Question

Mr. Aponi has a history of dementia. His dementia limits his ability to respond appropriately to questions and at times Mr. Aponi is easily agitated and resistant to nursing care. He refuses to take his medications, spitting them back out, gripping the bedside rail when the nurse tries to turn him, and yelling out for his wife to save him.

Case Study

Mr. Aponi is an 85-year-old man with a history of dementia. He is a resident of a long-term facility. Mr. Aponi’s frequent incontinence necessitates the development of therapeutic communication to facilitate activities of daily living (ADL) care and frequent skin hygiene. The nurse caring for Mr. Aponi for the first time soon learns that talking slowly and softly is the most effective way of focusing the client’s attention and prompting him to follow basic instructions such as turning side to side. The nurse feels uneasy about speaking to Mr. Aponi as if he were a child in some ways. However, the nurse finds that this manner of speech keeps Mr. Aponi calm and that he responds well to praise and compliments and that he is very helpful to the nurse in assisting with his own care. On the second day of caring for him, the nurse notes that Mr. Aponi is more agitated and needs frequent reorientation regarding where he is. The nurse needs the assistance of another person to hold Mr. Aponi’s arm steady while assessing his blood pressure since Mr. Aponi keeps pulling his arm away yelling “no.” At one point in the day, Mr. Aponi tells the nurse, “There was a little boy in the room a minute ago. Where did he go?” The nurse knows there was not a little boy in the room, but does not know how to respond. The nurse ignores Mr. Aponi’s comment and redirects his attention to what is on television. When saying good-bye to Mr. Aponi at the end of the second day, the nurse is disappointed that Mr. Aponi does not seem to recognize the nurse or remember that the nurse has been caring for him for the past two days. The nurse is saddened to see him so confused and is emotionally exhausted after two days of responding to his frequent changes in behavior.

Questions

The nurse caring for Mr. Aponi overhears another nurse state, “Well, of course he is confused. He is 85 years old.” How should Mr. Aponi’s nurse respond?

Describe the following strategies for caring for a confused client: validation, redirection, and reminiscence.

Discuss the importance of nonverbal communication when communicating with a person who is confused and agitated.

What are three nursing diagnoses appropriate for Mr. Aponi’s plan of care?

Answer 1

Answer:- Aponi's nurse told to another nurse Aponi suffering from memory lapse and also judgement lapse Confusion is arise because he is unable to recognised any face it starts  from early stage of dementia ,
Disorientation, confusion about person , place and time is sign of delirium which change in long term leads to dementia.

Answer:-02 Care of confused patients

01) Validation :- validation involves communicating with patient people who have dementia in a way that acknowledges thier words and actions with respect and empathy.

The theory behind validation therapy suggests that people in this situation are driven by basic needs that are hard for them to express beacuse of thier disease.

validation therapy can be used by caregiver to help with dementia work through thier struggle to express these things.

@ most important factor of validation therapy is Listening . By listening attentively and respond respectfully you validate a person with dementia by showing your willingness to entire the patient world rather than trying to force them into yours.

Redirection :- Caring of confused patient by redirecting :-

1). Nurse stay-connected with patient who confused.

2). Assess the environment of surroundings may be noisy so need to redirect the environment by calm and silence.

3). Don't try explain or reason , debate is not good idea with confused patient.

4). Go outside helps the patient to see the beauty of nature

5). Introduce a meaningful activity

6). Use touch to calm and focus.

Reminiscence :-

it means sharing life experiences memories and stories from the past.

mainly person with dementia is more able recall things for many year ago then recent memories

So reminiscence draw on his strength.

Reminiscence activities:-

Listen them thier favourite music

look at photos

Enjoy tactile activity like painting

smell familiar scent and taste favourite food

Answer:-03 Non verbal communication with communicating a verbal confused patient techniques are following:-

1. Facial expressions :- facial expressions same on all cultures like sadness , happiness, anger , fear it helps to patients understand positively with arguments.

2. Body movements and posture:- the way someone moves carries themselves state of mind and mood.

3. Gestures:- waving ,pointing helps to patient understand easily.

4. Eye contact :/ Gives a positive attitude

5. Touch : a way to speak without using words.

Answer :- Nursing Diagnosis for mr. aponi 's plan care :-

1.) Risk of trauma related to disorientation or confusion

2.) Disturbed thoughts process related to condition.

3.) impaired verbal communication

4.) self care deficits related to disease condit