An Organic Disorder of Dementia and Treatment of Patient
The aim of this essay is to identify an individual who has been cared for in my practice with an organic disorder of Dementia, the purpose of chosen this topic is because Dementia is one of the most common diseases that affect older patient. The Essay will identify the signs, symptoms and causes of dementia in relation to the individual identified. The essay will also follow a theoretical evidence of nursing assessment and apply a person cantered to the care and treatment of patient identified, the essay will explore and identify nursing intervention and recovery oriented which address the chosen individual biological, psychological and social needs.
Furthermore, the essay will discuss the roles and responsibility of mental health nurse in the context of working in partnership across family, organisation, ethical, legal, cultural and professional boundaries. For this case study, all the names listed in this episode of treatment are pseudonyms that are not connected to any person.
The nursing and midwife council states that protecting the privacy and confidentiality of the patient and handling the information of all patients according to the policy is part of the role of the nurse and must be used for the reason provided. Furthermore, the Data Protection Act (2018) states that anyone responsible for the use of personal data must follow the principles of data protection such as fair, lawful, accurate and appropriate use. The patient has been chosen because there is an opportunity to participate in his care. His son consent was sought has Jay lack the capacity to give informed decision.
During my placement in semester 4 with the older adult I worked and supported a patient that was Diagnosed with a Vascular Dementia. Mr Jay is a 79-year-old Caucasian man with a diagnosis of Vascular Dementia ICD Code and long-term history of depression due to loss of his wife. According to Mind depression is classified as a low mood that could last for longer period. It can affect people’s daily activities and altered their mood. Causes of depression may be due to relationship breakdown, loss of loved ones which occurs as a predisposing factor for Mr Jay. He was brought up in an orphanage until the age of 16, he met his mother and father later in life and had a brother who has passes away according to,
After leaving the orphanage he join the army and later become a lorry driver , he described himself as a brilliant individual who experience childhood bullying from peers, he had 2 sons who are now grown up his eldest son lives with him and his the main carer. His brother and his mother had a history of dementia, he used to live with his wife and his eldest son in a three-bedroom house before she passed way. According to Zubin and Spring the stress vulnerability model, stressors can have a serious effect on a person’s vulnerability.
Mr Jay was vulnerable as his wife died and both his mother and brother also died of dementia making him prone to having the Disease , all this impacted his life style by smoking excessively and drinking alcohol, he used to have many friends but most of them have moved on with their lives leaving him with a much-reduced social life.
Mr Jay has type 2 diabetes and hypertension for the last 25 years which could contribute to Vascular dementia. Hypertension is the leading cause of cognitive impairment, however as argue by Biessel et al, People over the age of 70 with type 2 diabetes is twice as likelihood of devoting late cognitive impairment or dementia compared to those without it he lives with his son before his recent moves to the older adult. His children visit regularly after they notice a declined in their fathers’ memory. Mr Jays symptoms began after he suffered a stroke which was followed by rapids declining in his memory.
Other signs observed by Mr Jay is communication difficulties and not able to recognise family members he also experiences hallucination and delusion. He has a disturbed sleep pattern and goes into other patients’ rooms where he collects their belongings stating that they were his. Dementia is a term used to describe a symptom collection including memory loss, reasoning problems, perception and communication skills. It also leads to a reduction in the ability and ability of a person to perform routine activities such as washing, dressing and cooking.
Vascular dementia is also known as multi-infarct dementia, affecting 10 to 20% of all people with dementia, and is the second most common form of dementia following Alzheimer’s disease. It is caused by brain anoxia, ischaemia, or hypoxia, which has resulted in brain damage associated with cardiovascular and cerebrovascular disease. However, World Health Organisation states that Vascular Dementia is the second largest type of dementia among people it is a condition that is caused by lack of blood supply to the brain which causes the cells to die.
Vascular Dementia is the second largest dementia that affect over 150000 people in United Kingdom. Also, World Health Organisation states that the globe has approximately 35.6 million people with Dementia and around 7.7 million new cases each year. In 2030 the number of people living with Dementia worldwide is expected to double, and by 2050 that figure will be more than three times higher.
An organic mental Disorder is the dysfunction in a brain disease which can be permanent or temporary which diminishes the activity of the brain due to illness that are not psychological in nature. Organic mental disorders are disorder that can be caused by brain tissue injury or diseases as well as chemical or hormonal abnormalities, these disorders may also be caused by toxic material exposure, neurological impairment and age related. However, some causes may arise as a result of Alcohol or Metabolic conditions such as liver, thyroid, kidney disease or vitamin deficiency. Other factors include trauma bleeding in or around the brain, low oxygen to the brain, blood clots, strokes, brain infection and heart infection may predispose an individual in developing an organic disorder.
In Jays case predisposing factors that might contributes to his risk of dementia include depression, lifestyle and generic history of dementia in the family. In addition, Mr Jay has an underlying physical illness such as Diabetes and Hypertension (ICD-I10) which could contribute to his Vascular Dementia. According to Alzheimer’s society people with stroke, heart disease or diabetes are at high risk of Vascular Dementia. Signs are visible sign of a condition, and symptoms are self-reporting of a physical or psychological symptom of a condition in clinical psychology, it could be difficult to distinguish the distinction between signs and symptoms.
Dementias is a term used in describing a set of symptoms such as reasoning problem, loss of memory, loss of communication and perception skills, inability to perform certain activities of daily living like dressing, cooking and washing. As suggested by in the British journal of cardia Nursing, risk factors that are associated with vascular dementia involved Age, smoking, raised blood pressure, serum, lipids, high dietary fat intake, and head trauma.
Dementia’ is a term used to describe a range of symptoms that affect language, problem solving, memory loss and difficulties with thinking. People with dementia often act aggressively due to fear, discomfort or frustration; hallucination is a negative prognostic sign, associated with rapid cognitive decline. Dementia is a disease with no cure, but can be managed. It is the responsibility of health care professionals to effectively use the right treatment that will reduce the deterioration of dementia from occurring. Assessment of patient is the fundamental principle of Nursing practice.
Before carrying out any form of intervention questions needs to be asked to be able to determine the type of care to be given to the individual been assessed. Having been seen by the GP and undertake series of blood text and urine text the Gp was not convince enough whether the changes in Mr Jay behaviour and cognition was as a result of depression after the loss of his wife or due to dementia. Mr Jay was invited for an initial assessment by writing, stating the reason for his assessment and also which specify the date, location and time of the assessment, consent for student nurse to be present was sought by Jay and family and was agreed.
Before diagnosis can be made proper assessment and text needs to be carried out in order to carry out fact and not mis diagnose a patient, the assessment will also help the in laying out possible intervention for the client and assist in making a diagnosis. there are various tools in place to text patient’s cognition and memory. In the case of Jay, tools such as ACE-R and MMSE are used within the Trust.
To protect Jays privacy as stated by the he was invited into a quiet room, the assessment took place by introduction of the nursing team and the reason for the meeting. A Mini Mental State Examination was conducted, and she score 12/30 which was very low. he maintained eye contact throughout the assessment, his speech was incoherent, and his answer were irrelevant to the questions that where been asked, he was labile in mood, facilitating between crying and then being jovial. He did not describe any unusual experience nor appear to be responding to any external stimuli. He was disorientated to place, time and person with no insight about his condition.
History of a patient must be considered during an assessment question around his life experienced, social and family history must be looked into. The Biopsychosocial model by Engel approach was considered. Jay son was very helpful in providing background information on his dad’s experience and around the family, health and social history which gave an insight into what triggers to the problem. Mr Jay has family history of dementia and continued deterioration in cognition, concentration and functional declined. He mostly presented with agitation, aggressive and disruptive behaviour.
People living with dementia are often present with agitated and erratic behaviour these could be as a result of their suspicious or feeling of been threatened or due to paranoid which can affect their safety. Jay was diagnosed with Vascular dementia after her assessment and series of test and investigation been carried out. Risk assessment is essential in planning care for patient with dementia. Mr Jay is vulnerable due to his poor mobility and his at high risk of fall, he is cognitive impaired in memory and functions which prone him to be unable to do daily activities such as dressing himself, feeding and attendance to his personal hygiene. he is at risk of harm to self and other as evidenced in his constant confrontation with other patient, there is also a high risk of absconding been evidenced to always stand by the door looking for his way on several occasion.
His constant wandering put him at high risk of fall and several unexplained bruises. All these risks cannot be eliminated but can be assessed and manage. person centred play a core value in nursing practice. its valued people regardless of age or cognition ability. May et al., also argues it individualised recognition that everyone is unique which includes the perspective of the person with dementia as central to all care planning. By adapt a person-centred approach in supporting Mr Jay in a realistic view of limitation he faced because of his rapid declined in cognition and functions will be considered.
There is no cure for dementia, however Mr Jay symptoms and experience can still be managed, regarding Jays Biological needs, medication has been considered as effective to his condition. According to the Department of Health, anti-psychotic medication can be used as a first resort for people with dementia with psychotic symptoms who are also aggressive. Medicine management is an essential component of practice for nursing and midwifes which involve administration of medication prescribing and supporting patients to take their medication correctly.
Regarding his biological needs Mr Jay is currently on physical and psychotic medication his on 1mg of lorazepam to be taken at night as a, Memantine 20mg, 25mg of quetiapine to be taken at night for psychotic symptoms and aggression, Amlodipine for blood pressure, metformin for diabetes, sodium valproate was also prescribed for mood stabilizer. Jays physical health examination will be monitored regularly both glucose level and hypertension. He was given advice on healthy diet and ways of living a healthy lifestyle. The NICE guidelines encourage healthy living and promote high quality care which are evidenced based intervention used by all health professional. CBT and interpersonal therapy can reduce the symptoms of depression in person living with dementia.
Jay has been involved in a validation therapy to support and reassure him work through his emotion, he was also offered a gardening therapy which helps his physical health condition as part of exercise. The Mental Capacity Act (MCA) helps and empower people who lack capacity to make decision regarding their care and treatment. According to the Mental Capacity a person is said to lack capacity when the cannot weigh, retained and understand informed decision .Mr Jay showed evidenced of cognitive impairment due to his condition his son who happen to be his main career was involved about making decision about his.it must also be noted that when making decision for someone who lacks capacity, it should be made base on their best interest. the Mental capacity act serves as an important legislation that impact the lives of those who lack capacity.
Therapeutic relationship was developed with Mr Jay so as to gain trust which is an important aspect of nursing process in any intervention that is being carried out. Mr Jays conditions affect his cognitive function and impairment which deprived him from carrying out his daily activities such as bathing , feeding and incontinent, there is a plan in place ensuring that his needs are met by assisting him with toileting, feeding ,and personal care ,ensure his offered choice of cloth by showing him or open his ward robe to choose as stated in his care plan .Mr jay was involved in participating in physical activities this also provide a protection for his brain structure and cognitive function. An alarm system has been put in place for Jay which alert staff of his whereabout and serves as tracking devices.it is used to locate a person to ensure their safety.
Mental health nurses must work in partnership with other qualified professionals like General Practitioners , Doctor, Psychotherapist, physiologist, psychiatrist, language therapy, social worker, families and relatives as well as carers as dementia is a life changing disease which can affect everything in an individual’s life including family and relationship. The role of mental health nurse in relation to family is by communicating with patient’s family offering them advice and information about medication and other available therapy which has been deemed to be affective as well as providing psychoeducation for family about dementia.
There are different multi agencies which are accessible to people with dementia such as GP, occupational therapy, nurse, social service and community services. Ethical consideration plays an important part in nursing practice, because nurses and other health care workers have a responsibility to provide a safe, effective and non-judgemental care to patients. Ethical issue observed in Jays case were her interference with other patients private space going into their rooms and taking their belonging is an issue because as much as we would not want to restrict Jays movement around the home, the privacy of other patients must be considered and respected.
As a nurse it is vital to understand and respect patients background, patients might present differently due to their cultural background. Nurse must be aware of culture and ethical differences.The pharmacology and non-pharmacological intervention that was collaborate used by the team in support of Jays care were deemed to be effective, the non-pharmacological intervention such as music therapy, massage, gardening, relaxation therapy were very useful and effective.
In addressing Jays behavioural challenges, the Oxleas dementia care tools was used which helped the staff in working with Jays mood and behaviours and look into what the causative factors of the distress could be. This tool focus on people’s environment, communication, life history, medication and side effect, pain and mood all these help in building a picture of what is happening in a persons life and devising approaches that may work in addressing them.
In conclusion, the essay has identified that has been cared for in practice with an organic disorder, the signs, symptoms and possible causes of a vascular dementia was identified, I have been able to draw up a clinical and theoretical research evidence discussing the nursing assessment and evaluation of a person centred recovery that identified the intervention using the Engel 1980 Biopsychosocial model of biological, psychological and social model to address the needs of an individual identified. Lastly, the role of mental health nurse when working in partnership across the family member, organisation was discussing along with cultural, legal and ethical boundaries.
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