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Case Study: Dementia.

Evidence Based Practice- Mr. Dale. Case Study- Nursing Case Study Assignment Help

Task:

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Dementia , Delirium,  Depression,  Interventions , Behaviours,  Restraint, Person centred dementia care. Every sentence should be appropriately referenced.

Students are to use the literature duly referenced to demonstrate evidence based practice, assessment and management. It is not necessary to copy the case study text into your assignment but reference can be made to it.

Presentation of Assignment 2 The case study needs to be presented in academic style with due referencing. It must include a title page with the topic number, topic title, assignment number and title, student’s name, contact details and the date. The assignment must be in size 12 font in Times New Roman or Verdana typeface and can be single line-spaced. The assignment is required to be submitted by the due date. The case study will need to be presented using the literature as evidence of your study around the particular needs of the client. The application of the relevant literature to the case study must form the majority of the assignment. An introduction and conclusion to the assignment is expected, as well as the reference list (entitled references). Appendices if used should be referenced and are placed before the reference list

Case:- 
Students are to undertake a case study and research the literature as to the assessment, planning, management and evaluation of the care for this person. Please refer to the assignment details document above for details. Dementia, Delirium and Depression 
Case Study for Assignment 2 Word Count 3000

Mr Dale (88) has been transported to the ED from his home where he lives with his 86 year old wife. His wife is in reasonable health but has become increasingly unable to care for her husband in their home. A grandson lives with them and helps with his grandfather’s care. Mostly, Mr Dale sleeps in a chair in front of the television or in his bed. He has a person come in to shower him twice a week. He has a diagnosis of dementia and a past history of ® CVA 20 years ago. He also has atrial fibrillation, Diabetes Type 2 and glaucoma. Since his CVA, his speech has deteriorated and he has become aphasic. He also has bilateral deafness and no longer wears his hearing aids. He was brought into the acute care hospital because he has confusion and has become increasingly incontinent of urine and faeces and has been found on the floor. He is accompanied by his grandson who speaks for him and describes that his grandfather has become increasingly confused and has hit out at the person who was trying to shower him. Mr Dale appears to be alert in the ED and after some time, is finally admitted to the medical ward.

Over the next 7 days, after being treated for a UTI, Mr Dale becomes increasingly dependent on nursing staff for all activities of daily living. He is extremely unsteady on his feet and keeps wanting to get up from the chair next to his bed. Generally he is compliant with care and appears to know he is in hospital. Various tests, included a Mini Mental State Examination are performed. His score is 19. He recognises his children who visit and answers closed questions with a yes or no. He is eating and drinking with assistance. It is recommended that Mr Dale is admitted to residential aged care and he is assessed by the ACAT team as needing high care.

The family find a residential aged care bed near the wife’s home and Mr Dale is admitted. His discharge medications include metformin, insulin, digoxin and enteric coated aspirin. He is kept in his bed for the first five days and after this a chair is purchased for him by his children, and he is then either in his bed or in the chair in his room. His children visit frequently and regularly. After a couple of weeks, the staff place Mr Dale in a ‘comfort’ chair and wheel him  to the television room where he appears to sleep most of the time, every day. He is no longer feeding himself. Despite all of this, his son is able to play a round of poker with him when he visits. Mr Dale remains incontinent of urine and faeces. The family place photographs around the room and start a diary of their visits. Mr Dale seems to wake up, enjoy and interact with his children and grandchildren when they visit. He is able to answer close ended questions and still recognises them.

One day after about three weeks, Mr Dale becomes aggressive and very difficult with the staff who are trying to get him into the shower. The General Practitioner is called. A urinalysis indicates a urinary tract infection and a groin rash is also present. Mr Dale is placed on antibiotics and the use of incontinence pads continues with an order of zinc cream application to the groin. The doctor is also considering prescribing respiridone for his aggression and an antidepressant as the doctor assesses that Mr Dale is depressed. Also an antipsychotic was considered it was not prescribed. The doctor believes this because of Mr Dale’ disinterest in life or anything other than food, and because of his sleeping pattern. Physical restraint is also being considered for the future if he becomes aggressive with staff. After this incident, the staff become fearful of Mr Dale. Certain staff members have been heard speaking to Mr Dale like he is a baby and also admonishing him. It is assumed by staff that Mr Dale is not orientated in time and place and has severe dementia and memory problems, despite him being aphasic and deaf and yet able to answer close ended questions, recognise his children and play cards.

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