HLTENN004 Diploma Nursing: Case Study on Dementia, Depression

This case study presents a nursing care plan for a 70-year-old male patient residing in a clinical placement facility, suffering from dementia, depression, anxiety, and incontinence, complicated by a history of alcohol and drug abuse. The patient's conditions have led to cognitive impairment, impacting his daily activities, memory, and social interactions. The care plan considers the Free Radicals Theory of aging, linking the patient's history of substance abuse to his deteriorating mental and physical health. The study also addresses the physiological aspects of aging and how substance abuse exacerbates these effects, ultimately affecting the patient's overall well-being and quality of life.

Running head: NURSING CARE PLAN
NURSING CARE PLAN
Name of the Student
Name of the University
Author Notes

1NURSING CARE PLAN
Introduction
This essay is the case study of an aged individual residing in a clinical placement
facility. Before starting to gather information about the patient, permissions were
obtained from the clinical placement facility. The person or the aged individual is a 70-
year-old man and suffers from dementia, depression, anxiety and incontinence. The
patient had a history of alcohol abuse, which may be responsible for his symptoms
associated with dementia. This is termed as alcohol related brain damage (Ridley,
Draper & Withall, 2013). This is common among older adults. Apart from alcohol, he
also had a history of drug abuse and this may be responsible for the symptoms
associated with anxiety and depression. Long-term use of cocaine and heroin have
been reported to lead to anxiety and depression among individuals (Naifeh, Tull &
Gratz, 2012). Incontinence is the inability to control urine discharge and leads to
involuntary release of urine. Incontinence had a significant impact on the life of the
individual as it affected both his mental and physical health.
This in turn further aggravated his symptoms of anxiety and depression (Felde,
Ebbesen & Hunskaar, 2017). These medical conditions have affected his way of life.
Anxiety, depression and dementia are usually associated with cognitive impairment
(Balash et al., 2013). He is unable to carry out his daily activities like walking,
communicating, getting dressed. He has often succumbed to falls and was subjected to
injuries as a result of his cognitive impairment. This has also affected his memory as he
frequently forgets that he has already eaten and quarrels with the nursing staff that he
was not given food. He also faces difficulties in understanding what others are saying
and often hallucinates. He has lost his confidence and does not come out of his room
and talk to others. He feels embarrassed due to his incontinence issues. Thus, his
social life is also affected further worsening his mental disorders.
The theory of ageing appropriate for this patient is the the Free Radicals Theory.
According to this theory, aging is caused because of assaults caused on the body either
internally or externally. These assaults damage the cells and subsequently the organs,
which results in improper or loss of vital function of the body (Vina et al., 2013).

2NURSING CARE PLAN
According to the free radical theory, ageing occurs because of accumulation of free
radicals over time. Biological structures undergo oxidative damage by free radicals.
Free radical damage is caused because of chain reactions, where one free radical helps
in the generation of another free radical, thereby resulting in subsequent damage to
various parts of the body. Free radicals can cause DNA cross-linking, which can result
in various medical conditions encountered during the ageing process, particularly
cancer. Free radicals are also associated with the formation of wrinkles and clogged
arteries of the heart concerning the ageing population. Nitric oxide and superoxide are
some of the free radicals associated with the ageing process. Various antioxidants can
help reduce the damaging effects of free radicals on the body (Kirkwood & Kowald,
2012). This theory is appropriate for the patient described in the case study because he
had a history of alcohol and drug abuse. Both alcohol and drugs are known to have
significant impacts on the body that can lead to serious consequences in the future.
Alcohol and drug abuse has been linked to deteriorating mental conditions in the
elderly. Moreover, alcohol abuse also leads to incontinence issues, particularly in the
elderly. Long-term alcohol and drug abuse leads to the accumulation of toxic
substances in the body that accumulates over the years and gives rise to various
medical conditions by damaging the various parts of the body. Reactive oxygen species
generated because of alcohol consumption can cause damage of cellular complexes
like proteins, fats or DNA. Moreover, alcohol also interferes with the immune system of
the body that acts as a defense system to protect from the effects of the reactive
oxygen species and the free radicals. Metabolism of alcohol in the liver leads to the
formation of reactive oxygen species. Moreover, alcohol also stimulates certain
enzymes involved in the production of reactive oxygen species. Alcohol has been linked
to the development of symptoms of depression. Drinking of alcohol causes the release
of serotonin, which helps to regulate the mood patterns of individuals. However, over
consumption of alcohol can start a vicious cycle, which in turn not only affects an
individual’s physical health but also mental health as well. Regular consumption of
alcohol affects the brain chemistry and reduces the level of serotonin, which is a key
factor in depression (Schnetzer, Schulenberg & Buchanan, 2013).

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Physiology of aging can be defined as the process that starts at birth and
continues throughout the life span of an individual. Aging depends on the genetic
constitution of an individual and also on the environmental impacts. The genetic
constitution of the body determine its ability to adapt to changes in the environment and
carry out repair of damages resulting from various environmental experiences. As aging
progresses, the body loses its efficiency, is unable to carry out repair activities due to
the environmental impacts and this in turn results in loss and damage to tissues. Ageing
is a progressive degeneration carried out at the physiological level involved in decline of
the functions of various organs and diminishing of the physiological reserves of the
body. (Abrams & Thompson, 2014). The patient has a history of drug and alcohol
abuse. Alcohol and drugs cause damage to brain cells or neurons and also prevents
the growth of new brain cells, thereby giving rise to various mental conditions in the
elderly like depression, anxiety, among others. As he aged, his bodily functions also
deteriorated and together with the years of damage caused on his body, further added
to the severity of the medical conditions that he experienced at his old age. As the body
ages, the individual undergoes several bodily changes including decline of mental
health. Thus, it can be concluded that apart from the growing age of the individual, his
alcohol and drug abuse has further heightened his physiological decline.

4NURSING CARE PLAN
Reference List
Abrams, A. P., & Thompson, L. A. (2014). Physiology of Aging of Older Adults. Dental
Clinics, 58(4), 729-738.
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.
Felde, G., Ebbesen, M. H., & Hunskaar, S. (2017). Anxiety and depression associated
with urinary incontinence. A 10‐year follow‐up study from the Norwegian HUNT
study (EPINCONT). Neurourology and urodynamics, 36(2), 322-328.
Kirkwood, T. B., & Kowald, A. (2012). The free‐radical theory of ageing–older, wiser and
still alive. Bioessays, 34(8), 692-700.
Naifeh, J. A., Tull, M. T., & Gratz, K. L. (2012). Anxiety sensitivity, emotional avoidance,
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Ridley, N. J., Draper, B., & Withall, A. (2013). Alcohol-related dementia: an update of
the evidence. Alzheimer's research & therapy, 5(1), 3.
Schnetzer, L. W., Schulenberg, S. E., & Buchanan, E. M. (2013). Differential
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Vina, J., Borras, C., Abdelaziz, K. M., Garcia-Valles, R., & Gomez-Cabrera, M. C.
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