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Healthcare Plan 7

Healthcare Plan

Name of Student

Name of Professor

Course Title

Date

Background Information

Patient’s Name: Victor Woods

Age: 74 years

Sex: Male

Demographics: Condition is rare in people under the age of 50 but common in people over 60 years and most common in age 70years and above.

Condition: Alzheimer’s disease and Hypertension.

Situation: The patient has an impaired mobility and his skin has lost its elasticity. The patient is forgetful and exhibits moments of confusion. The patient lives at a nursing home.

Medical History

Victor was diagnosed of Alzheimer’s disease in 2016 with reports of symptoms few months earlier. His medical records showed that he had poor cognitive skills and impaired memory. There had also been changes in his behavior and personality. There are also records of brain imaging tests that indicate progressive loss of brain cells. He has also been managing hypertension for over 5 years. The care giver reports that he spends most of his day in bed and makes slight movement of his body and extremities occasionally as he is unable to make significant movements without help from someone. Diagnosis showed he had pulse of 110bpm and blood pressure reading of 165/95mmHg. Victor has been on non-selective beta blockers drugs for management of hypertension. He also takes cholinesterase inhibitors for management of the Alzheimer’s disease.

Upon physical examination, Victor showed a BMI of 21.2kg/m2, pulse of 94bpm, and blood pressure of 160/90mmHg. He had JVP of 6.5cm of H2O and 18 respirations per minute. There was no sign of retinopathy, lung crackles or swollen limbs. The carotid artery had no bruit but his skin showed sign of loose elasticity. He had impaired mobility and could barely move on his own. Results from medical imaging tests showed progressive loss of brain tissue. His neuropsychological screening tests results (Mini mental state examination), showed cognitive impairment.

Medical Assessment

Based on evidences from Victor’s medical history, physical examination and screening tests, it shows he has Alzheimer’s disease and hypertension. He has progressive loss of brain tissue which accounts for his impaired mental activity and forgetfulness. He also has a high blood pressure reading showing hypertension.

Care Plan

Nursing Intervention	Rationale
Monitor blood pressure and take record. Measure thighs and arms thrice, 3-5 min apart while patient is at rest, while sitting and while standing. Ensure correct cuff size and technique is used.	Comparing blood pressure readings gives a better picture of vascular involvement or problem scope (Cheryl et al., 2016).
Assess the general condition of the skin and daily assess for increasing number of risk factors.	Older patients have less elastic skin, moisture, padding and thinning of their epidermis which makes their skin more prone to impairment.
Assess the ability of the patient to move.	Immobility is a risk factor for pressure injury (Alderden et al., 2017).
Assess the ability of the patient to process thoughts every shift. Observe for changes in memory, difficulty in communication, change in thought pattern, disorientation and cognitive functioning	A negative change may indicate deterioration and a positive change my indicate improvement (Kennison & Long, 2018).
Assess client’s level of disorientation and confusion.	Confusion could range from a mild disorientation to agitation and could develop slowly over months or quickly within a short time. This could be indicative of effectiveness or ineffectiveness of treatment (Fazio et al., 2018).
Assess client’s ability to relate to events, motivation, interests in the surroundings and activities, and changes in memory pattern.	There could be a decrease in memories of recent events and more active memory for past and pleasant events. To compensate for insecure feelings, client may be assertive or aggressive. Patient may develop narrow interest and have challenges accepting lifestyle changes (Livingston et al., 2020)
Familiarize patient with the surrounding if patient’s short term memory is intact. Radios, calendars, newspapers and magazines can be used.	This helps improve the patient’s awareness of self and environment. However, this does not work for irreversible dementia as patient no longer understands reality (Alzheimer’s Association, 2020).
Assess client for simultaneous use of CNS drugs, dehydration, poor nutrition, sensory deprivation, infection or other conjoining disease processes.	This could cause change in mental health and confusion.
Maintain a daily routine to avoid problems arising from sleep deprivation, starvation, thirst or inadequate exercise.	If the needs of the client with Alzheimer’s disease are not met, it could trigger aggressiveness and agitations (Livingston et al., 2020).
Give freedom to client to sit near the window and make use of magazines or books.	It shows client’s sense of reality and ability to distinguish between day and night. Also, respecting patient’s personal space allows some degree of control.
Assist the patient by labeling drawers, use notes of reminders, color coding or use of pictures.	It helps to assist patient’s memory by use of reminders and location of articles and items.
Allow freedom to move and wander in a controlled environment.	This helps to increase the patient’s security leading to a decrease in hostility as behaviors that are difficult to prevent are permitted within a supervised environment.
Give positive feedback and reinforcements for positive behaviors	This reinforces progress and increases patient’s confidence,
Place a limitation on decisions that the patient makes. Communicate with the patient with support, warmth and concern.	Patient may be unable to make the simplest of decision which could trigger frustration and distraction. Avoiding this helps to increase the feeling of security. Patient will respond positively to actions showing warmth and care.
Provide opportunities to interact socially but don’t force it.	Helps prevent isolation. Forcing it could trigger aggression.
Give instructions one at a time.	Patient requires extra time to process information. Too many instructions could lead to confusion.
Instruct family members on how to interact with patient. Listen carefully and give attention even if stories are repeated by the patient. Avoid asking questions that patient may not be able to answer.	Questions may cause frustration and embarrassment if patient can’t answer them as it will remind them of diminishing ability.
Inform family members of the disease process and what should be expected and provide a list of support for them.	The care for persons with Alzheimer is expensive, time consuming, emerging draining and could be emotionally devastating (Alzheimer’s Association, 2020). The family should be aware of these so they can prepare ahead.

Treatment Goal

At the end of the treatment, Victor should have adequate maintenance of psychological and mental function as long as possible and reversal of behaviors if possible. Victor will have an improved thought process, be oriented and aware, and maintain an optimal level of reality if possible. Family members will be able to portray understanding of the situation and demonstrate appropriate care and coping skills.

References

Alderden J., Rondinelli J., Pepper G., Cummins M., Whitney J. (2017). Risk factors for pressure injuries among critical care patients: A Systematic Review. International Journal of Nursing Studies. 71.

Alzheimer’s Association. (2020). 2020 Alzheimer’s disease facts and figures. The Journal of the Alzheimer’s Association.

https://doi.org/10.1002/alz.12068

Cheryl R., Himmelfarb D., Commodore-Mensah Y., & Martha N. (2016). Expanding the role of nurses to improve hypertension care and control globally. ScienceDirect.

https://doi.org/10.1016/j.aogh.2016.02.003

Fazio S., Pace D., Maslow K., Zimmerman S., & Kallmyer B. (2018). alzheimer’s association dementia care practice recommendations. The Gerontologists. 58.

https://doi.org/10.1093/geront/gnx182

Kennison M., & Long E. (2018). The long journey of alzheimer’s disease. Journal of Christian Nursing. 35.

Livingston G., Huntley J., Sommerlad A., Ames D., Ballard C., …,& Banerjee S. (2020). Dementia prevention, intervention, and care: 2020 Report of the Lancet Commission. The Lancet. 396.

 

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