13.5/15

Case Study 17.2
Brittany M. Hicks
Lakeview College of Nursing
N-309
March 16, 2012

Case Study 17.2
1.	According to Alzheimer’s foundation web site found at http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp, what stage of cognitive decline is Claudine experiencing at this point?
	After reading the article about the stages of Alzheimer’s, I would say that Claudine is experiencing stage 3, mild cognitive decline (Stages of Alzheimer’s, 2010). Stage 3 is characterized by difficulty in organizing, misplacing objects, and difficulty performing tasks (Stages of Alzheimer’s, 2010). She admitted that she had a memory problem also. Others have also noticed her decline in memory, her husband and daughters noticed that she need assistance when preparing for Thanksgiving dinner. 
2.	Discuss the definition of dementia using the Hartford Institute for Geriatric Nursing Evidenced-Based Practice Web site at http://consultgerirn.org/topics/dementia/want_to_know_more (Fletcher, 2008). What is the prevalence?  
	Dementia is a syndrome that involves both memory impairments and cognition disturbances (aphasia, apraxia, and agnosia), most patients also have a comorbidity (Fletcher, 2008). Dementia is recognized through behaviors and normal functioning (Fletcher, 2008). Common forms of dementia are Alzheimer’s, vascular, and lewy body dementia (Fletcher, 2008). 
	There is a high occurrence amongst Americans that suffer from Alzheimer’s disease; approximately 5% of 65 year olds live with this disease. According to Fletcher (2008), 4-5 million Americans have Alzheimer’s disease (Fletcher, 2008). Worldwide prevalence of Dementia is 24.3 million, with 6 million new cases per year (Fletcher, 2008).
3.	After conducting an internet search, identify three reputable Web sites where Claudine’s family can obtain information about Alzheimer’s disease. Below I listed three approved websites that Claudine’s family could find information about Alzheimer’s that is reputable.
http://www.alz.org/about_this_site.asp (Alzheimer’s Association)
http://www.nia.nih.gov/alzheimers (National Institute on Aging)
http://www.mayoclinic.org/alzheimers-disease/ (Treatment & Diagnosing Alzheimer’s disease)
4.	What warning signs (behaviors) for Alzheimer’s disease does the family find on the Alzheimer Association website at www.alz.org/10signs?
	Out of the 10 signs of Alzheimer’s I believe that these three characterized what Claudine is experiencing: difficulty completing familiar tasks at home, memory loss that disrupts daily life, and misplacing things (Stages of Alzheimer’s, 2010). The reason that I chose these particular three is because her husband said that she kept progressively forgetting and misplacing items. She also had to use recipe cards to help prepare Thanksgiving dinner; typically she is able to do it on her own. Her family also noticed that she didn’t set the table with the items she is accustomed to at Thanksgiving time. 
5.	According to Alzheimer’s Association at http://www.alz.org/alzheimer’s_disease_steps_to_diagnosis.asp what kind of practitioner should Claudine visit?
They should likely see a geriatric nurse practitioner as they specialize in these diseases and can give you the best care.  
 According to the Alzheimer’s Association, no one “type” of practitioner is best for diagnosing Alzheimer’s disease. The Alzheimer’s Association can help a person find a local practitioner to start the process. Or, a family might choose to visit their regular physician/practitioner. A general medical practitioner might refer Claudine
to a psychiatrist, a neurologist, or a psychologist for further examination, diagnosis, and treatment

6.	What kinds of recommended treatments might Claudine’s family anticipate to slow the progression of Claudine’s disease? Find some of these at http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
There are two types of medications that are FDA approved to help correct memory loss disorders they are cholinesterase inhibitors and Memantine (Standard Treatments, 2010).The cholinesterase inhibitors stop the breakdown of acetylcholine, helps delay worsening symptoms. Common cholinesterase inhibitors are: Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne) (Standard Treatments, 2010). Memantine is to help with memory loss; this can be used solo or with another medication for maximum results (Standard Treatments, 2010). This medication regulates glutamate activity and decrease symptoms of Alzheimer’s (Standard Treatments, 2010). 
7.	What could you tell the family about potential respite services for them? Find information at http://www.alz.org/living_with_alzheimer’s_respite_care.asp
	There are a few options for respite care to help with someone who has Alzheimer’s. They have in home services as well as adult daycare activities depending on what is best for the individual. Some in home care respite services include: skilled care (help with medication administration), personal assistant (help with ADL’s), adult companion (company/visitors), and lastly a maid to help with housekeeping maintenance) (Respite Care, 2007). Adult daycare is a center that entertains Alzheimer patients providing them a safe environment depending on the severity of the disease (Respite Care, 2007).
8.	What are some reasons for which the nurse might recommend an adult day care center as a potential option for Mr. Everett to pursue? Find some of these in the Adult Day Center’s pdf document linked from http://www.alz.org/living_with_alzheimers_respite_care.asp
	A nurse may recommend an adult daycare center if they feel that the patient would benefit from it. It would give their family a break from doing all of the caregiving. It would also allow the patient time to interact with others socially (Respite care, 2010). Some of the services that adult daycare center provide include: activities, personal care, counseling, nutrition, healthcare services, behavior management, and therapy if needed (Respite care, 2007). 
9.	What are three questions you would advise the family to consider as they grapple with this issue? You can find some of these as the Web site of the National Institute on Aging http://nia.nih.gov/Alzheimers/Publications/homesafety.htm#safe
Some of the questions that can be asked of Claudine to see if she is safe on her own are can she recognize danger (fire), is she content at home, and lastly does she show signs of depression or agitation (Home safety for people with Alzheimer’s disease, 2010). 
10.	What are two actions Claudine’s family could take to promote safety in the home’s entryway?
	To help with patients that maybe disoriented or at risk for a fall, make sure that all clutter is picked up and that no cords are on the floor as this is a trip hazard. It may also be helpful for Claudine’s family to place a rail in the entry or a sitting spot for her if needed. 
11.	What are your thoughts on how to best handle this situation in relation to Claudine knowing the truth? 
	I believe that Mary should tell her mother the truth, it is better for her to know than for it to be a secret. I feel that they would be doing a disservice to Claudine and themselves by keeping this from her. She will recognize that he is not attending the family functions, but she may not understand why. Honesty is the best in my eyes. 

 

				References
Alzheimer’s disease. (2012). Retrieved from http://www.mayoclinic.org/alzheimers-	disease/
Fletcher, K.  (2008). Nursing standard of practice protocol: Recognition and 			management of dementia. Hartford Institute of Geriatric Nursing. 			Retrieved from 			http://consultgerirn.org/topics/dementia/want_to_know_more
Home safety for people with Alzheimer’s disease (2010). National Institute on 	Aging. (NIH publication No. 02-5179). Retrieved from 	http://nia.nih.gov/Alzheimers/Publications/homesafety.htm#safe
Respite Care. (2007). Alzheimer’s Association. Retrieved from http:// 	www.alz.org/living_with_alzheimer’s_respite_care.asp
Stages of Alzheimer’s. (2010a). Alzheimer’s Association. Retrieved from 	http://www.alz.org/alzheimer’s_disease_stages_of_alzheimers.asp 
Standard treatments. (2010b). Alzheimer’s Association. Retrieved from 	http://www.alz.org/alzheimer’s_disease_standard_prescriptions.asp		
Steps to diagnosis. (2010c). Alzheimer’s Association. Retrieved from				 http://www.alz.org/alzheimer’s_disease_steps_to_diagnosis.asp