Nursing Report: Patient Care Plan for Elderly Patient, Alzheimer's

This nursing report details the care plan for an 87-year-old patient with multiple health concerns, including Alzheimer's disease, depression, anxiety, diabetes, and other chronic conditions. The report discusses the pathophysiology of the patient's symptoms, focusing on the risk of falls, confusion, and chronic lower back pain. It outlines pharmacological interventions, including Paracetamol, Mirtazapine, and Oxazepam, detailing their actions, adverse effects, contraindications, and nursing considerations. Furthermore, the report covers essential assessments and investigations, such as neurological, cardiovascular, renal, and gastrointestinal assessments, highlighting their impact on the patient's care plan. The report also emphasizes the importance of monitoring vital signs and blood glucose levels, providing recommendations for achieving better health outcomes for the patient. This comprehensive analysis aims to guide effective patient care and management.

1Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

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Introduction
The patient Mr X, an 87-year-old man, was admitted to the care facility with multiple
health concerns. The name of the patient has been kept confidential as an ethical concern.
The patient is a retired professor and lives with his wife who is the primary care giver. The
patient had previously suffered aspiration pneumonia and APO for which he had to be
admitted to the FMC. However, since his wife was not able to cope with the stress of looking
after him, he had to be admitted to the aged care facility as a permanent resident. The patient
has been suffering from Alzheimer disease, depression for the last few months, anxiety, type
2 diabetes mellitus, hearing loss, hypercholesterolaemia, glaucoma, stent-femoral artery,
macular degeneration, TURP since the last ten years, peripheral vascular disease, chronic
heart failure and chronic lower back pain. From the chief presenting conditions it is to be
noted that the patient needs immediate attention and an appropriate care plan is to be outlined
for the patient to achieve better health outcomes. The present paper would discuss the
pathophysiology of the patient’s main signs and symptoms and explain the pharmacological
interventions for these conditions. This would include the action of the durg, adverse effects,
contraindications and nursing considerations. The assessments and investigations for the
patient would be discussed, highlighting how these could impact on the care of plan for the
patient. Lastly, recommendations would be outlined for achieving better outcomes for the
patient.
Pathophysiology and pharmacology
The patient at the time of admission to the aged care facility has been presenting with
multiple symptoms that required immediate actions to be taken against them. The prime
patient concern is a risk of falls due to hearing loss, visual impairment and confusion, that
might lead to adverse physical injury. The patient is suffering from Alzheimer’s disease that

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has been detected recently. According to Wimo et al., (2013, p. 15) hearing and sight loss are
the two most striking complication suffered by a patient of Alzheimer's disease, a form of
dementia. A number of cross-sectional studies have pointed out that there lies an association
between sensory impairments and cognitive decline in case of dementia. Such sensory
impairments include hearing and visual impairment. Dementia, including Alzheimer's
disease, is one of the major disorder suffered by individuals aged 70 and above wherein a
number of problems are suffered by the patient. The pathology of this disease is marked the
abnormal aggregates of beta-amyloid deposited in the brain in the form of senile plaques
along with neurofibrillary tangles of abnormally phosphoryated tau. Dementia leads to a
number of visual problems such as colour vision loss, visual acuity loss, changes in pupillary
response to mydriatics, defects eye movements, disturbances of complex optical functions
such as reading and detecting objects. The decline in hearing ability is a neurological
impairment due to the changes in the functioning of the brain. Risk factors for falls in older
patients include both intrinsic (person-centered) and extrinsic (environmental) factors. Some
of the most important intrinsic factors can involve balance impairment, hearing, cognition,
muscle strength, vision, gait, and symptoms realted to depressions. Hearing dysfunctions is
found to be the third most common chronic ailment in the older adults aged 65 years and
above. Hearing impairment can decrease the quality of life and is independently related with
difficulties in walking, functional decline, social isolation and impaired cognition. A number
of research studies have highlighted hearing dysfunction in relation to fall related risks.
Patients suffering from hearing impairment need increased attention for the detection and
processing of auditory cues, leaving alteredattentional resources for balance control
(Steinberg etal., 2015, p. 446). Vision impairment is directly linked with risk of falls. The
direct and simple mechanism is that people having vision impairments do not identify
environmental hazards beyond their line of sight (Beltran et al., 2015, p. E5844-45).

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Confusion and disorientation are other patient symptoms that need attention. The
patient had been wanderingfrom one place toanother and have the predisposition to get lost.
In addition, he had been getting into other resident’s room. These conditions present him with
the increased risk of getting harmed. These conditions are related to Alzhiemr’s disease.
Though short term memory of Alzhemier’s patients are lost, the long term memory of these
patient links to the past life. Mrs. X’s Wandering behaviour is a result of the fact that he was
a paediatric Professor and he used to wander from place to place in the hospital looking after
his patients.The rationale behind such conditions is dementia that is known for giving rise to
extremely difficult situations for the patient to cope up with. The main cause of the confusion
and disorientation is the progressive damage to the cells of the brain due to Alzheimer's
disease. The functioning of the brain is hampered to the extent that the patient struggles to
understand and perceive the environment around (Berry, 2014,p. 123). Chronic lower back
pain (LBP) is the next symptom drawing the attention of the carer. Lower back pain is termed
as chronic after 3 months if the normal connective tissues do not heal within this time period.
A slow rate of tissue repair in the relatively avascular intervertebral disk impairs the
resolution of chronic LBP. Traumatic and degenerative conditions of the spine are the
common causes of chronic LBP (Arneja et al., 2016, p. 453). In the present case, the patient
has been suffering from this condition that has affected his activities of daily living (ADL).
The patient relies completely on his wife for daily functioning. Dementia patients have
difficulties in expressing their pain. The rationale being reduced ability to communicate with
others and reduced cognitive ability. As a result, they find their own ways of getting relieved
from the pain (van Kooten et al., 2017, p.523). In the present case, the patient might be
wandering for getting relief from pain in the chronic back pain. Further the pain might be
impairing the patient’s ability to carry out ADL. The researhers point out that pain and
functional impairment is the cause of reduced ability to carry out ADL.

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Based on the main signs and symptoms that the patient has been presenting, the
pharmacological intervention for the patient would include Paracetamol, Mirtazapine, and
Oxazepam. Paracetamol, or acetaminophen, is a common drug used for relieving pain in
patients. The drug has been recommended as the first-line treatment for low back pain.
Though the drug does not generally have any adverse side effect, some patients might
develop allergic reactions, severe dizziness, liver damage and trouble in breathing.
Contraindications include renal impairment, acute inflammation of the liver and poor
nutrition. A nurse is to check whether the patient is taking any other medication that has
paracetamol as a constituent. Evaluation of therapeutic response is also essential (Lehne&
Rosenthal, 2014, p. 254). Mirtazapine is a common drug indicted for treating depression in
patients. The effectiveness of the drug is indicated by mood elevation. The side effects of the
drug include nervousness, delusions, feelings of restlessness, drowsiness, headache,
constipation, dysphagia and weakness. The contraindications for this drug include
hypersensitivity to mirtazapine, acute Myocardial Infarction, infection, fever, jaundice,
hematologic disease and ethanol intoxication. Patients are to be monitored for the worsening
of depression by the nurse. Orthostatic hypotension is to be monitored along with the history
of cerebrovascular disease (Adams & Urban, 2015, p. 57).
Oxazepam is the choice of drug for treating and managing anxiety in patients. The
drug has hypnotic, anxiolytic, sedative, and skeletal muscle relaxant effects. The side effects
of the drug include dizziness, drowsiness, vertigo, mental confusion, lethargy, skin rahs,
oedema and slurred speech. Contraindications for this drug include hypersensitivity to
oxazepam and other benzodiazepines and psychoses. Nursing considerations for the drug
include signs of overdose. In case the patient suffers depressed daytime psychomotor
function the physician is to be informed (Karch&Karch, 2016, p. 87).

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Investigation
Since the patient suffers from Alzheimer, a common form of dementia, it is
imperative to carry out a neurological assessment for understanding the extent of cognitive
function decline. The role of neurological assessment in dementia is well explained by
Nielsen et al., (2016) who state that cognitive deficits arising due to dementia are different
from that of age-related complications, making the neurological assessment more demanding.
Patient assessment pertaining to the neurological functioning enhances the ability to clinically
diagnosis the disease early in its course, as for the case of Mr X. The assessment is significant
for understanding the deficits in executive functions accountable for the mental manipulation
of concept information, cue-directed behaviour and problem solving skills. The test is to
encompass those for reflexes, eye movement, speech, coordination, muscle strength and tone,
and sensation. The assessment in the present case determined that Mr X had anxiety and
confusion as the main complications arising due to dementia.
A cardiovascular assessment is imperative for a patient with dementia since heart
disease is a risk factor for dementia. The rationale is that reduced cerebral blood flow (CBF)
as a result of heart disease is known to worsen the vascular homeostasis of the brain. The
cognitive problems faced the patient, as a result of beta- proteins and tau protein build-up are
magnified as a result. Studies also indicate that dementia patients having a history of heart
disease have more chances of having structural and functional cardiac abnormalities (Liu et
al., 2017). Cardiovascular assessment for Mr X revealed blood pressure at 151/85 mmHg.
This reading is higher than the normal value for BP at 120/80 mmHg. The heart rate was
normal at 90 bpm as the normal values are 60-100 bpm. This information indicated the need
for controlling blood pressure through medication and proper dietary intake.
Renal assessment is important for the patient since it helps in identifying renal
impairments, monitoring disease progress and assessing baseline measurements before

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commencing on medications. Since the patient, in this case, needs to be administered a
number of medicines for his presenting signs and symptoms, it is desirable that renal
assessment is done. Based on the results of this assessment the medication regimen can be
outlined (Wanner et al., 2016, p. 325). The patient in the present case has reported faecal
incontinence. A thorough gastrointestinal assessment would be thus required in this case.
This condition is marked by the involuntary passage of faeces or the inability to control the
discharge. Assessment of the condition would enable the nurse to improve the quality of life
for the patient. Since the Mr X is unable to carry out ADL by himself and has several
impairments, addressing the concerns of faecal incontinence would be suitable to relieve him
from associated complications.
The care facility did not record patient’s vital signs for 3 months even though their
policy is to do monthly vital signs for each resident. Vitals signs are the main indicators of
the patient’s health condition and determine the respiratory, neural,circulatory, and
endocrinal functions. Vitals signs are a mechanism to communicate a patient's condition and
severity of disease. The parameters help nurses in identification of the interventions that are o
be given to the patient and making decisions concerning the response of patients to
treatment.In the context of care provided to elderly patients, vitals signs act as the indicators
that needdistinct attention since these individuals experience in their cognitive, physiological
and psychosocial health. Vitals include the physiological measurement of blood pressure,
heart rate, respiratory frequency and temperature(Black, 2016, p. 264).Monitoring these
parameters for Mr X is important sicne he is at high risk of altered functionality as a result of
aging and dementia, considered the phase of greatest vulnerability due to comorbidities.The
importance ofBGL being undertaken once weekly is also to be highlighted. For Mr X BGL is
to be taken on Friday pre-meal as per doctor order as they have missed this as well since
6/6/2017. The last BGL result pre-meal on 6/6/2017 was 6.4 mmol/l while at present it is 6.1

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mmol/l. BGL is to be checked once in a week for for ensuring that the level is under control
(Aleppo etal., 2017, p. 539). Some classes of oral drugs can lead to hypoglycemia or low
blood sugar so regular monitoring is needed. Changes in body weight also determine BGL
and confer the need of regulary monitoring BGL.Blood glucose level is to be assessed since
the patient had been suffering from Type 2 diabetes. In case a patient has diabetes, it is
recommended to provide the patient with a diet that meets the nutritional needs of the body as
well as lowers the level of blood glucose. For the majority of healthy individuals, normal
blood sugar levels are as follows: between 4.0 to 6.0 mmol/L (72 to 108 mg/dL) when fasting
and up to 7.8 mmol/L (140 mg/dL) 2 hours after eating.
The mental health status of MrX was assessed by mini mental status examination
(MMSE) tool. Assessment of the mental health status is important element of overall
examination of a patient. It augments other forms of assessment components like the
atienthistory of complaints, and helps in providing cue for a detailed assessment such as
cognitive assessment or psychometric testing. Though the health history might be static, the
mental status is dynamic. The mental status examination is aguide to structure data regarding
the patient’s mental functioning (Pasi et al., 2015, p. 253).
Recommendation
Based on the patient condition and the assessment findings, a number of
recommendations are outlined for addressing each of the patient concerns. Firstly, the patient
must be supported to achieve optimal health and wellbeing through participation in different
activities. This is to include both physical and social heath care. The patient has been
suffering from dementia, and thus his cognitive functioning needs special attention. The
patient can be given memory activities such as puzzles that would augment his cognitive
skills for enhancing his mood and eliminating chances of social isolation; the patient needs to

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engage in any recreational activity. For this purpose, a professional can be helpful who would
help in assisting with the activities (Butcher et al., 2013, p.214). Since the patient has
impaired body functioning and chronic back pain and struggles with his ADL, appointing a
physiotherapist would be noteworthy who can bring improvements in his mobility and ability
to carry out activities in an independent manner.
Fall prevention is a key aspect of the care plan for the patient since the patient is at
increased risk of suffering falls due to visual and hearing impairment. Firstly, an armband is
to be given to the patient to wear so that other professionals can easily identify high-risk
patients and act accordingly. Using a visual cue outside the door of the patient’s room would
alert the carers about the risk of falls. The number of safety companions, when increased,
would ensure that those who are disoriented, such as Mr X, are provided with continuous
observation and monitoring for preventing falls. Bed alarms are useful so that patients can
call for help at day time of the day or night. Ensuring that the bed is provided with side rails
and the washroom has handrails is important. One also needs to ensure that the floors are dry
and not slippery. Spills of any form are to be avoided, and the floor has to be free from any
heavy furniture or any other things that might lead the patient to trip (Potter et al., 2016, p.
56).
The elements of patient care would be dietary intake, pain management, BGL
assessment and observation of vital signs to detect changes in patient condition. A dietician is
to be consulted who would outline the dietary chart as per the body requirements of the
patient (Black, 2016, p. 57). Pain management would be possible with the administration of
medications at regular intervals. BGL assessment and observation of vital signs is important
to promote suitable dietary intake. A social worker would encourage the wellbeing of the
patient by providing emotional support so that the patient can express his feelings. It is to be
noted that the communication made with the patient has to follow the ‘5 S’ rule- Slow,

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Simple, Specific, Show & Smile that is effective for dementia patients (Potter et al., 2016, p.
98).

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References
Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson
Education.
Aleppo, G., Ruedy, K. J., Riddlesworth, T. D., Kruger, D. F., Peters, A. L., Hirsch,
I., ...&Rickels, M. R. (2017). REPLACE-BG: a randomized trial comparing
continuous glucose monitoring with and without routine blood glucose monitoring in
adults with well-controlled type 1 diabetes. Diabetes Care, 40(4), 538-545.
Arneja, A. S., Kotowich, A., Staley, D., Summers, R., &Tappia, P. S. (2016).
Electromagnetic fields in the treatment of chronic lower back pain in patients with
degenerative disc disease. Future science OA, 2(1).
Beltran, W. A., Cideciyan, A. V., Iwabe, S., Swider, M., Kosyk, M. S., McDaid,
K., ...&Boye, S. L. (2015). Successful arrest of photoreceptor and vision loss expands
the therapeutic window of retinal gene therapy to later stages of disease. Proceedings
of the National Academy of Sciences, 112(43), E5844-E5853.
Berry, B. (2014). Minimizing confusion and disorientation: Cognitive support work in
informal dementia caregiving. Journal of aging studies, 30, 121-130.
Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health
Sciences.
Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2013). Nursing
Interventions Classification (NIC)-E-Book.Elsevier Health Sciences.
Karch, A. M., &Karch. (2016). Focus on nursing pharmacology. Lippincott Williams &
Wilkins.

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Lehne, R. A., & Rosenthal, L. (2014). Pharmacology for Nursing Care-E-Book.Elsevier
Health Sciences.
Liu, E., Dyer, S. M., O’Donnell, L. K., Milte, R., Bradley, C. E., Harrison, S. L., ... &Crotty,
M. (2017). Association of cardiovascular system medications with cognitive function
and dementia in older adults living in nursing homes in Australia.
Nielsen, T. R., Phung, T. K. T., Chaaya, M., Mackinnon, A., &Waldemar, G.
(2016).Combining the Rowland Universal Dementia Assessment Scale and the
Informant Questionnaire on Cognitive Decline in the Elderly to improve detection of
dementia in an Arabic-speaking population. Dementia and geriatric cognitive
disorders, 41(1-2), 46-54.
Pasi, M., Salvadori, E., Poggesi, A., Ciolli, L., Del Bene, A., Marini, S., ...&Toschi, N.
(2015). White Matter Microstructural Damage in Small Vessel Disease Is Associated
With Montreal Cognitive Assessment But Not With Mini Mental State Examination
Performances. Stroke, 46(1), 262-264.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-
Book.Elsevier Health Sciences.
Steinberg, S., Stefansson, H., Jonsson, T., Johannsdottir, H., Ingason, A., Helgason, H., ...&
Kong, A. (2015). Loss-of-function variants in ABCA7 confer risk of Alzheimer's
disease. Nature genetics, 47(5), 445-447.
vanKooten, J., Smalbrugge, M., van der Wouden, J. C., Stek, M. L., &Hertogh, C. M. (2017).
Prevalence of Pain in Nursing Home Residents: The Role of Dementia Stage and
Dementia Subtypes. Journal of the American Medical Directors Association, 18(6),
522-527.