14/15 good job

Case Study 17.2
Simone Walker
Lakeview College of Nursing
Nursing of the Gerontological Client
March 25, 2012

Case Study 17.2
1. According to the 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?    The correct answer is stage 3
	The cognitive decline Claudine is experiencing is Stage 4, which is moderate cognitive decline (Mild or early-stage Alzheimer's disease) according to the Alzheimer’s Association (2010). In this stage a person starts to have symptoms like: forgetfulness of recent events, impaired ability to perform challenging mental arithmetic like, counting backward from 100 by 7s, greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances, forgetfulness about one's own personal history, and becoming moody or withdrawn, especially in socially or mentally challenging situations (Alzheimer’s Association, 2010). 
2. Discuss the definition of dementia using the Hartford Institute for Geriatric Nursing Evidence-Based Practice Web site at http://consultgerirn.org/topics/dementia/want_to_know_more
(Fletcher, 2008). What is the prevalence?
The definition of 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, and agnosia) and disturbance in executive functioning (Fletcher, 2008). The prevalence of dementia is: affects about 5% of individuals 65 and older, four to five million Americans have Alzheimer's disease (AD), 13.2 million are projected to have AD by 2050, and global prevalence is about 24.3 million, with 6 million new cases every 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.
	Here are three reputable websites Claudine’s family should use:
1.	http://www.alzfdn.org
2.	http://www.alz.org
3.	http://www.ahaf.org/alzheimers/
4. What warning signs (behaviors) for Alzheimer’s disease does the family find on the Alzheimer’s Association Web site at www.alz.org/10signs?
The 10 warning signs for Alzheimer’s are: 
1. Memory loss that disrupts daily life             
2. Challenges in planning or solving problems 
3. Difficulty completing familiar tasks at home, at work or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing 
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality (Alzheimer’s Association, 2010). 
5. According to the Alzheimer’s Association at http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp what kind of practitioner should Claudine visit?
The kind of practitioner that Claudine should visit:  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

Neurologists, who specialize in diseases of the brain and nervous system 
Psychiatrists, who specialize in disorders that affect mood or the way the mind works 
Psychologists with special training in testing memory and other mental functions (Alzheimer’s Association, 2010). Preferably a doctor who specializes in the geriatric field.  
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
The recommended treatments to slow the progression of Claudine’s disease are medications like: 
Donepezil (Aricept) is approved to treat all stages of Alzheimer's. 
Rivastigmine (Exelon) is approved to treat mild to moderate Alzheimer's. 
Galantamine (Razadyne) is approved to treat mild to moderate Alzheimer's.
Tacrine (Cognex) is approved to treat Alzheimer’s because of its serious side effect, it is 
not prescribed.
Memantine (Namenda) is approved by the FDA for treatment of moderate to severe Alzheimer’s (Alzheimer’s Association, 2010).  
7. What could you tell the family about potential respite services for them? Find information on these at http://www.alz.org/living_with_alzheimers_respite_care.asp
The types of respite services the family may be inform about are: 
In-home care services which offers a range of options including: companion services provide the individual with dementia company and help supervise activities; personal care or home health aide services assist with bathing, dressing, toileting and exercising; homemaker or maid services help with laundry, shopping, and preparing meals; and skilled care services help with medication and other medical services (Alzheimer’s Association, 2007). 
Adult day center is a place where the person with Alzheimer’s can be with others in a safe environment. They have planned activities, such as music and art programs. Transportation and meals are often provided to the adults (Alzheimer’s Association, 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
Based on the information, the nurse may recommend an adult day care center as an option for Mr. Everett due to Mr. Everett not being able to have time to do things like get a haircut and showing signs of being stressed out. This is proof that he should look into adult day care and be able to have a break from caregiving and take care of other things like getting a haircut.
9. What are three questions you would advise the family to consider as they grapple with this issue? You can find some of these at the Web site of the National Institute on Aging http://www.nia.nih.gov/Alzheimers/Publications/homesafety.htm#safe
The questions that I would advise to the family think about are:
Does the Claudine:
•	recognize a dangerous situation, for example, fire?
•	know how to get help?
•	wander and become disoriented?
•	show signs of agitation, depression, or withdrawal when left alone for any period of time (National Institute on Aging, 2010)? 
10. What are two actions Claudine’s family could take to promote safety in the home’s entryway?
	Keeping the entryway, hallways and walkways free/clear of clutter and remove scatter rugs and throw rugs. The use of textured strips or nonskid wax on hardwood and tile floors to prevent slipping. Install secure locks or the doors and windows and have a spare key placed somewhere outside of the house in case they lock you out (National Institute on Aging, 2010).
11. What are your thoughts on how to best handle this situation in relation to Claudine knowing the truth?
	I believe the husband and family should tell Claudine and if she forgets what you told her just tell her again the situation. I do not think the family should lie to Claudine. If she had a relationship with the son in law he could still visit.

References
Alzheimer’s Assoication (2007). Respite care. Retrieved from: 
	http://www.alz.org/living_with_alzheimers_respite_care.asp
Alzheimer’s Association (2010). Stages of Alzheimer’s. Retrieved from:
	http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
Alzheimer’s Association (2010). Standard treatments. Retrieved from: 
	http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
Alzheimer’s Association (2010). Steps to diagnosis. Retrieved from:
	http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp
Alzheimer’s Association (2010). 10 warning signs of Alzheimer’s.
	http://www.alz.org/alzheimers_disease_know_the_10_signs.asp
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
National Institute on Aging (2010). Home safety for people with Alzheimer’s disease. Retrieved 
	from: http://www.nia.nih.gov/Alzheimers/Publications/homesafety.htm#safe