Early Stage Dementia Nursing Care

Early face madness Nursing C beThe aim of this case subject is to explain and dish antennas the nursing palm of a 69 year old gentlewoman who has recently been diagnosed with early tip mania. This case study pass on demonstrate my knowledge and spirit of evidence based nursing practice whilst exhibiting my efficiency to comp block offium a programme of c be which is based on this.The structure of this study will adopt take up of the nursing process, i.e. opinion of the client and planning of handle in quitnership with the client. The nursing process requires the nourish to carry out a holistic assessment of clients needs which takes into con inclineration the individuals physical, social, psychological and spiritual existence in order to produce an appropriate plan of supervise (Kenworthy et al, 2006). This case study shall also discus the nature and possible poses of Simones unhealthiness. The experiences of Simone established in this case study will be influ enced by the intent of a biomedical, psychological and social approach to dementedness.This case study is based on a fictitious confederacy psychiatric nursing assessment of a person called Simone. Simone is a 69 year old lady who has just received a diagnosing of early peg dementia. Simone lives with her daughter who is aged 40 and is a paraplegic who in the last twelve months has had two bouts of depression. Although Simones daughter is able to look after herself to a great extent she does require some of her arrives help. It became evident from the assessment that Simone appe atomic number 18d very anxious about her diagnosis as well as what will happen to her daughter. Although Simone appears orientated to place she appears to get flustered at times when she dirty dog non answer some question. There appears to be no concerns in relation to Simones physical severalise of health. Simone stated that she does non need help at the moment and that she will cope. Simone has no f amily locally and since she began face after her daughter 10 years ago, Simone appears to consecrate lost touch with many of her friends. Simones topographic point is corking and well equipped they both wish to continue living here although it appears as though they are anxious about coping. Simones daughter reported that on a few occasions recently her mother had burned food while cooking.According to National wellness Service (NHS, 2009) dementia is a coarse mark. In the year 2000 18 million battalion worldwide were said to arrive at been living with the condition with that figure projected to rise to 34 million by the year 2025 (Alzheimers Disease International, 2010). At give birth there are approximately 700,500 great deal in the United Kingdom with dementia and although it is something which largely affects people in later life there are currently at least 16,000 people in the UK under the age of 65 who have the illness (Department of wellness, 2009). Dementia can af fect anyone regardless of their gender, ethnicity or class. At particular risk of developing dementia are people with learning disabilities.Dementia is a devastating and severe illness and can be defined as a syndrome which is associated with a issuing of illnesses in which there is a progressive decline in many areas of functioning. These areas overwhelm memory, reasoning, communication skills and our ability to carry out daily activities (DOH, 2009). Furthermore people may experience behavioural and psychological symptoms such as psychosis, depression and aggression (World Health Organisation WHO, 1992).There are different forms of dementia, the most special K being Alzheimers which accounts for 62% of all cases. With Alzheimers the chemistry and structure of the brain is altered and brain cells die. The onset of Alzheimers distemper is said to be slow and the decline is gradual over many years. The second most commons cause of dementia is vascular dementia (VD) with the most common type being Multi Infarct Dementia (MID), this is where the brain has been damaged by repeated small strokes. MID can also be caused by high blood pressure, irregular heart rhythms or diseases which cause damage to the arteries in the brain. As a subject of MID the patients condition gradually gets worse in steps and the person will commonly deteriorate until they have a stroke were they will deteriorate before having another stroke and deteriorating further. a good deal people will have both types of dementia. Other forms of dementia include but are not limited to dementia with Lewy bodies (DLB) and fronto-temporal dementia (FTD) (Ouldred Bryannt, 2008). Dementia with Lewy Bodies is thought to be the third most common cause of dementia. Those who have it have microscopic changes called Lewy bodies in the nerve cells of the brain which are caused by tiny protein deposits in the brain which disrupt its functioning. Visual hallucinations and delusions often occur. Fron to temperal dementia is rarer and the person affected may have personality changes before their memory is affected.Progression of dementia is different for each individual, for some it may be plum rapid whilst for others it may be more gradual. Clinical features of the disease can be classified into terzetto stages although these may not be present in every person and not all people will move by means of each stage (Alzheimers familiarity, 2007).Simone had visited her GP recently in relation to a series of vague physical complaints stock- hush recently she also admitted that she was worried that she had been having lapses in memory as well as becoming very intolerant of her daughter at times.According to the Scottish political sympathies (2010) some people may be reluctant to attend their GP if they are worried they have dementia, some people may wait for as colossal as two years. The fear of dementia in the person or in their family is seen as the most significant barrier to seeking a diagnosis (National Audit Office, 2008). It is usual practice for General Practitioners to start the assessment process before referring the person to a local memory assessment clinic or community health team for further fine assessment (Ouldred Bryannt, 2008). A bio medical approach is one style of understanding dementia and this view may have been important in ensuring Simone has a proper diagnosis.The Mini -Mental State Examination was developed as a screening instrument for diagnosing dementia which results in assessment of things such as, memory, language and visuoperceptual function. In Simones case, when cognitive impairment was detected, the MMSE will have been utilised to detect dementia. Whilst trying to determine whether Simone has dementia she will have been asked if she wishes to know the diagnosis as well as whom else she would like to know ( pleasant, 2007). A tot up of less that 24 out of a possible 30 points is said to indicate an abnormal result h owever patients with scores between 21 and 25 can be considered for re evaluation in 3 to 6 months. Those with a score of greater than 25 reduce the probability of cognitive impairment.NICE (2007) root on the result of this MMSE assist in determining the appropriateness of pharmacological interventions. For cognitive symptoms of Alzheimers dementia, Donepizil, Galantimine and Rivastigmine which are acetylcholinesterase inhibitors are utilised. Nice recommend the prescribing of these three for those who have a diagnosis of Alzheimers disease of conduct severity that is unflinching by an MMSE score of between 10 and 20 points. For non- Alzheimers dementia and mild cognitive impairment the acetylcholinesterase inhibitors and Memantine should not be prescribed for the treatment of cognitive decline (NICE, 2007). Should the use of music be an natural selection for Simone as past of her care plan there would be a need to assess whether Simone requires assistance with medication admi nistration including storage of medicines ( NMC, 2010). The possibility of a pill dispenser (dossett box) may be useful to encourage refine dosage and timing (Alzheimers Scotland, 2010). Also bodied into the care plan would be the need to inform Simone of the side effects of the medication as well as monitoring Simone for any effects (NHS, 2007).Dementia has been know to be referred to as having three stages. A comprehensive assessment has concluded that Simone has been diagnosed as having early stage dementia. The early stages of dementia it is also referred to as mild with the next stage known as moderate/middle and finally severe/late. Nice (2007) suggests that after Simones received her diagnosis informing her of what this entails should be incorporated into her plan of care. As a view as I would ask Simone if she wishes that her and her family receive this study. This information would include the signs and symptoms of dementia (NICE, 2007). Sign (2006) argue that the infor mation should be offered to patients and their carers in advance of the next stage of the illness.One of the problems arising from the assessment is that Simone appeared anxious about her diagnosis and what might happen to her daughter. This would be an important time for the nurse to hear to gauge Simones knowledge understanding of the disease and offer information step by step depending on her ability to cope with it (Lecouturier et al 2008). The importance of a client centred approach is central when planning care for Simone (NICE, 2007). As a nurse it is important to recognise Simones theory of her life, and to realise that what counts is her perception of her situation and not just what the expert may think (Rogers, 2003). In order to achieve this successfully the nurse may plan to establish a therapeutic relationship with Simone. Good communication between all those tortuous including the nurse, client, relatives and specialists within the multidisciplinary team must take place wherefore in order to create a holistic and individualised plan of care (Hinchliff et al, 2003).As a nurse I could adopt the use of a mannikin to provide a basic framework for the helping process for exemplar Egans skilled helper model (Hough 2006).This is concerned with obtaining the clients current picture, it helps clients clarify the key issues which require to be changed (Egan, 2007). The chief(prenominal) doctrine is helping clients to tell their stories, whilst enabling clients to develop new perspectives that help them reframe their stories, also to help clients achieve supplement by determining which part to work on first (Egan, 2007). Skills the nurse could use here include basic listening skills, paraphrasing and reflecting, summarising, asking questions and using silence (Egan, 2007). These skills will underpin the therapeutic relationship (Rogers, 2003).This model also looks at the preferent picture and is concerned with helping Simone describe and choose what she wants, again the main principle here is to help her imagine a better future and help her choose down-to-earth and challenging goals that are real solutions to the problems and unused potentials which have been identified (Egan, 2007). The third stage is concerned with the way forward, the main principle is to help Simone review and choose possible strategies, along with resources and put these into a existent plan to achieve goals (Egan, 2007).It is clear that Simone and her daughter wish to carry on living at home for as long as possible wherefore by helping Simone recognise and understand the illness and its stages will assist in identifying her strengths and highlighting the things she can do as well as plan ahead for the future. At this moment in time Simone feels as though they are coping however residue could be part of the care package (NICE, 2007). Written and verbal information should be passed on regarding local support groups that Simone could attend on her own, or with friends and family.It is important to encourage Simones independence for as long as possible by encouraging her to carry on independently with those activities of daily living she still appears to be managing. Simone appears to be have isolated herself over the last few years therefore the pickaxe of attending a day hospital may be offered with transport to and from being put into place. The option of befriending may encourage Simone to get out and about in improver to support and companionship (Volunteer Centre, 2010).As it has been reported that Simone has burned her food lately this could pose a risk to Simone and also her daughter. As part of Simones plan of care I would be required to draw on the expertise of members of the multi-disciplinary team for example an occupational therapist who could visit in order to carry out a kitchen assessment. Simones vulnerabilities and risks to herself and others, as a result of her cognitive impairment would be identified by c arrying out a risk assessment. offend of Simones care plan would include a risk management plan (NHS, QIS, 2007). This care plan would identify the roles and responsibilities for all members of the multidisciplinary team including Simone, her daughter, the community mental health nurse, occupational therapist, psychiatrist, social worker and also physiotherapist. at heart Simones plan of care it is alert to ensure that risk assessment is continuous as Simones dementia progresses through the stages then so in any case will the risk to her and others increase. As a community psychiatric nurse I have a responsibility to draw on expertise from the relevant disciplines and make referrals accordingly (NMC, 2010) for example as Simone progresses through the stages there may be a risk of falls and therefore as part of the risk assessment and plan of care I would refer Simone to a physiotherapist.As a nurse I should always seek valid consent from the person to share the information obtai ned via assessment with other agencies that may be involved in the care planning process (NMC consent). Simone has been presumed to have capacity to make decisions regarding her care and treatment however as the dementia progresses this may no overnight be the case. If a person appears to lack capacity to make a decision then the grooming of the Adults with Incapacity identification number must be followed. This Act sets out principles which must be adhered to in addition to a Code of Practice, these principles include, presumption of capacity, supporting a person to make decisions, an individuals practiced to make inexpedient decisions, the best interests of the person and ensuring the least restrictive alternative (Griffith Tenhnah, ). As Simone appears to have been diagnosed early this allows time to discuss and plan for the future. This may include discussing the provisions of the above mentioned act for example, while Simone still has capacity she may nominate a spokespers on (attorney) to make decisions regarding her personal welfare including healthcare and consent to treatment should she move incapable. This is known as lasting powers of attorney (LPA).Another provision under the Mental Capacity Act that may be discussed with Simone is that of Enduring Power of Attorney (EPA) where Simone could appoint someone which would give them the legal right to manage Simones financial affairs.As a nurse it is important to discuss the use of an advanced narrative as part of the plan of care as this would enable Simone, while she is still well tolerable to do so, to write a statement which outlines the way in which she wishes to be treated should she become ailing and no longer have capacity ().Dementia is a terminal illness and NICE (2007) recommend a palliative care approach from the time of diagnosis until death. As a result the care plan should incorporate Simones wishes in relation to end of life care for example a preferred place to die. The provision of palliative care in the UK is said to favour those with cancer (Fallon Hanks, 2006) although those with dementia can have equally as severe symptoms and similarly poor prognosis. Therefore planning ahead for Simones end of life care may result in a good quality service with improve experiences for Simone and her daughter (Scottish Government, 2008). Discussions might also take place around the possibility of a do not resuscitate decision, if Simone felt this was appropriate it could be documented. This would ensure that no attempt is made to resuscitate Simone in the event of cardiac arrest if this is her wish (National Health Service Scotland, 2010).People who care for relatives with dementia are said to suffer higher levels of stress and ill health than the general public (Scottish Dementia Strategy). This may well be a significant change for Simones daughter. As Simone wishes to stay at home it is vital that a carers assessment is carried out and appropriate support and info rmation is provided as it may become too difficult for her daughter to sustain otherwise and could result in Simone requiring admission to care services. The option of respite should be a vital part of the care plan (NICE, 2007).In conclusion, this essay has provided an explanation and parole regarding the nursing care of a 69 year old lady who has recently been diagnosed with early stage dementia. This case study has present my knowledge and understanding of evidence based nursing practice and demonstrated my ability to utilise this in order to outline a plan of care.Alzhiemers Scotland (2010)http//www.alzscot.org/pages/info/safety.htmNational Health Service Choices (2009) Your health your choices Dementia. 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