FYI: Without page numbers for your direct quotes it would be considered plagarism

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Case Study 17.2
Gregory Cahill
Lakeview College of Nursing

1.  Claudine is experiencing moderate cognitive decline.
2. The following definitions and prevalence is taken from Fletcher (2008): “Definitions/Distinctions
1. Dementia is a clinical syndrome of cognitive deficits that involves both memory impairments and a disturbance in at least one other area of cognition (e.g., aphasia, apraxia, agnosia) and disturbance in executive functioning. 1
2. In addition to disruptions in cognition, dementias are commonly associated with changes in function and behavior.
3. The most common forms of progressive dementia are Alzheimer's disease, vascular dementia, and dementia with Lewy bodies; the pathophysiology for each is poorly understood.
4. Differential diagnosis of dementing conditions is complicated by the fact that concurrent disease states (i.e., co-morbidities) often coexist.
B. Prevalence
1. Dementia affects about 5% of individuals 65 and older. 2
2. Four to five million Americans have Alzheimer's disease (AD) 3
3. 13.2 million are projected to have AD by 2050. 3
4. Global prevalence of dementia is about 24.3 million, with 6 million new cases every year.”
3.  Three reputable websites include Hartford Institute for Geriatric Nursing http://consultgerirn.org/topics/dementia/want_to_know_more, PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001767/ and the Alzheimer’s Associating http://www.alz.org/. 
4.  The 10 warning signs of Alzheimer’s according to "Alz.org," (2011)  are “memory loss that affects daily life, challenges in planning or solving problems, difficulty completing familiar tasks at home, at work or at leisure, confusion with time or place, trouble understanding visual images and spatial relationships, new problems with words in speaking or writing, misplacing things and losing the ability to retrace steps, decreased or poor judgment, withdrawal from work or social activities, changes in mood and personality.” 
5.  According to “Alz.org” (2011) you should be evaluated by a physician if you suspect Alzheimer’s
6.  Anti-cholinesterase’s are commonly prescribed to slow the progression of Alzheimer’s.
7.  Potential respite services for them could include hiring a friend or neighbor to watch Claudine for a few days, they could hire a professional with the appropriate level of skill, or they could look into moving her into a facility for a few days.
8.  Adult day care centers can be good options because they are flexible.  Adult day cares can be used for all or part of the day and 1-5 days a week depending on the needs of the client.  They also offer meals, companionship and activities for their clients.  
9.   Three questions to consider when deciding to leave someone with Alzheimer’s at home are: does the person become confused or unpredictable under stress, recognize a dangerous situation, for example, fire, know how to use the telephone in an emergency (NIA, 2011). 
10.  Two actions to promote safety in a home’s entry way are remove scatter rugs and throw rugs and use textured strips or nonskid wax on hardwood and tile floors to prevent slipping  (NIA, 2011).
11.  I think that Claudine should be told the truth when she is having a good day, meaning a day when she is behaving and is more mentally alert than other day, but she should only be told once.  I would not keep telling Claudine if she forgets about the divorce.  People with Alzheimer’s need help to keep calm and safe and reorienting her to the reality of her daughter’s divorce could cause her to behave in a way that is unsafe.  Ultimately it does not matter what I think because the family should make the decision.  

References
Alz.org. (2011, December 1). Retrieved from 
     http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp 
Fletcher, K. (2008, January). Nursing standard of practice protocol: Recognition and    
     management of dementia. Retrieved from   
     http://consultgerirn.org/topics/dementia/want_to_know_more  
NIA. (2011, November). Home safety for people with alzheimers. Retrieved from 
     http://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-    
     disease/general-safety-concerns