hlt54115-Diploma of Nursing: Contribution of Pathology in Nursing

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Case Study

Edith, a 77-year-old lady presented to the emergency department (ED) via ambulance after falling in her home. On assessment Edith does not have any fall related injurie other than a minor graze on her left elbow.

Edith appears slightly confused and is asking for Margaret, her daughter. When contacted Margaret attends the ED department and informs staff that Edith’s local doctor recently identified Edith as recently been experiencing dementia, most probably due to Alzheimer’s disease. Margaret states that Edith does not appear more confused than normal. Given this the ED team do not suspect a potential alternative diagnosis of delirium.

Social History

Edith is a widow of five years, lives in her own home with minimal support from Margaret. Edith is relatively independent. She still drives a car, she self-regulates by not driving at night and only driving to her local shops, a friend’s house and her GP when needed. At the shops Edith pays for her groceries with larger notes as she seems unclear of how much to pass to the cashier. She became lost on the way home from the shops last week and was upset as she could not recognise where she was. After an hour she found her way home. Margaret gave her mother a mobile phone for just this type of emergency but Edith cannot understand which buttons to push and finds using the mobile phone frustrating. hlt54115-Diploma of Nursing: Contribution of Pathology in Nursing

Question 1

Edith requires a physical assessment in the ED. Provide evidence based person centred (ie Edith) rationales for each assessment provided below. ECG Respiratory Ax Skin Ax Mini cognitive assessment.

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Question 2

Edith has presented with dementia, most likely in the context of Alzheimer’s Disease.

List six 6 signs and symptoms of early Alzheimer’s disease which Edith is experiencing. For each sign and symptom provide detailed data from scenario to support your answer. Provide your answer in a table below. Do not apply your answer to the ED setting.

	Six (6) signs and symptoms of early Alzheimer’s Disease Edith is experiencing. Source of each must be cited	Evidence/ data from Edith’s history to support presence of the sign and/or symptom.
1
2
3
4
5

Question 3

The medical team perform further testing to rule out any potentially reversible cause of Edith’s dementia. Edith undergoes various tests to exclude other possible contributing pathology. The medical team send Edith for a brain perfusion scan, also called a SPECT (single-photon emission computerised topography). These results confirm that a diagnosis of Alzheimer’s disease is most probably the cause of Edith’s dementia. Why is it important for Edith and her family to have a definitive diagnosis? Use literature to support your discussion. hlt54115-Diploma of Nursing: Contribution of Pathology in Nursing

Question 4

Edith is transferred to the ward. The medical team commence Edith on an initial 4 weeks dose of 5mg BD of Donepezil (TN Aricept) with a view to monitoring Edith for effects and incrementally increasing the dose over time.

Explain to mode of action of Donepezil with respect to the pathophysiology of Alzheimer’s Disease?

Question 5

Alzheimer’s disease is associated with progressive memory loss. Outline why Edith is experiencing progressive memory loss.

Question 6

The following nursing problems are relevant for Edith:

Potential for decreased nutritional status impacting well-being and cognitive state and

Progressive impairment of memory and ability to live in her own home. For each of the above nursing problems and provide five (5) relevant evidence based interventions for Edith that consider the specific clinical progression of Alzheimer’s Disease. Prioritise your interventions from 1(highest priority) to 5 (lower priority) for each problem. Justify your prioritisation with consideration of Edith situation Include evidence based rationales for each intervention explaining why the interventions are specifically relevant for Edith who has Alzheimer’s Disease. Answer may be supplied table format such as the example below.

Problems	Write your justification of prioritisation here
Problem 1	Evidence based Intervention	Rationale – supported by literature.
	1.	1.
	2.	2.
	3	3.
	4	4.
	5	5.

	Problem 2 Write your justification of prioritisation here.
Problem 2	Evidence based Intervention	Rationale – supported by literature.
	1.	1.
	2.	2.
	3.	3.
	4.	4.
	5.	5.

Question 7

Edith is still driving a car but admits she occasionally gets lost and is losing confidence. What duty of care do the health care professionals have to Edith with respect to her driving a car now that she has a formal diagnosis of Alzheimer’s Disease? You may include reference to your State authorities eg. Police or Road authority. hlt54115-Diploma of Nursing: Contribution of Pathology in Nursing

hlt54115-Diploma of Nursing: Contribution of Pathology in Nursing