CaseStudy -Dementia-UNFOLDING_Reasoning William “Butch” Welka, 72 years old
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Course
NURS MISC
Institution
NURS MISC
Cognition
Interrelated Concepts (In order of emphasis)
• Pain
• Mood and Affect
• Psychosis
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each
Category/Subcategory Covered in
Case Study
Safe an...
Morgan Adams, 72 years old
Primary Concept
Cognition
Interrelated Concepts (In order of emphasis)
• Pain
• Mood and Affect
• Psychosis
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
,History of Present Problem:
Morgan Adams is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II and dementia
who has been hospitalized for exacerbation of heart failure three times the past six months. He is now a resident of
Pineville Healthcare Center, a local long-term care facility the past four months because his dementia progressed, and
his wife Rita was unable to care for him. When Rita visited Morgan this morning, she reports to the nurse that he is
more confused and is concerned because Morgan is easily angered. Morgan insists that he sees his friend Roger, who
served with him in the Navy, is in the room, but he died ten years ago. Rita approaches the nursing station with tears in
her eyes and states,
“What is happening to my husband? This just isn’t like Morgan to act like this! Please do something to help him!”
Personal/Social History:
Morgan has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to visit
Morgan every day after work. Morgan was a salesman for 35 years before he retired seven years ago. Morgan believes
he is at Pineville Healthcare Center for rehab, but his family is concerned that it is no longer safe at home if he were
alone. Rita was just awarded guardianship due to his declining mental status.
WRhEaLtEVdAaNtaT CnldinihcaalvSeigncilfiincainccael: significance to the
DfraotamfrtohmePhreissetnot nurse?
rPireosbleamre:
72 yo male w/ HF, COPD, HTN, DMII and The clinical significance of the patient’s behavior is that he is experiencing
dementia. Hospitalization Hx for HF x3 in past confusion and could be experiencing some confusion related to his heart failure or
3 mos. Resides in long term care of COPD Where he is not receiving enough oxygen/blood (hypoxia or hypoxemia)
dementia. LOC change today w/ flow to his brain. Also, medication SE can be contributing to this, too. Does he
hallucinations. have a UTI or other infection?
RELEVANT Data from Social History: Clinical Significance:
Patient and wife have been married for 51 years Patient is no longer able to make his own decisions. His confusion may also be
have 3 children. Rita is now pt’s guardian. Pt attributable to unfamiliar surroundings and not understanding why he is there. He
does not understand why he is at SNF. is well loved by his family who make sure to visit him. They are worried that he is
not “himself”.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current
meds?
(Which medication treats which condition? Draw lines to
connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD 1. Fluticasone/salmeterol 1. Long Acting Beta-2 1. Chronic treatment and
• Hypertension diskus 1 puff every 12 hours agonist/Corticosteroid maintenance of COPD & asthma
2. Albuterol MDI 2 puffs combination inhaler; anti- producing decreased
• Heart failure asthmatic; anti-inflammatory inflammation and histamine
• Diabetes type II every 4 hours PRN
2. Selective Beta-2 response in lung tissues thereby
• Dementia shortness of breath
adrenergic agonist; increasing ability to exchange
3. Lisinopril 10 mg PO daily bronchodilator gases.
4. Atenolol 25 mg PO BID 3. Long-acting angiotensin 2. Acute treatment for COPD &
Color coded match of drugs
5. Furosemide 20 mg PO converting enzyme Asthma relaxing bronchial
with the corresponding
daily inhibitor; antihypertensive smooth muscles in order to
indication for use.
6. Hydrochlorothiazide 25 4. Cardio Selective-Beta exchange gases during an acute
Please know that some of the exacerbation of COPD.
mg 1 tab PO daily blocker; antihypertensive
green and dark blue boxes can 3. Decrease of hypertension
7. Metformin 1000 mg 5. Sulfonamide;
be interchangeable, as and heart failure as a result
PO BID antihypertensive; diuretic
medications such as lisinopril,
8. Glyburide 10 mg PO BID 6. Benzothiadiazide; diuretic; of suppression of the renin-
atenolol, and angiotensin-aldosterone
9. Memantine 5 mg PO daily antihypertensive.
hydrochlorothiazide can be 7. Antihyperglycemic; system.
used to treat both biguanide 4. Management of hypertension
hypertension and heart failure. 8. Second generation alone or in combination with
sulfonylurea; antihyperglycemic other anti-hypertensives by
9. N-methyl-D-aspartate giving rise in intracellular
(NMDA) receptor calcium and triggering the
antagonist/antidementia ryanodine receptors to release
calcium stored in the
sarcoplasmic reticulum (SR),
thus increasing cardiac
, contractility. And, also off
label- management of HF.
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