nursing

Background:

Mr. Johnson is an 82 years old and has just been admitted to the long term care facility two months ago. His family members could no longer take care of him because his dementia had advanced after Mrs. Johnson passed away earlier that year. He has two sons and one daughter who is pregnant with his first grandchild. Lately he has gotten more confused on where he is and why they will never let him see his wife. Mr. Johnson started to isolate himself in his room and the only time he would lighten up was when his daughter came to visit him. However she does not live close by and so she only gets to see him sometimes only once a month or less. Mr. Johnson believes that he is in a hospital and they just will not allow his wife to visit. Sometimes this causes him to act out, combative and has been known to wonder into others rooms to look for her is what he states. The sons do not visit much because they feel they do not have time and their dad doesn’t recognize them as his sons anyways. He either thinks they are complete strangers or he thinks he is in his 30s again and these were his two buddies.

During our patient evaluation today we had made a new care plan/ revise the previous care plan because of ineffectiveness of reaching goal set. The abnormal results of his assessment was the following: orientation x1, his bowel movements have been altered has been having 3 days of constipation the CNA’s charting states, his bowel sounds have diminished activity however there is still a presences of some in all four quadrants. Also in the CNA’s charting it states that his urine output is dark yellow and has decreased the amount of times he urinates. He has very dry skin, loss of skin turgor, and has lost 5 lbs. this week. When examining his back

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there was an area on his coaxes that was a stage 1 pressure ulcer. Blood pressure was low for him 94/60; radial pulse was weak but fast at 104bpm. Temperature was 99.2 F, oxygen saturation was 93% and pain level on scale of 1-10 was a 6 located in his head/ headache his respirations were 30 bpm.

Nursing Diagnosis would be Ineffective Self- Health Management r/t depression. A client goal setting would be something we would want to include the patient in for this situation. The client will increase his healthy lifestyle habits by attending 1 activity a day and consuming 1 16oz of water a day for 3 weeks total. Interventions would be as a nurse I would talk with the patient and identify the reasons for actions that are not therapeutic and discuss alternatives to them (Ackley & Ladwig, 2014). As a nurse I would also talk with the patient about their depression/ condition and listen for what they use to enjoy doing and integrate that into an option for daily activity. This would also be beneficial with his dementia and life his spirits. If he could not come up with anything I would talk with the children and even see if they would come and participate more. Also addressing their concerns with him not remembering them; this may help them come around to see their dad more often which would lift his spirits. These interventions would prevent all day isolation in his room or bed and relieve some pressure from his stage 1 pressure ulcer. Also bringing his water pitcher to activities and possibly having a chart saying how many days the residents have finished their 16oz pitcher by the end of the day and at the end of the week give them a small prize. This amount of water can always be increased and would also give

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an added benefit for other patients. Evaluation: At the end of 3 weeks I would check his progress to see if he was able to complete his goal and if his health has improved.

In both of the research articles I had found on depression in dementia patients; comes to the conclusion that interventions through activities of some sort are beneficial and show a decrease in depressed mood. One trial showed that dementia patients with depression were treated through an intervention with their family caregivers (Scholey & Woods,) Therefore a significant reduction of depression was observed (Scholey & Woods,). Other interventions that have shown to be useful are selection of realistic, concrete goals, group work to minimize isolation, and life reviews and reminiscing (Chen, 2017). An interesting intervention article I had also found was about a trial testing the effects of a 15 month wheelchair bound resistance band exercise program for wheelchair bound dementia patients with depression and behavioral problems (Chen, 2017). The exercises were three times a week for 40 minutes (Chen, 2017). They were measured 6 times at 3 month intervals and the results of the intervention showed a significant change with less depression and fewer behavioral problems (Chen, 2017). These are the kind of intervention we should advocate for our client and be more aware that there are a lot of dementia patients with depression.

During my data gathering on my patient I had used the Geriatric Depression Scale on my patient and after tallying everything together his results where that Mr. Johnson is mildly depressed (Williams, 2016). He scored a 19 out of 30 however 19 was the top of the mildly depressed; therefore it could go up if we do not find an intervention for his depression (Williams, 2016).

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Reference

Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An      evidence-based guide to planning care (10th ed.). Maryland Heights, Mo:      Mosby/Elsevier.

Chen, K.-M. (2017). Resistance Band Exercises Reduce Depression and Behavioral      Problems of Wheelchair-Bound Older Adults with Dementia: A      Cluster-Randomized Controlled Trial. Journal of the American Geriatrics      Society, 65(2). Retrieved from EBSCO MegaFILE database. (Accession No.      121289474)

Scholey, K., & Woods, B. (n.d.). A Series of Brief Cognitive      TherapyInterventionswithPeople Experiencing Both Dementia and Depression: A      Description of Techniques and Common Themes. Clinical Psychology &      Psychotherapy, 10

Williams, P. (2016). Basic geriatric nursing (6th ed.).

(2) Discussion - Activities for the Older Adult with Dementia

After review of this module's resources, describe two (2) activities that you, as the nurse in a long-term care facility, would implement in one day for your client.

Your client is between the ages of 80 to 90 years old, and has early dementia (stage 1). It is your choice of how disabled, physically, your client is. Is he/she mobile without assistive devices or in need of assistive devices, such as a cane, walker or wheelchair, etc.?

· Describe in detail how you would motivate your client to join group activities and encourage active participation.

· You can include interdisciplinary team members to help, if needed, and explain what roles they would play.

· The activities can range from very generic and simplistic to more complex. This will depend on your clients' abilities.

· Describe how long each activity will last and details of how each activity will be played out by the client.

· You may include pictures or a hyperlink to a video that you think portrays your activities.

Hypothetically, think as if your family member has dementia, lives in a long-term care facility, and what you hope the nursing staff would have your loved one involved in for fun in a day's time.

Please make an initial post by midweek, and respond to at least two other student's posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.

Discussion Board Rubric: Discussion questions provide you a format to respond, expand, integrate, and reflect on your understanding of the module content. Expectations from the faculty include students will actively participate in discussion to share and gain new insights, critique ideas, and to pursue the goal of constructing new knowledge.

PLEASE FOLLOW THE RUBRICS FOR WRITTEN ASSIGMENT AND DISCUSSION.

DO NOT FORGET ALL WRITTEN ASSIGMENT APA STYLES