Iscuss and Critique the clinical decisions for the immediate short and long care of the patient in the scenario

College of Nursing, Midwifery and Healthcare

Nursing Practice and Decision Making 1 a Dementia Scenario

Service User:
Edith Jones is a 72 year old woman who has a diagnosis of Dementia.


Present situation:
Edith has recently been discharged from an acute hospital following an admission for acute confusion and a UTI. Prior to discharge Edith was assessed by social services who increased the care package to twice daily visits for personal care and domestic help. The carer informed Edithas son Brian that she is increasingly concerned that Edith is becoming more confused and agitated over the last 2 weeks. Edith often pushes the carer when she is trying to assist her with bathing, and prepared food is often not eaten and sometimes found on the floor. The carer also says that sometimes Edith will speak to her in Welsh and gets frustrated when she doesnat reply in Welsh. The son has requested a visit from the GP and an assessment by the Older Adults community mental health team.


Personal and social history:
Edith originates from South Wales and is a retired seamstress; is widowed and lives alone with the support of her family and carers visiting once a day. She has one son, Brian, who lives 20 minutes from her and often calls in to see her most evenings. Brian is married and has two children (4years and 6months). Edith was brought up to speak Welsh as her first language and often talks with Brian in the evenings in her preferred dialect.


Medication on discharge:
Rivastigmine


Assessment:
Mini Mental State Examination Score: 11

Edith is agitated, restless and is confabulating.

There are several bruises on her arms and shins, which the son was not aware of. Edith says she got the bruises from doing the gardening.

Edith spontaneously speaks Welsh during the visit.

Edith refers to Brianas wife as his fiancA©e and that she canat wait to have grandchildren, telling him to hurry up because she isnat getting any younger.

Vital signs: Temp: 37.5 degrees; BP: 100/60; Pulse: 90

Edith tells the GP & the CPN she has eaten a roast because its Sunday and itas the family tradition to get together to have a family meal, yet it is Wednesday and there is food left uneaten and a cold pot of tea on the table in the living room.

Brian is concerned that his mother has no recollection of her grandchildren and is finding her behaviour very distressing.


Discuss the clinical decisions for the immediate, short term and long term care






























Aims of the Module

You will be able to:

a? Provide skilled and effective care across of variety of settings and which is compassionate, maintains dignity and promotes health and wellbeing.

a? Develop increasing awareness of the importance of shared decision making in the assessment, planning implementation and evaluation of care, which is informed by the best available evidence and which complies with local and national guidelines.

Learning Outcomes

1. Promote an environment in which human rights, values, customs and spiritual beliefs of the person and family are respected.

2. Undertake a systematic, comprehensive, holistic assessment that enables immediate and personalised care for people with mental and physical health problems

3. Demonstrate an in depth knowledge of common physical and mental health problems as well as possible co-morbidity, relevant to field of practice

4. Critically analyse and evaluate the effectiveness of a range of possible evidence based interventions using shared decision making with users, carers and other care professionals.

5. Recognise, interpret and respond appropriately to signs of deteriorating physical and mental health.