UNFOLDING Reasoning - Primary Concept Cognition Interrelated Concepts...

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Dementia UNFOLDING Reasoning

William “Butch” Welka, 72 years old Primary Concept Cognition Interrelated Concepts (In order of emphasis) •Pain •Mood and Affect •Psychosis •Clinical Judgment •Patient Education •Communication •Collaboration NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment Management of Care 17-23% ✓ Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% ✓ Psychosocial Integrity 6-12% ✓ Physiological Integrity • Basic Care and Comfort 6-12% ✓ Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved. 1 / 3

2 • Pharmacological and Parenteral Therapies 12-18% ✓ • Reduction of Risk Potential 9-15% ✓ • Physiological Adaptation 11-17% ✓

History of Present Problem:

William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II and dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He is now a resident of Pineville Estates, a local long-term care facility the past four months because his dementia progressed and his wife Rita was unable to care for him. When Rita visited Butch this morning, she reports to the nurse that he is more confused and is concerned because Butch is easily angered. Butch insists that he sees his friend Roger, who served with him in the Navy, is in the room, but he died ten years ago. Rita approaches the nursing station with tears in her eyes and states, “What is happening to my husband? This just isn’t like Butch to act like this! Please do something to help him!”

Personal/Social History:

Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to visit Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch believes he is at Pineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were alone. Rita was just awarded guardianship due to his declining mental status.

1.What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: History of heart failure, COPD, HTN, DM II and dementia Has been hospitalized for exacerbation of heart failure three times the past six months.Angry, confused, and hallucinating

All these conditions affect the vascular components of the body and increase the risk of stroke. COPD and HF can also cause him to not receive enough oxygen and blood flow to the brain which could cause the dementia to advance at a quicker rate.End stages of HF S&S include confusion and impaired thinking.COPD could be the cause of the HF exacerbations.S&S of end stage heart failure and is also a S&S of vascular dementia.RELEVANT Data from Social History: Clinical Significance: Married for 51 years 3 adult children that visit regularly Wife visits daily Thinks he in rehab Wife awarded guardianship

Has support at home Has family that visit routinely, routine is important for dementia patients Has continued support at the hospital Could be upset when he finds out why he is in the hospital Wife is the person in charge of decisions related to his care Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved. 2 / 3

3 2.What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?(Which medication treats which condition? Draw lines to connect) PMH: Home Meds: Pharm. Classification: Expected Outcome:

•COPD

•Hypertension •Heart failure •Diabetes type II •Dementia 1.Fluticasone/salmeterol diskus 1 puff every 12 hours 2.Albuterol MDI 2 puffs every 4 hours PRN shortness of breath 3.Lisinopril 10 mg PO daily 4.Atenolol 25 mg PO BID 5.Furosemide 20 mg PO daily 6.Hydrochlorothiazide 25 mg 1tab PO daily 7.Metformin 1000 mg PO BID 8.Glyburide 10 mg PO BID 9.Memantine 5 mg PO daily

• COPD Long Acting

Beta-2 agonist/Corticosteroid combination inhaler; anti-asthmatic; anti- inflammatory

• COPD Autonomic

nervous system agent; Beta-adrenergic agonist (sympathomimetic); Bronchodilator (respiratory smooth muscle relaxant) 3.HTN Long-acting angiotensin converting enzyme inhibitor; antihypertensive

• HTN & HF (off label

use) Cardio Selective- Beta blocker; antihypertensive

• HF Electrolytic and

water balance agent; loop diuretic; antihypertensive.

• HF Electrolytic and

water balance agent thiazide; diuretic; antihypertensive.

7. DM

Antihyperglycemic; biguanide

• DM Second

generation sulfonylurea; antihyperglycemic

• Dementia N-methyl-

D-aspartate (NMDA) receptor antagonist/antidementi a

• Will demonstrate a

decreased inflammation and histamine response in lung tissues AEB increasing ability to exchange gases.

• Will decrease acute

exacerbations of COPD.

• Will decrease

hypertension AEB decreased BP

• Will manage HTN in

combination with other anti-hypertensives AEB stable BP readings

• To decrease edema

caused by HF, decrease HTN AEB decreased swelling and stable BP levels

• Will demonstrate

reduced reabsorption of water and decreased BP and water retention which can cause edema AEB less edema

• Will demonstrate

reduced BS reading AEB decreased levels of BS

• Will demonstrate

reduction in blood glucose AEB FSBS readings

• Will demonstrate a

reduction in dementia S&S AEB decreased glutamate

Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

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