Case Study (Dementia)

Jim Lee, 78, and his wife, Marie, 69, have been living together and managing fairly well until lately. The couple has 2 grown children who both live out of town but visits every 3 months and at holidays and birthdays. One day, Jim was found unconscious on the floor, breathless and pulseless. He was rushed to the hospital with the help of the neighbor but was dead-on-arrival. He died due to cardiac arrest while Marie was left with severe depression. Her daughter convinced her to move to their house, which is out of the town, however, Marie wanted to stay at their home and wait for his return. When her children would call to check her, she would often be crying and confused or frightened. On one visit, they found her looking very tired, dressed in a wrinkled dress that looked soiled. She looked as if she had lost weight, and she couldnt remember what she had eaten for breakfast . One of the children remembered that before his father died, he noticed that Jim had taken several routine tasks his mother has always done, such as planning and helping to cook their meal, doing some of the household and having the grocery. His mother seemed more forgetful and would ask the same questions over and over again and stories are usually about her childhood years. One month after Jim died, the neighbors found Marie wandering around the neighborhood one morning lost and confused. It was now clear to her children that their mother could not remain in her home alone and take care of herself . Her daughter decided that Marie would come to live with her family. They moved her in with them, but even after getting settled at her daughters home; Marie continued to be confused and often did not know where she was. She kept asking where Jim was and forgot her grandchildrens names. At times, she grew agitated and would accuse them of stealing her purse or other possessions. Marie would sometimes forget to go to the bathroom and would soil her clothes. She always forgot to brush her hair and teeth and take a bath, and often needed help with these activities. She spent much time packing her bags to go back to her home and see her husband, Jim.

Interventions:
Encourage client to follow her usual routine and habits of bathing and dressing to help her cope with memory loss and confusion. Always orient Marie of what is the date, where is she now, and introduce her to the family members. To help Marie to reminded and do all her self-care responsibilities, make a daily checklist of her daily routine. Monitor food and fluid intake to ensure that Marie is getting adequate fluid and nutrition because in the scenario, it seems that she often eat poorly because she always forget if she has eaten or not, and have limited appetite. Try to avoid feeding the client until this becomes necessary. Sit with her at meals to provide cues to continue eating, try to minimize noise and undue distraction, and prepare desirable and nutritious snacks and food that she can eat without utensils, such as sandwiches or fresh fruits. Promote an adequate balance of rest and activity in her daily routine by encouraging and assisting her to engage in mild physical activity, such as walking, which helps the client feel better, stimulates bowel elimination, and helps her to sleep better at night. Because safety from injury is a risk for Marie due to dementia, caregivers should encourage as much independence as possible for the Marie in performing self-care responsibilities, since she is an able one, but should provide support when she is engages in potentially dangerous activities such as cooking and bathing. For example, sit in the kitchen and chat with Marie while she is cooking, or sit outside the door while she is bathing rather than doing it for her. Promote interaction and involvement: Plan activities geared to her interests and abilities Reminisce with her about the past Employ techniques of distraction, time away, going along, or reframing to calm Marie when she is agitated, or confused

CASE STUDY (DEMENTIA)

SUBMITTED BY: LOREDO, APRIL GRACE MONDEJAR, FRANCHESCA MYLLS PINUELA, NERISSA HIDROSOLLO, TERI LAWRENCE SUBMITTED TO: HERMINIO CALANZA III (USA-PCI 2)

ANNABELLE DIAZ, R.N. (USA-CI)

ASSESSMENT:
GENERAL APPEARANCE & MOTOR BEHAVIOR : Looking very tired, dressed in a wrinkled dress that looked soiled She looked as if she had lost weight Loss of ability to perform familiar tasks (apraxia), such as dressing , bathing or combing her hair Conversation becomes repetitive. Example is that every time the children visit Marie, she would ask the same questions over and over again and stories are usually about her childhood years MOOD & AFFECT : There are catastrophic reactions, like of Marie crying and confused or frightened, and at times, agitated and would accuse them of stealing her purse or other possessions. MOOD & AFFECT : There are catastrophic reactions, like of Marie crying and confused or frightened, and at times, agitated and would accuse them of stealing her purse or other possessions. THOUGHT PROCESS: The ability to think abstractly is impaired, resulting to loss of ability to plan, sequence, initiate and monitor, in which the Maries ability to perform tasks such as planning activities, budgeting and planning meals is lost. Delusions of persecution is present, in which she accused others of stealing her purse or other possessions. SENSORIUM & INTELLECTUAL PROCESS : Recent and immediate memory is impaired, example is when Marie couldnt remember what she had eaten for breakfast Disoriented to time and place, example is when Marie is confused and often did not know where she was. Marie is chronically confused about the environment Hallucinations are usually present wherein Marie spent much of her time packing her bags to go back to her home and see her husband, Jim

DEMENTIA
It is a general term for a decline in mental ability severe enough to interfere with daily life. It is a mental disorder that involves multiple cognitive deficits, primarily memory impairment, and at least one of the cognitive disturbances.

Cognitive Disturbances in DEMENTIA

What Causes Dementia?

Diseases that cause degeneration or loss of nerve cells in the brain such as Alzheimer's, Parkinson's and Huntington's. Diseases that affect blood vessels, such asstroke, which can cause a disorder known as multiinfarct dementia. Toxic reactions, like excessive alcohol or drug use. Nutritional deficiencies, like vitamin B12 and folate deficiency. Infections that affect the brain and spinal cord, such as AIDS dementia complex and CreutzfeldtJakob disease. Certain types of hydrocephalus, an accumulation of fluid in the brain that can result from developmental abnormalities, infections, injury, or brain tumors. Head injury -- either a single severe head injury or chronic smaller injuries that often occur from boxing. Illnesses other than in the brain, such as kidney, liver, and lung diseases, can all lead to dementia.

STAGES of DEMENTIA
MILD: Forgetfulness is the hallmark of beginning difficulty finding words, losses objects and begins to experience anxiety about these loses occupational and social settings are less enjoyable

MODERATE Confusion is apparent, along w/ progressive memory loss. Can no longer perform complex tasks but remains oriented to person and place Toward the end of this stage, the person loses the ability to live independently and requires assistance because of disorientation to time and loss of information, such as address and telephone number.

SEVERE Personality and emotional changes occur. May be delusional, wander at night, forget the names of his or her spouse and children Requires assistance in activities of daily living