Video Case Study - Caring for Patients With Alzheimer Disease

Nurse Darian works in a long-term care facility and is caring for Rosemary, an 84-year-old female with a history of Alzheimer disease who was admitted following an open reduction and internal fixation, or ORIF, for a hip fracture a few weeks ago. In collaboration with the registered nurse, RN Piper, Nurse Darian 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, Nurse Darian 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. Nurse Darian also notes that as the evening progresses, Rosemary becomes more impulsive, and tries to get out of bed on her own.

Next, Nurse Darian 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 Darian re-enters Rosemary’s room to gather additional information.

Nurse Darian: Hi Rosemary. How are you feeling?

Rosemary: I've never met you.

Nurse Darian: That’s okay, Rosemary. I’m your nurse, Darian. I met you earlier today. Are you having any pain right now?

Rosemary: Why does everyone have so many questions all the time?

Nurse Darian 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 siderails by Rosemary’s head are up, as well as one siderail by her feet. She then moves towards the open space in the bed to exit, so Nurse Darian moves to prevent her from getting up on her own.

Nurse Darian: Careful there. Let’s get you comfortable and back in bed safely, Rosemary. We can put your favorite show on the television.

Rosemary: Okay.

As Nurse Darian 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 PAINAD, to assess her pain which he determines is 5 out of 10.