND NURSING CARE PLAN ON DEMENTIA
CASE STUDY AND NURSING CARE PLAN ON DEMENTIA
Name of the Student
Name of the university
Author’s note

1CASE STUDY AND NURSING CARE PLAN ON DEMENTIA
CASE STUDY
This is the case study of a Patient A who is 75 years old, who is living with
dementia, and has been under the live in support of a residential care. Dementia has
affected the life of patient A, as he was suffering from memory loss of recent events.
The patient was already suffering some mild cognitive impairment, which has worsened
over time and the person is having difficulties in performing even the simplest tasks.
The patient was having several episodes of depression and schizophrenia, which have
led to his hospital admission. Patient A was having low to moderated tremors. He had
also been suffering from some incontinence issue which has further deteriorated his self
confidence. Patient has also got a past history of substance abuse and alcohol.
Incontinence is common is patients with dementia as cognitive deficits in patient causes
loss of visuospatial abilities and frontal lobe dysfunction that interferes with the patient's
ability to recognizes the needs to go to the toilet, to recognize the toilet, to disrobe or
use the toilet properly. The brain fails to control the sphincter muscles of the bladder
(Orme et al., 2015). He is unable to move on his own which signifies an end stage
dementia. The patient has also reported that he is having difficulties in swallowing. Brain
imaging and blood tests have confirmed the occurrence of dementia (Selmen et al.,
2012). Mood testing IQ examination has also indicated towards the occurrence of
dementia. Subjective data reveals that the patient had been suffering from tremors.
Tremors, confusion and shuffling can be associated with Lewy body dementia
(Reijnders et al., 2013). It is the most misdiagnosed and the second most common
cause of progressive dementia. Occurrence of lewy bodies is linked with ageing. The
patient was also suffering from age related incontinence issues. The patient had been
reported to be suffering from Vitamin B 12 and folate deficiencies have also taken a toll
on the life of the patient, which can be one of the perpetuating factors behind dementia
(Moor et al., 2012). Vitamin D is known for its ability to utilise phosphorus and calcium of
the body. The results of the ‘mini-mental state examination’ result were compared to the
Vitamin D status of the patient and were found to be quite low than the normal value
(Moor et al., 2012). vitamin D have numerous functions in the nervous system of
animals, such as regulation of the neuro-trophic factors, calcium homeostasis, release

2CASE STUDY AND NURSING CARE PLAN ON DEMENTIA
of the neurotransmitters, oxidative stress mechanisms, and modulation of the
inflammatory process and immune system (Moor et al., 2012)..
Cognitive impairment is one of the common symptoms of the dementia.
Dementia is a disease related to brain and such a disorder might disrupt the problem
solving capacity and judgement function of the brain, which has led to behavioural and
metal problems in the patient A (Reijnders et al., 2013).
Although the world has advanced in the fields of molecular biology, the mysteries
controlling the lifespan of the human is still to be unravelled. Many theories that fall in
the two broad categories ‘programmed and error theories’ have found to be
unsuccessful explaining the process of ageing. Yet one of the modern theories that go
well with this case study is the 'free radicals theory (Liochev, 2013)'. This theory was
introduced by Dr. Denham Harman, who has proposed that free oxidative radicals and
super oxides damages the macromolecular cell components, such as lipids, sugars,
nucleic acids and proteins, causing the cell to stop functioning (Kirkwood & Kowald,
2012). The body poses some natural antioxidants that curb the ill effects of the oxidative
radicals.
Reactive oxygen species (ROS) are the by-product of the mitochondrial electron
transport chain during aerobic respiration. If the ROS are produced in excess then it
overwhelms the natural antioxidants of the body and due to which cells such as the
neuronal microglia gets damaged. ROS are produced in abundance in the central
nervous system (Kirkwood & Kowald, 2012). The brain is vulnerable to oxidative
damage as it is rich in peroxidizable fatty acids, responsible for the 20% of the total
oxygen consumption of the body. The oxidative species causes nitration of the lipids,
leakage of the DNA strands and the nitration of the proteins of the neuronal cells
(Liochev, 2013). Free radicals are also found to be responsible for the extrinsic skin
ageing by the damaging the skin DNA (Zuluaga et al., 2012).
The case study reveals that the patient had a past history of alcohol addiction. It
should be noted that the environmental sources of oxidative radicals includes smoke,

3CASE STUDY AND NURSING CARE PLAN ON DEMENTIA
alcohol and saturated fat. Thus alcohol can be considered as one of the precipitating
factor behind the formation of the oxidative stress in the brain (Kruman eta l., 2013).
Although neuronal damage due to oxidative stress was supported by Vitamin C
level lower in aged patients, yet low Vitamin B level is associated with depression,
agitation, irritability, agitation as seen in case of patient A (Tarter & Van Thiel, 2013).
Ageing can be considered as a progressive physiological degeneration causing
cessation of the function of the organ system and reduction of the physical reserve
(Selmen et al., 2012). Among most of the body systems the two systems that are
significantly affected are the skin and the brain. In general there is a neuronal loss both
in the brain and the spinal cord. Loss of the neuronal dendrites hampers the synaptic
transmission (Tarter & Van Thiel, 2013). Sense of smell, taste, touch, and hearing
diminishes with time (Balash et al., 2013). Mild to moderate cognitive impairment takes
place. In case of brain diseases the cognition is greatly affected causing drastic,
unmanageable behavioral change. Impaired synaptic activity leads to depression and
anxiety (Balash et al., 2013). All these can be linked to the current health condition of
patient A. Furthermore elderly patients with dementia can have urinary incontinence as
impaired neural control mechanisms fails to control the pelvic floor muscles causing
involuntary bladder contraction leading to incontinence (Grant et al., 2013).
Furthermore, alcohol consumption can deteriorate the condition of the heart and the
blood vessels and can exacerbate the process of ageing. It can also worsen the mood
disorders and memory loss in the patient (Tarter & Van Thiel, 2013). Smoking and
drugs can damage the neuronal cells and ceases the development of the new nerve
cells, which may give rise to several cognitive ailments (Kruman eta l., 2013). Elderly
people often develop complications with the stomach enzymes and the acids that are
required for the synthesis of Vitamin B. This is mainly due to the thinning of the stomach
lining that reduces the acids of the stomach. This is one of the physiologies of ageing
that can be linked with the condition of patient A (Kirkwood & Kowald, 2012). Hence the
physiological processes of ageing such as neuronal loss, vitamin B deficiency,
incontinence and mental health problems like depressions, schizophrenia can be well
related to the concerned patient of the case study.

4CASE STUDY AND NURSING CARE PLAN ON DEMENTIA
References
Balash, Y., Mordechovich, M., Shabtai, H., Giladi, N., Gurevich, T., & Korczyn, A. D.
(2013). Subjective memory complaints in elders: depression, anxiety, or cognitive
decline?. Acta Neurologica Scandinavica, 127(5), 344-350.
Bedi, R. (2015). Dementia and oral health. Journal of public health policy, 36(1), 128-
130.
Grant, R. L., Drennan, V. M., Rait, G., Petersen, I., & Iliffe, S. (2013). First diagnosis
and management of incontinence in older people with and without dementia in
primary care: a cohort study using The Health Improvement Network primary
care database. PLoS medicine, 10(8), e1001505.
Kirkwood, T. B., & Kowald, A. (2012). The free‐radical theory of ageing–older, wiser and
still alive. Bioessays, 34(8), 692-700.
Kruman, I. I., Henderson, G. I., & Bergeson, S. E. (2012). DNA damage and
neurotoxicity of chronic alcohol abuse. Experimental Biology and Medicine,
237(7), 740-747.
Kyle, G. (2012). An insight into continence management in patients with dementia.
British journal of community nursing, 17(3).
Liochev, S. I. (2013). Reactive oxygen species and the free radical theory of aging. Free
Radical Biology and Medicine, 60, 1-4.
Moore, E., Mander, A., Ames, D., Carne, R., Sanders, K., & Watters, D. (2012).
Cognitive impairment and vitamin B12: a review. International psychogeriatrics,
24(4), 541-556

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Noble, J. M., Scarmeas, N., & Papapanou, P. N. (2013). Poor oral health as a chronic,
potentially modifiable dementia risk factor: review of the literature. Current
neurology and neuroscience reports, 13(10), 384.
Orme, S., Morris, V., Gibson, W., & Wagg, A. (2015). Managing urinary incontinence in
patients with dementia: Pharmacological treatment options and considerations.
Drugs & aging, 32(7), 559-567.
Reijnders, J., van Heugten, C., & van Boxtel, M. (2013). Cognitive interventions in
healthy older adults and people with mild cognitive impairment: a systematic
review. Ageing research reviews, 12(1), 263-275.
Selman, C., Blount, J. D., Nussey, D. H., & Speakman, J. R. (2012). Oxidative damage,
ageing, and life-history evolution: where now?. Trends in ecology & evolution,
27(10), 570-577.
Tarter, R. E., & Van Thiel, D. H. (Eds.). (2013). Alcohol and the brain: Chronic effects.
Springer Science & Business Media.
Zuluaga, D. J. M., Ferreira, J., Montoya, J. A. G., & Willumsen, T. (2012). Oral health in
institutionalised elderly people in Oslo, Norway and its relationship with
dependence and cognitive impairment. Gerodontology, 29(2).