Notesale: Turn your study into money

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The purpose of this assignment is to draw upon evidence base that allows the student to
develop knowledge and skills which can be applied in contemporary nursing practice
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To demonstrate caring for a person this will address four key aspects of
the nursing process (assessment, planning, implementation and evaluation of care) and use
relevant theoretical knowledge and research to underpin the care provided
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Dementia is a neurological illness that affects around 800,000 people in the UK costing the
economy an estimated £23bn annually
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We know that 5% of people over the age of 65 have a diagnosis of moderate to severe
dementia and the prevalence increases with age with around 30% of people over the age of
85 (Jorm AF, Korten AE and Henderson AS ,1987)
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They highlighted that nurses should
have a good knowledge base so they can apply appropriate care and share information about
the diagnosis and what it means
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In contemporary nursing we are aware that our National Health Service is
constantly changing and therefore we must work in collaboration with general practitioners
and other professionals to ensure patients’ needs are being met (DOH, 2013)
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Mr P was an elderly gentleman with a history of falls, seizures and bi basal
pneumonia; he recently had a delirium following a fracture neck of femur and cerebral
vascular accident
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P after his wife expressed concerns regarding his memory
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Throughout the stages of the process it is
important to introduce and re-introduce yourself to the person as often the person will not
remember who you are
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The Single Assessment Process (SAP) for older people is a
document which allows the nurse to gain various aspects of information about the person
(DOH, 2002a)
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It is also
useful to ask the informant questions about what changes they have observed in the person,
this could be their partner
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The medical history from the GP is important too
as this contains historical information which may identify any risk factors or causes which
may have contributed to the memory problems
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Multidisciplinary assessment of the older person addresses current and potential care needs that
can be provided by different professionals
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, 2006)
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, 2010; Woodford and George (2008)
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, 1975) and has extra domains which test frontal
executive functioning (Bak & Mioshi, 2007)
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The test has the ability to detect the early stages of AD
and is able to differentiate between the different subtypes of dementias
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Orientation to time and place can be comprised early on in the disease but
is not always the first symptom as this may remain intact for longer (Becker et al
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Attentional deficits are present in the disease and this can be tested by asking person can
backwards in 7’s
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Early AD causes defects in the anterograde and episodic memory which
would be recognisable and lower than baseline in the cognitive assessment, (Hodges JR &
Greene JDW, 1995)
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, 1989)
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Contributory to the learning process this demonstrates failures in the encoding process
which explains why a person with AD would forget a scheduled appointment or an event,
eventually the learning process becomes incapacitated (Vliet et al
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Neuropsychological
research suggests that not all memory deficits are present in early AD (Heindel et al
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The most recognisable impairments of memory are failures in anterograde or episodic
memory domains and are suggestive of an early feature in AD, this explains why Mr P scored
extremely low on this domain and could not recall information (Hodges & Patterson, 1996)
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To test language and apraxia we asked Mr P to name as many animals as he could in one
minute which demonstrates if the person is having difficulty generating words, as the disease
progress people have difficulties articulating (Croot et al
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Executive function such as
fluency and sequencing are often common in AD for example being able to complete a jigsaw
(Albert et al
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, 2004)
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Praxis is tested by the person’s ability to engage in and follow instructions
such as alternating hand movements or making a gesture
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We asked
Mr P to hold out his arms in front of him for a minute and then walk along the room and back
to check for any abnormal gait, dystonia which can be visually observed during the cognitive
assessment
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For this part of the
test we asked Mr P if he wears glasses to ensure this wouldn’t affect the scoring
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, 2001)
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A person with AD would lose the ability to sustain conversation and therefore impact on their
relationships with people and in turn cause social isolation or depression
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Another problem is that people with
AD have impairments so they do not recognise tone in speech or emotion, Allender &
Kaszniak, (1989) suggests that this is linked with lack of facial expression
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, 2004)
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As cognition declines it affects the way a person think,
communicates and they lose some life skills
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The nursing strategies will
be guided by The Progressively Lowered Stress Threshold (PLST) which is a framework for
nursing care in dementia (Hall, G
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1987)
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However it is considered that needs may change due to cognitive decline and therefore
would be part of the on-going nursing process
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Mr P declined pharmacological treatment of cognitive enhancing medication donepezil,
because of his longstanding views of medication
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This has been shown to significantly delay
further decline in cognitive memory and reduce side effects such as behaviour (Ligthart SA,
Moll van Charante EP, Van Gool WA, Richard E, 2010)
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Mr P was dependant on his wife and carers to assist with daily living tasks such as bathing,
help with co-ordinating clothes that were reasonable to the environment and meal
preparation
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Another aspect of care is to ensure any
pain is under control and comfort measures have been addressed if necessary, pain can be a
contributory factor to behaviour and education so it is important this is addressed (Chibnal,
Tait, Harman & Luebbert, 2005)
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But it is important to discuss why an early diagnosis has
benefits such as tailoring care that is appropriate to the person and that they can make
decisions about their care (Christie & Cunningham, 2009)
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Doctors can ensure safe prescribing and avoid treatments which
may be harmful to the person such as anti-psychotics, this type of medication would be
harmful to Mr P as he has mixed Alzheimer’s with vascular dementia
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As people lose their ability to weigh up and make sense of information they may be judged to
be incompetent (Cody et al
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Principle one of the Mental Capacity Act is to start with the presumption that all adults have
capacity irrespective of their condition (MCA, 2005)
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When assessing Mr P he understood his diagnosis and could
communicate what he understood about the disease
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The MCA states that a person must be able to
comprehend to comprehend a decision, weigh up the information, retain information and
communicate this by any means, if they are unable to complete one of these then they are
considered to lack capacity (MCA, 2005)
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Mr P was incapable of being able to manage daily finances for himself or care for himself in
terms of daily living
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We explained that a LPA is someone who will make decisions on their
behalf if they lose the ability to be able to decisions for themselves
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, Gath, D
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, 1996)
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The carer
can deliver simple but effective based interventions which is therapeutic for the person and
asked Mr P’s wife to play music for around 15 minutes every day
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, 2010)
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Research has
shown that carers of people with dementia suffer from more physical and mental health
problems that a non-dementia carer (Brodaty H, Green A, Koschera A, 2003)
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P about our involvement, the outcomes of our assessment and
the care we provided
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The nursing process involved a comprehensive assessment on cognitive function, and used
findings of the assessment to plan care involving Mr P and his wife
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We provided information about
his condition and advice on managing how to manage this along with legal advice to help
them plan for the future
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