Mr. Jake was presented to the facility with agitation and deterioration in cognitive function beyond the expected limit. He is an older man aged 75 years with a past medical history of coronary artery disease and dementia. Moreover, the patient had undergone an aortic valve replacement to treat the artery. A relative disclosed that he had occasionally been experiencing memory loss since 2010, which worsened after aortic valve replacement two years later. He could not utter coherent sentences when brought in, and he forgot his previous conversations. The family said that he forgot or confused their names sometimes.
He was presented to the facility with functional disorders in his daily routine, such as driving, preparing meals, and handling money. He would get agitated and irritable easily and often got aggressive with his wife and anyone close to him. The laboratory exams showed no defects, and the brain appeared to have no issue. As a nurse, I must observe the patient keenly and orient them into reality (James et al., 2017). The nurse should also explain and enforce positive feedback because the patient was disturbed by his state.
Pathophysiology
Mr. Jake had symptoms of depression which was associated with his dementia state. Secondly, he had agitation and irritability, which his wife noted. After examining him, a distressed mood and distant thoughts were detected. Moreover, he had slurred speech, difficulty expressing his thoughts, and understanding what others said. The symptoms of dementia are; memory loss, poor judgment, and confusion (Jha & Mukhopadhaya, 2020). Moreover, such patients have trouble handling money and often get lost within their neighborhoods. Mr. Jake’s wife confirmed that the patient experienced these characteristics.
The cause of dementia is damaged brain cells, which obstructs the brain cells from communicating with each other. When the brain fails to function normally, thinking, behavior, and feelings are affected. When specific brain regions are obstructed, their functionality deteriorates. For example, in Alzheimer’s disease, brain cells fail to stay healthy and communicate with each other because of high protein levels inside and outside the cells (Xiao, 2020). The hippocampus is the center for learning and memory, and the first brain cells to be damaged come from this region. Memory loss is one of the initial signs of dementia.
History
My patient, Mr. Jake, had been diagnosed with coronary artery disease and hyperlipidemia. He has a history of dementia, and he used to take medication until recently. These conditions were diagnosed in the hospital, and a prescription to manage them was given. He underwent coronary artery bypass grafting. The patient had also been given statins to manage hyperlipidemia. Statins help in lowering cholesterol levels in the body. The doctor had advised him to consume healthier fats and eat more omega-3 foods as a sustainable plan for the cholesterol issue (Xiao, 2020). Patient A has been taking foods with more fiber as advised by his doctor.
Nursing Physical Assessment
Mr. Jake recorded blood pressure of 117/78 mmHg, which shows that his blood pressure was not affected by dementia. Moreover, he had normal bowel sounds that clicked 15 times per minute. The patient could move around independently without a wheelchair or assistive devices. Apart from his agitation issue, the cognitive and neurological tests showed no anomaly. Nevertheless, psychiatric evaluation demonstrated that the patient had depression, the leading cause of his symptoms.
Related Treatments
For the symptoms of Alzheimer’s, Mr. Jake was given galantamine twice a day and donepezil once a day to reduce the symptoms. The two prescriptions are given to patients with this condition to help them restore comfort and independence (Jha & Mukhopadhaya, 2020). Moreover, the caregivers of the affected patients are encouraged and relieved of their worries. It can be devastating to care for a dementia patient who shows no signs of improvement. Donepezil prevents acetylcholine breakdown in the brain, whereas galantamine prevents both the acetylcholine breakdown and facilitates the release of more of it in the brain by stimulating nicotinic receptors.
Nursing Diagnosis and Patient Goal
The main problem for Mr. Jake is dementia accelerated by depression. It was established through the psychiatric evaluation, and the patient confirmed feeling depressed about his state. The depressed state caused him agitation and made him get violent. In order to help the patient, the depression needed to be addressed, and then treat dementia. Since the patient was on donepezil once a day, the dosage was increased to twice daily (Lam, 2018). Furthermore, psychotherapy was recommended to treat the symptoms of depression.
Nursing Interventions
As a nurse, I must care for the patient and provide patient education to the wife and his close relatives. I will accomplish these goals by helping him remain calm and talking to him to familiarize him with reality. I would advise the wife and family members to talk to him more so that his memory may come back. Stimulative and enjoyable activities are recommended to keep the patient active (Trivedi, 2019). It would help him forget his worries and trigger the brain to function. The family should help him by keeping familiar objects around him, such as photo albums.
I will advise my patient to have a simple activity schedule to help him stay on track. Mr. Jake needs to use reminders and notes of his daily tasks. Moreover, he should keep a list of routine tasks and directions for two weeks. When this period was over, Mr. Jake was advised to return to the hospital for a check-up. Nevertheless, I provided my contact to his wife and advised her to inform me of his progress. I would occasionally call in to check on him to ensure he followed the prescriptions and doctor’s advice to the letter.
Evaluation
Mr. Jake returned to the facility for evaluation after two weeks. He was cheerful and bubbly, and his speech had returned. He denied feeling depressed, and the wife added that he had stopped the violence. The patient’s brother, who had accompanied the two, commented that his brother had transformed into a more organized and cooperative family member. Nevertheless, Mr. Jake admitted that he was still using notebooks to record his daily tasks, although he could remember most things. He cited not wanting to leave room for mistakes, so he preferred following the written schedules. Initially, the patient would make poor financial decisions, so they had to prepare a budget to avoid overspending. The intervention had worked for this patient because he got better and regained his speech and socialization. He is more familiar with his condition and is determined to recover.
Recommendations
The patient needs to have a healthy diet and make it a routine. Hence, his meals should consist of whole grains thrice a day. He should eat vegetables and fruits at least once a day and avoid excess red meat. Furthermore, he should increase physical activity by exercising and challenging his mind (Gorman & Anwar, 2018). The patient should avoid smoking and alcohol as they are harmful to the brain. The idea is to keep the brain as healthy as possible. Cognitive exercises such as board games and crosswords are recommended to help the brain stay active. Nonetheless, the nurse has to monitor the patient’s progress and should check on him occasionally.
References
Gorman, L. M., & Anwar, R. F. (2018). Neeb’s mental health nursing. F.A. Davis.
James, J., Knight, J., Cotton, B., Freyne, R., Pettit, J., & Gilby, L. (2017). Excellent dementia care in hospitals: A guide to supporting people with dementia and their carers. Jessica Kingsley Publishers.
Jha, A., & Mukhopadhaya, K. (2020). Alzheimer’s disease: Diagnosis and treatment guide. Springer Nature.
Lam, R. W. (2018). Depression. Oxford University Press. 10.1093/med/9780198804147.001.0001
Trivedi, M. H. (2019). Depression. Oxford University Press, USA, 10.1093/med/9780190929565.001.0001
Xiao, J. (2020). Physical exercise for human health. Springer Nature.