Clinical week 8

Week 8 Clinical grade is an average of: Week 8 Case Study Clinical Participation ** Please copy and paste case study into a word document, complete, and upload here before due date. Case Study: INITIAL CLINICAL SCENARIO: The nurse is caring for Loretta, a 64-year-old female, admitted to the geropsychiatric unit with a diagnosis of Alzheimers disease of 2 years with decreasing cognitive functioning. A family member of the client has power of attorney, including health care proxy, and is available to answer questions. The family member reports that Loretta is getting worse (unable to care for herself, not responding to questions, occasional incoherent speech) and requires constant assistance and supervision. The family has a rotating schedule, but it is getting more difficult to care for her. Loretta presents with unawareness of environment and orientation. She is unable to follow simple commands except when requested by the family member. In responding to questions, her speech is mostly incoherent except for a couple of words. The family member states that she is not recognizing many of her family, even those close to her. If given simple instructions, she is unable to follow them. Vital Signs: BP 136/68, Temp. 98.4 orally, HR 72, Resp. 14, O2 Sat 97% on room air Labs: CBC and CMP within expected limits Orders: The provider has prescribed donepezil 10 mg po once a day. UNFOLDING CLINICAL SCENARIO INFORMATION: Loretta has been hospitalized for the past week waiting for transfer to a skilled nursing home with memory care. She is now being prepared for discharge. Little has changed in Lorettas demeanor and cognitive skills, though she loves when music therapy comes and becomes very animated and sings along. Discussion Questions: What assessment findings support the findings of Alzheimers? How is Alzheimers diagnosed? List and describe two different assessment scales that can be used to assess dementia. What safety considerations may be included when planning care for this client? What is donepezil? What is the mechanism of action? How does it work in the body? What symptoms would you expect to improve? What are the side effects of this medication? Contraindications? The nurse comes up with the following nursing problems. Please list and explain 4 nursing interventions for each. Risk for physical Harm Confusion Unable to care for Self What education should be provided to the patient about her condition? The Family? The nurse reports the patient enjoys music and music therapy. How could we incorporate this into the patients plan of care