Your patient is an 82 year old female patient who has late stage Alzheimer’s disease. She...

Your patient is an 82 year old female patient who has late stage Alzheimer’s disease. She has been increasingly confused and agitated, was found to be hypotension and tachycardia and was brought to the emergency department for treatment. The ED began to treat her for dehydration and she is being admitted to the medical unit for further treatment and monitoring. What are your primary concerns for this patient and what assessments and interventions would be associated with your concerns and why?

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Expert Solution

The primary concern for the patient will be severe electrolyte imbalance,other symptoms of delerium and Hypovolemic shock. The main concern of the health care provider should be to prevent the patient from going in to shock.

In late stage Alzeimer's disease the main cause of dehydration would be forgetting to drink water or take feeds. the hypovolemic status of the patient is causing the Hypotension and tachycardia.

In this patient the assessment data should include,

VITALS SIGNS including temperature.impending shock can be assessed by closely monitoring vital signs.
assessing the breathing pattern of the patient and her risk for aspiration.
mental status and cognitve status of the patient should be assessed. delerium should be ruled out.
patient should also assessed for urine output,visual ability,incontinance.
cardiac function assessment
assessment of skin colour,turgor and elasticity
assessment of urine colour

The interventions should be,

rehydrating the patient is the primary function.

intravenous IV therapy or total parentral nutrition after assessing the kidney functions of the patient.
oxygen therapy if required
cardiac support and assessment including EKG,continuous cardiac monitoring.
maintaining Blood pressure.[by means of IV therapy and agents like noradrenaline]
the confusion and agitation in this patient implies electrolyte imbalance. severe HYPONATREMIA should be treated with intravenous adminstration of sodium.
Insertion of a feeding tube in late stage alzheimer's patients is advisable.it will prevent risk for aspiration and also help in proper maintanance of hydration
lab investigations like s.eletrolytes,kidney function tests,hemogram,MRI,etc.

Nightingale answered 1 year ago

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