Case study - Alzheimer disease: Nursing

Nurse, Daan works in a long term care facility and is caring for rosemary, an 84 year old female with a history of Alzheimer's disease who was admitted following an open reduction and internal fixation or O Ri F for a hip fracture a few weeks ago.

In collaboration with the registered nurse, RN Piper, nurse, Daan goes through the steps of the clinical judgment measurement model to make clinical decisions about rosemary's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nursed Darien recognizes important cues including rosemary's inability to recall her daughter's name, her disorientation to date and time and that she becomes agitated when asked several questions in a row.

Nursed Darien also notes that as the evening progresses, rosemary becomes more impulsive and tries to get out of bed on her own next nurse, Darien analyzes these cues.

He understands that dementia is a neurological condition caused by structural changes in the brain and is characterized by a progressive decline in mental functions including memory, thinking, language, behavior, mood, and personality.

He knows that rosemary's dementia can be exacerbated by illness such as the surgery for her hip fracture and changes to her familiar environment.

Nurse, Darien reenters Rosemary's room to gather additional information. Hi, Rosemary.

How are you feeling? Ive never met you.

That's ok. Rosemary.

I'm your nurse, Darien. I met you earlier today.

Are you having any pain right now? Why does everyone have so many questions all the time?

Nurse Darien notes that Rosemary begins to sit up in bed and tries to swing her legs to the side of the bed to stand up the two side rails by Rosemary head her up as well as one side rail by her feet.

She then moves toward the open space in the bed to exit. So nurse Darien moves to prevent her from getting up on her own careful there.

Let's get you comfortable and back in bed safely. Rosemary, we can put your favorite show on the television.

Ok. As nurse Darien assists Rosemary back into bed, he notices that she groans and tenses up with movement.

Since Rosemary is unable to verbalize her pain, he uses the pain assessment in advanced dementia scale, also known as pain ad to assess her pain, which he determines is five out of 10.

Then before leaving the room, he ensures her bed alarm is turned on. He also notes that Rosemary's room is at the end of the hallway near the stairwell, making it difficult for nursing staff to get to her quickly.

If her bed alarm goes off. Nurse da and realizes rosemary needs effective safety management.

Now using the information he's gathered. Nurse Darien reports his findings to RN Piper.

And together they choose a priority hypothesis of risk for injury. Then they generate solutions to address rosemary's risk for injury including pharmacologic and non pharmacologic interventions.

And they established the expected outcome that after intervening, rosemary will not fall or injure herself during the shift.

Nurse Darien then takes action to implement these solutions. He recognizes that Rosemary's pain can cause increased agitation.

So he administers her prescribed pain medication using safe medication administration principles. He also knows that moving Rosemary's room closer to the nurse's station can help staff accommodate her needs and account for her safety more effectively.

So nurse Darien collaborates with the unit charge nurse to move Rosemary's room closer to the nurse's station. The charge nurse approves the room change and during Rosemary's evening walk with the physical therapist, they move Rosemary's belongings to her new room once she's settled in the new room, nurse, Darien ensures that Rosemary's bed alarm is on and turns the television on to her favorite show while she eats dinner.

At the end of the shift nurse, Darien hears Rosemary's bed alarm go off. He reenters the room to find her trying to get out of bed.

I don't wanna be cooped up in there anymore. I want to be near other people.

Nurse Darien then assists Rosemary to a reclining chair and moves it into the hallway directly outside the nurse's station.

Nurse, Darien also recalls from her progress notes that rosemary used to work as an artist. So he asks if she would like to do some drawing.

Rosemary eagerly agrees and spends the remaining time of Dion's shift safely drawing in her chair. All right.

As a quick recap, nurse, Darien recognized and analyzed cues related to rosemary's risk for injury and in collaboration with RN Piper prioritized hypotheses and generated solutions to address this problem.

Nursed Daan and RN Piper then took action by implementing pharmacologic and non pharmacologic measures to address rosemary's risk for injury and evaluated her outcomes comparing them to the expected outcomes.

Since rosemary remained safe during the shift, they determined that the plan of care was successful.