In: Nursing
Chapter 25
An 83-year-old woman has been experiencing progressive memory loss over the past 6 years. She knows who her husband and daughter are, but she often forgets who her son-in-law and grandchildren are. Her symptoms began with forgetting small items, such as names, dates, and telephone numbers. A few years later, she started misplacing things and accusing her grandchildren of stealing them even when they had not been over in weeks. She also believes her family is whispering about her behind her back and purposely speaking too low for her to hear them, which has really upset her. Over the past 6 months, her functional status has declined. She needs assistance with dressing, toileting, and transferring in and out of the bathtub. She has been known to leave the kitchen burners on, has great trouble finding the words she wants to use, and tends to frequently wander off in the neighborhood. These issues immensely frustrate her and her family. Her husband has scheduled an appointment with their health care provider to discuss options in caring for his wife.
While obtaining the health history, the husband tells the gerontological nurse that it is a relief to have someone other than himself care for his wife; he is simply physically and mentally exhausted from caring for her at home. He says that they have a daughter, but he does not want to ask her for help because she has her own family to raise and care for. He further mentions that he cannot afford institutional care for his wife.
A. anxiety, related to financial insecurity.
B. social isolation, related to unrelieved caregiving responsibilities.
C. caregiver role strain, related to limited resources for caregiving.
D. ineffective individual coping, related to perceived powerlessness.
A. True
B. False
Here the husband tells that he is mentally and physically exhausted. i.e. care giver role strain.
He also told to the nurse that it will be helpful if someone other than him is available for caring her wife. i.e. limited resources here resource is referred to the caregiver.
So the most appropriate nursing diagnosis is caregiver role strain, related to limited resources for care giving.
True:- for older adults, caregiving activities such as bed bath, mouth wash, feeding, toileting, etc, will occupy much of the time of both the care givers and the care recipients.
Cognitive impairment =
The word cognitive is related to mental functions such as knowing, thinking, perception, memory reasoning, problem solving, etc.
If there is any impairment in these type of mental functions, then it is called cognitive impairment.
3 D's of cognitive impairment :=
(1). Dementia =progressive deterioration of mental functions such as memory loss, reasoning ability, etc.
(2). Depression =a morbid sadness or it's a mental state of depressed mood.
(3). Delirium =mental state of excitement.
Nurses Role in caring PD patients:
Parkinson's Disease is a chronic progressive neurological disorder caused as a result of loss of neurotransmitter dopamine in the brain that control movements.
Manifestations include tremor, slow movement, limb stiffness, difficult balance and posture.
Gerontological nurses role=
1.Health Educator: Teach both the family mebers and the patient about various techniques to enhance voluntary physical movement.
2. Encourage and assist them to do ROM exercises to avoid a rigidity and contractures. Regular day time rest is also encouraged.
3.Dietician : advise them to take a fluid intake of 2 litres per day and to increase the dietary fibre intake. Mild laxatives can be used regular time for easy bowel movements.
4.Medication instructor: instruct and monitor the the Right medicines in right time, right dose, right patient and right route.
5.Teacher:Teach about the diet, exercise, rest,etc to both patients and the family members. Teach them to do various tasks such as bathing, dresseing, eating, etc. of their own slowly when the drug starts working for them.
6. Psychological supporter: Each person have their own dignity. Don't ignore them if they are not able to respond to certain stimulii. Go on speaking and encourage them to complete their task and do certain difficult actions.