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DEME20002 Supporting and caring for people with Dementia Assignment Sample

Learning Outcomes Assessed

1. Analyse the diverse presentations of people with dementia and the impact this may have on their care.

2. Demonstrate the comprehensive assessment of people at risk of or experiencing dementia.

Aim

The aim of this portfolio is for you to demonstrate your ability to appropriately assess the diverse presentations of people with dementia using a comprehensive assessment tool.

Instructions

There are three parts to this portfolio.

Part one: Select two case studies located on Moodle and describe the presentation of the two people with dementia.

Part two: Explain how diverse presentations of people with dementia may impact the care delivered to them by health professionals.

Part three: Describe and justify your comprehensive assessment of the people in the two case studies selected. This assessment must include physiological, psychosocial, and cognitive assessment.
Ensure each part of the e-portfolio is substantiated with peer-reviewed literature.

Literature and references

The number of references you should use is not limited. You should consider using references when you have used material from another source .You may also use seminal scholarly literature where relevant. Additional suitable references include textbooks and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing.

Case study

Case Study 2. Mary Hobson.

Mary is a fifty-three-year-old woman who resides in the Fairfield Elsis Residential Aged Care Facility. She has lived in the facility for three years, after being found by neighbours in her house, on the ground, following a fall. Mary has no next of kin and her medical records indicate that she has previously had children, however, she does not appear to have contact with any of them at present. Mary needs encouragement with all areas of ADL care. She will commonly sit for hours on end unless she is encouraged to move. The facility has asked you to come in and assess Mary and suggest some strategies to motive and inspire her to increase her activity.

Meeting with Mary

When you meet with Mary, she immediately embraces you, and calls you the name of one of her children. She asks you about the football and grins widely as she talks happily of how Collingwood is likely to win the grand final. She talks about many different topics: cake making, cathedral windows, and sings hymns through your conversation. She seems very pleased that you have come to visit. She is less motivated to move from her
seat and when you suggest a walk, she says “No no no no...”. She looks slightly disturbed that you want her to move. You notice that toward the end of the meeting, she begins to become slightly over familiar, and you notice that there is a change in her demeanour.

Significant history

Mary has quite a lengthy medical history listed in her notes, involving injuries from previous falls (one only a few weeks ago), dental issues, bunions on both feet, arthritis in her legs and fingers, vitamin B deficiency, anorexia, previous diagnosis of alcoholism, and a past diagnosis of depression, along with her diagnosis of early-onset dementia, possibly alcohol-related dementia.

SOLUTION

Presentation of two people with dementia:

Mary (53 y, Female): The presentation of her symptoms of dementia indicates that she currently does not have any contact with any of her children, nor does she have any close relative to care for her. Her symptoms show that she has absolute disinterest to move, walk or be active.

In addition, she needs encouragement in all areas of daily-life activities. Also, the meeting with Mary has confirmed that she suffers from delusions and hallucinations because she was taking the names of her children and having some conversations about football matches, cathedral, and cake making that were not relevant indeed.

(Barry &75y, Male): Barry resides with his son at his residence who cares about his food and also gives him company. The case about Barry suggests that he has post-traumatic stress resulted from the Vietnam war. Barry has some frightening memories of the Vietnam war and thus suffers from panic attacks and sleep deprivation. Barry’s disease is called vascular dementia (Gowan & Roller, 2019). As suggested in the case study, Barry had recently suffered a stroke and that might have blocked an artery in the brain.

Part two

The way diverse presentations of dementia patients influence care delivery:

The diverse presentation of dementia affects the care delivery process because all patients have unique symptoms and have unique life experiences. In the case of Mary, she has no interest in moving or having doing activity. She suffers from delusions, hallucinations and many underlined diseases such as deficiency of Vitamin B, anorexia, dental issues, and many others. Her past medical history confirms that she has multiple issues and alcohol-related dementia. Patients like Mary need empathy because emotional support provides patience and insights to them. Thus, treating these patients with empathy would generate better care outcomes (Arvanitakis, Shah & Bennett, 2019).

However, in the case of Barry, he is suffering from post-traumatic stress disorder (PTSD) followed by the Vietnam war. He has traumatic memories of the war and gets panic attacks and sleepless nights. His condition reveals that he is not comfortable sharing much about the experience of the war. In addition, Barry also undergone a stroke which resulted in visio-perceptual difficulties. Since Barry is resistive in nature but is open to discussion for possibilities, an effective CBT would help him combat the issues.

Impact of the assessment on nursing care:

The care delivery process by nurses for dementia patients depends on their age, history of their life experiences, severity of dementia, and the presence of other underlying medical conditions (Kim, 2019). Referring to the case study of Mary, patients like her must be provided with suitable tools like an easy chair where they can feel comfortable. Also, ssome familiar and interesting decorations can make them feel engaged to their surroundings. These might encourage them to be more mobile and be active. Also, caregivers and nurses must empathize with patients like Mary and avoid questioning them (Harrison et al., 2018).

Furthermore, patients like Barry often need psychological therapeutic interventions. Gowan & Roller (2019) suggests that psychotherapies and Cognitive Behavioural Therapy can effectively help patients with vascular dementia and post-traumatic stress. For these patients, the nurses must also consider exposure treatments. Thus, it can be said that the diverse presentation of people with dementia tends to influence the way of care delivery by health professionals.

Part three

Comprehensive assessment for Mary:

Physiological: The falls risk assessment of Mary reveals she has high risk of falling as she was found collapsed on the floor before being admitted to the care unit. Also, she is immobile and has number of underlined diseases like anorexia, previous alcoholism, deficiency of Vitamin B and so on. Additionally, the pressure ulcer risks for Mary are also high as she was an alcohol and thus has high chances of liver ulcers. Moreover, the deficiency of Vitamin B can lead to mouth ulcers.

Psychological: Tools like Beck Depression Inventory (BDI) can be used to assess her depression and anxiety. Diagnosis reveals that she still longs for her children and is lonely. The psychological assessment reveals that refusal to walk or move can be characterized by old-age, increasing severity of dementia, orthopaedic aspects, and decreased functionalities. This assessment is important as this reveals about the psychological status of the patients and hence determines the care giving procedure.

Cognitive: The tools like Cognitive Impairment Scale PAS can be used for assessing her cognitive aspects. The diagnosis reveals that she was suffering from cognitive decline and having hallucinations and hence have been facing difficulties with her ADLs.

Comprehensive assessment for Barry:

Physiological: The falls risk assessment of Barry reveals that he has high risk of falling as he has visio-perceptual issues and depression. His old age can be another contributing reason to his falls risk. The pressure ulcer assessment of Barry’s case reveals that he does not have any symptom of developing ulcers and hence the risk is low. Barry must be exposed to some like-minded people as him with whom he can connect and communicate easily.

Psychological: The psychological assessment tool like Cognitive and neuropsychological tests can be used to determine his anxiety and depression scales (Beckman et al., 2019). The diagnosis reveals that barry has declining thinking skills and he finds it difficult to connect and communicate with people. This assessment would help the care givers to determine the level of care needed and to give the most suitable psychotic therapies.

Cognitive: The cognitive assessment can be done through Dementia Severity Rating Scale (DSRS). This assessment reveals that the type of dementia Barry has entails reasoning, memory, planning, and other types of thought processes resulted from the trauma of the Vietnam war. A recent psychological theory called Emotional Processing Theory states that the exposure treatments can be helpful for these patients’ cognitive condition as it would prevent the trauma memories to be negatively incorporated within their brain (Hayes, 2015). 

References

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia. Jama, 322(16), 1589-1599. https://jamanetwork.com/journals/jama/article-abstract/2753376

Beckman, E., Lazar, K., Van Hulle, C., Cole, A., Asthana, S., & Gleason, C. (2019). Association of traumatic brain injury, post-traumatic stress disorder and vascular risk with cognitive function in a veteran population: the brave study. Alzheimer's & Dementia, 15, P1559-P1559. https://doi.org/10.1016/j.jalz.2019.08.160

Gowan, J., & Roller, L. (2019). Changed behaviours in people with dementia. AJP: The Australian Journal of Pharmacy, 100(1180), 69–77. https://doi.10.3316/informit.320828203940274

Harrison, S., Cations, M., Jessop, T., Hilmer, S., Sawan, M., & Brodaty, H. (2018). Approaches to deprescribing psychotropic medications for changed behaviours in long-term care residents living with dementia. Drugs & Aging, 36(2), 125-136. https://doi.org/10.1007/s40266-018-0623-6

Hayes, A. (2015). Facilitating emotional processing in depression: the application of exposure principles. Current Opinion In Psychology, 4, 61-66. https://doi.org/10.1016/j.copsyc.2015.03.032

Kim, H. (2019). An analysis of the need for aid tools in dementia patients: focusing on the normal elderly, dementia patients, and caregivers of dementia patients. Indian Journal of Public Health Research & Development, 10(11), 4399. https://doi.org/10.5958/0976-5506.2019.04300.6

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