Question

Case Study, Part 2 (p. 1723) In the winter after his visit to the gerontologist, Mr. Wallace begins experiencing increased agitation and wandering in the afternoons and evenings. One afternoon at the adult day care center, Mr. Wallace slips out the door undetected. By the time the day care providers realize he’s gone, he has left the grounds and is wandering the neighborhood. The day care providers call Ms. Wallace and 911, and a search for Mr. Wallace commences. Ms. Wallace and two police officers find Mr. Wallace 2 miles from the day care center. He has no idea where he is or how he got there. He has taken a fall, and his face and hands are covered in scrapes. The officers radio for an ambulance as Ms. Wallace attempts to talk to Mr. Wallace. He panics because he does not recognize his daughter, and he pushes her to the ground. He then throws punches at the officers when they prevent him from running away. The paramedics arrive and restrain Mr. Wallace. Once he is restrained, Ms. Wallace is able to calm him down. He is then transported to the emergency department, where you are the admitting nurse. Mr. Wallace is calm upon his arrival at the hospital, and you are able to treat his injuries without incident. You attempt to speak with him, but he indicates he is tired and promptly falls asleep. You use this opportunity to interview Ms. Wallace. She states that aggression has become common during her father’s increasingly frequent periods of confusion. Sometimes he doesn’t recognize her; other times, he mistakes her for his sister. He is also increasingly unable to use basic objects—such as pencils, toothbrushes, and combs—and relies on Ms. Wallace for many basic ADLs. In addition, he occasionally experiences urinary and fecal incontinence. Ms. Wallace is shaken by the day’s events and the situation in general, and she begins to cry. When Mr. Wallace’s gerontologist arrives in the ED, you inform her of these developments. She adds 20 mg of buspirone (BuSpar) three times daily (tid) to Mr. Wallace’s treatment regimen to lessen his agitation and aggression. The doctor also tells Ms. Wallace that Mr. Wallace is starting to transition from moderate to severe Alzheimer disease, and she recommends that Ms. Wallace begin looking for a nursing home that specializes in the care of individuals with this condition.

Question 1 What are the priorities for Mr. Wallace’s care to decrease his risk of wandering and injury during his remaining time at home?

Question 2 What independent interventions can you perform to address the caregiver role strain felt by Ms. Wallace?

Question 3 What additional information or education do you anticipate Ms. Wallace will need in light of the doctor’s recommendation?

Question 4 Which of Mr. Wallace’s symptoms indicate he is transitioning from moderate to severe AD?

Question 5 What steps can Ms. Wallace take at home to lessen the incidence and severity of Mr. Wallace’s sundowning episodes?

Question 6 Why is it important for Ms. Wallace to find an institutional care situation for Mr. Wallace now rather than waiting until he reaches a more severe stage of AD?

Answer 1

1) Always wear clothing tag or ID jewelry searching for identity clues. One to one supervision is necessary. Advanced technology we can use, that is GPS band should be provided for the patient.Remove all hamfull object from his room. Avoid driving.

2)Help prevent wandering by following these tips.

• Maintain a daily routine – keep a regular schedule for sleeping, eating and other normal activities. Routines help soothe patients with dementia, and can help prevent boredom and anxiety, which can lead to wandering.
• Involve the patient in daily exercise to help maintain a healthy body and reduce aches and pains, which can cause agitation and lead to wandering.
• Avoid busy, crowded settings, such as shopping malls, loud sporting events or grocery stores that can be disorienting.
• Pay attention to signs of discomfort, pain, hunger and thirst to prevent patients from wandering to look for these things. Ask them if they are comfortable or need anything.
• Reassure patients that they are safe and remind them where they are. For example, “You’re in your favorite chair watching baseball on TV. This is a good place to be.”
• Make your home wander-resistant with modifications, such as “hiding” door locks by moving them above or below the normal location, camouflaging door handles by painting or covering them with material that matches the door, using motion detectors and bells attached to doorknobs, using night lights throughout the house, and keeping car keys out of sight.

3) Asking neighbors to alert you if they see your loved one wandering

• Notifying local police in advance about their condition and that they may wander; if they do wander off and you cannot find them quickly, notify the police that they are missing and remind them they are a “vulnerable adult”
• Keeping neighbors contact information handy in case your loved wanders away from home
• Providing the patient with a medical alert identification bracelet that displays their condition and contact information
• Keeping a recent photo handy.

4 ) Memory loss that disrupts daily life.

• Difficulty in daily using objects such as pencil tooth brush ,comb
• Confusion with time or place.
• Trouble understanding relationships.
• experiences urinary and fecal incontinence.
• Wandering.

5) Get regular exercise.

Give Mediterranean diet.

Ensure he is taking proper sleep.

provide calm and quit environment

  Stay involved socially.

  Join a support group

6) Because Ms Wallace is a primary care giver. She is the superviser in this scenario. So health education should given to her. Adviced her to maintain all requirement to Mr Wallace to stay safe