The 3 Ds Dementia - Delirium and Depression- Free Sample

Question: Case study about the 3 Ds Dementia, Delirium and Depression. Answer: Introduction According to the fact sheet published by WHO (World Health Organization), dementia can be considered as a syndrome, which can cause severe deterioration in behavior, thinking process, memory and as well as everyday activities. According to the research study of Steen et al. (2013), it is recognized that older people are the most vulnerable groups towards dementia. However, it was argued by Wall and Duffy (2010), who stated in their paper that despite the vulnerability of the older people towards dementia, it is found that the association of dementia with aging is not very normal. Worldwide it is found that there are 47.5 million people who are affected by dementia (Potter et al. 2011). The evidence also reflects that there are approximately 7.7 million new cases have been reported in every year (Dickens et al. 2011). Dementia is detected as one of the important reasons behind the dependency and disability among the older people in Australia (Yaffe et al. 2011). The research study of Cruz-Jentoft et al. (2010) reflects that dementia not only has social, psychological, physical as well as the economical impact on the patients but also on the families, cares givers, and close personals. This chronic disease is progressive in nature, in which the cognitive functions of the patients start deteriorating. Dementia can be caused by different reasons such as the death of brain cells due to severe injuries in the brain and occurrence of Alzheimers or brain stroke. The occurrence of dementia can mainly affect thinking orientation, learning capacity, calculation, comprehension, judgment and language of the patient. Brief history of the case studies Mr. David Geoffrey is a patient of 88 old, who has been transported to ED from his home. Mr. David Geoffrey lives with his wife (86-year-old) and a grandson, who take care of him. Mr. David Geoffrey had a medical history of CVA 20 years ago. Recently he is diagnosed with dementia. Apart from these, he is also diagnosed with atrial fibrillation, glaucoma and diabetes type 2. He has shifted emergency department due to his sudden ill behaviour with the care giver who helps him to take a bath and increasing incontinent of Urine and feces. After the primary treatment in ED, Mr. David Geoffrey recovered from his current situation and therefore shifted to the medical ward. It is found that he has bilateral deafness and no longer uses his hearing aids. Because of his increasing incontinent of Urine as well as faeces, he was admitted to the acute care hospital. After seven days of admitting him in the medical ward, it is found that he becomes increasing dependent on the nurses to perform all of the daily activities. After running different tests including a mini mental state examination, the doctors decided to send him to the residential aged care near his house under the surveillance of the ACAT team. Doctor prescribed him several medicines, which may include metformin, digoxin, insulin and enteric coated aspirin. First, five days he stayed in bed then he started using his "comfortable chair, even started playing poker with his son. However, it is found that his condition deteriorated again, and he developed Urinary infection with a groin rash. It is also recognized that he started ill-behaving with his care givers in such a way that most of the staffs are now fearful of Mr. David Geoffrey. Many staffs said that sometimes he speaks like he is a baby and also admonishing him. According to the doctors despite his playing cards and answering close ended questions he is a victim of severe dementia and developed severe memory problems. Issues identified From the case study of Mr. David Geoffrey, several health-related issues were identified. From the case study, it is evident that Mr. David Geoffrey is suffering from acute dementia. However, apart from dementia, it is found that there is also other health related issues that are bothering Mr. David Geoffrey. The identified health issues in the provided case study are as follows- David Geoffrey is an 88 old person; therefore, it is certain that he is going through some health-related issues due to his aging. He is diagnosed with dementia in his later life David Geoffrey is also suffering from atrial fibrillation David Geoffrey is suffering from Diabetes Type 2 David Geoffrey is also diagnosed with glaucoma. David Geoffrey has a speaking problem due to CVA, which occurred 20 years ago David Geoffrey is also suffering from bilateral deafness and does not like to use his hearing aids. David Geoffrey is suffering from increasing confusion and a lack of decision making ability David Geoffrey is showing increasingly incontinent of urine and faeces. The behavior of Mr. David Geoffrey with his care givers is decreasing in a continuous manner. David Geoffrey scored only 19 in Mini-Mental State Examination, which reflects his continuously fading memories. Past medical history Mr. David Geoffrey is a poor person who is 88 years old and suffering from dementia. While exploring the medical history of Mr. David Geoffrey, it is recognized that he had suffered from CVA, which occurred 20 years ago. According to Witlox et al. (2010), Cerebrovascular attack (CVA) can be developed due to the bad circulation of blood in the blood vessels, which supplies blood to the brain. In this disease, the brain blood vessels become damaged in such a way that it causes severe health-related issues, such as muscle weakness in the body, blurred vision, balance disorder, reduced sensations of touch, and weakness in limbs, headache, mental confusion and slurred speech. Due to the occurrence of this disease, Mr. David Geoffrey is suffering from most of the health related issues especially difficulty in speaking, speech loss, mental confusion and partial deafness. Medications From the case study, it is found that the doctor suggested a list of medicines for the help of poor Mr. David Geoffrey. The list of medicines may include metformin, digoxin, enteric coated aspirin, and insulin. However, these medicines were prescribed to him before his admission in the residential aged care. When his condition deteriorated in the residential aged care, and he was diagnosed with urinary tract infection with a groin rash, the doctor prescribed a number of antibiotics with zinc cream application to the groin. The doctor also prescribed him risperidone for his aggression coupled with antidepressant considering his present mental conditions (Goodman et al. 2010). Assessment undertook According to Scandol, Toson and Close (2013), it is recognized that the diagnosis of dementia can be made only after a proper assessment. In this case study, the doctor also followed a particular assessment procedure to determine the present condition of the patient (Mr. David Geoffrey). The identified assessment procedure is as follows- Collecting data about the medical history of Mr. David Geoffrey Cognitive state examination Mental state examination with the help of Mini-Mental State Examination Physical examination of Mr. David Geoffrey Other biochemical tests From this case study, it is found that the doctor used a number of assessment procedure step by step depending on the current physical and mental condition of Mr. David Geoffrey. However, the analysis of medical history has been done before the deteriorating condition of Mr. David Geoffrey's health. After completion of assessment procedure, the doctor diagnosed Mr. David Geoffrey as a dementia patient in his acute condition and prescribed proper medicines and ordered proper interventions too help Mr. David Geoffrey. Brief Outline of Pathophysiology Dementia is considered as a result of different types of brain diseases as well as several system degenerations. Although Cooke et al. (2010) showed the Alzheimers disease is the main reason behind the occurrence of dementia, it was argued by Sydenham et al. (2012), who stated that dementia can take place due to several reasons that can lead to the damage of brain cells and resulted in dementia. The primary dementia is progressive and irreversible in nature. The primary dementia is consists of two distinct types such as dementia of the Alzheimers type (DAT) and vascular dementia (multi-infarct dementia). The genetic factors of dementia are as follows- Familial Alzheimers disease, which is coupled genetic disorders on the chromosome number 1, 14, and 21 (Declercq et al. 2013). The mutation of the genes on the chromosome number 1 and 14 are particularly responsible for the occurrence of this disease, which normally encode for amyloid precursor protein. The excess presence of apolipoprotein E4 (Apoe4), a cholesterol-bearing protein on the chromosome number 19, is found among the patients who are suffering from Alzheimer's disease than that of the general population (Sinclair et al. 2011). The biochemical factors- People with Alzheimers disease are experiences a relative deficient of acetylcholine, which is a neurotransmitter and helps to transfer signals to the brain (Sousa et al. 2010). The presence of amyloid plaques, as well as neurofibrillary, is found in the brain of the Alzheimer's patients. Slow viral infection, as well as autoimmune processes, can lead towards dementia. Secondary dementia can take place due to several reasons such as-Acquired immunodeficiency syndrome, chronic meningitis, Creutzfeldt-Jakob disease, Huntingtons disease, Parkinsons disease, Wilsons disease, Thalamic dementia, Anaemia, Deficiency states, Cardiac or pulmonary failure, Hepatic encephalopathy (Cowdell, 2010). After the diagnosis of Mr. David Geoffrey, it is recognized that he is not a victim of Alzheimers disease. Therefore, it can be assumed that in the case of Mr. David Geoffrey, the growing age, and long term cardio vascular disease is the main reason behind the occurrence of dementia. Pharmacological treatments According to the case study, it is recognized that Mr. David Geoffrey is suffering from acute dementia. Therefore, a number of behavioural and psychological problems are experiencing by him. After discharging from the hospital, the doctor prescribed him several medicines, which may include metformin, digoxn, insulin and enteric coated aspirin. The metformin and insulin were prescribed to control his type 2 diabetes. On the other hand, digoxn was prescribed to treat his poor cardiovascular condition. Enteric coated aspirin was also prescribed to protect the heart. Therefore, it can be said that doctor did not mention any medicine in order to treat dementia. In order to treat dementia, donepezil, galantamine, and rivastigmine can be prescribed in a controlled dosage. Although these drugs were designed to treat Alzheimers disease, Tsopelas et al. (2011) showed that these drugs are extremely helpful to treat dementia patients, while applied in controlled dosages. Apart from these, antips ychotic drugs and antidepressants can be prescribed in order to control behaviour problems of Mr. David Geoffrey. Apart from prescribing medicines to treat Alzheimers, the doctor also needs to prescribe medicines for high cholesterol and high blood pressure since Mr. David Geoffrey is a patient of CAV. According to Sousa et al. (2010), application of these drugs cannot cure existing dementia, but they are proved as helpful to decrease the risks of heart disease and future stroke. Psychosocial requirements According to Moyle et al. (2011), psychosocial intervention is one of the most important weapons to fight against dementia and provide supports to the patients with dementia in order to help them to lead a better life. The selection of psychosocial interventions for dementia is dependent on the preferences as well as the needs of the patient. After evaluating current mental state of Mr. David Geoffrey and analyzing his basic needs, the following psychosocial interventions can be taken- "Behavioural management techniques centered on individual patients' behavior"- according to Prince et al. (2013), this intervention technique is helpful to reduce depression and other behavioural symptoms of Mr. David Geoffrey. Cognitive stimulation- according to Strydom et al. (2010), this intervention will be helpful for the reduction of depression as well as the agitated behaviour of Mr. David Geoffrey. Verbal and non-verbal communication behaviours- this intervention will be helpful in order to improve his communication skills and improve his life style. Staff communication techniques for use in daily routine- according to Forti et al. (2010), this technique is also helpful to improve the communication skill of Mr. David Geoffrey. Physical and psychosocial support According to the case study, Mr. David Geoffrey is an 88-year-old dementia patient, who lost all enthusiasm to be physically active. Mr. David Geoffrey is hugely dependent on his care givers, especially on the nurses for his well being. It is found that he is detached from all of the physical activities, and he spends most of his times on his bed. After seven days of admitting in the residential aged care he started to sit on his comfortable chair; however there were no signs of any other physical activities. In this situation, the following intervention can be provided to Mr. David Geoffrey as psychosocial and physical support- Support and encourage Mr. David Geoffrey to increase his fitness positive behaviour and physical function. Making verbal communication with Mr. David Geoffrey, in order to make him realize that he is not alone and have full support from his family. The nurses or staffs can educate him about the physical fitness so that he can be less dependent on the other people for his well-being (Clegg et al. 2013). Cognitive stimulation can be used as an intervention to reduce his depression and behavioural symptoms (Yaffe et al. 2013). Environmental considerations According to Cruz-Jentoft et al. (2010), the care plan of dementia should be developed based on the considerations of the environmental factors along with the psychosocial factors and the physical health of the patient. It is recognized that most of the behavioural concerns arise among the dementia patients due to specific environmental causes. Dementia patients are agitated as well as overwhelmed by the presence of several environmental stimulations. According to the case study, it is found that Mr. David Geoffrey is extremely agitated when he was admitted to the residential aged care. In order to help Mr. David Geoffrey, the staffs of this residential aged care need to be more patience and provide special care towards Mr. David Geoffrey. In addition, the family members need to visit him very often and spend a quality time with him so that he does not feel alone. The infrastructure or the environmental condition of the residential aged care need to be evaluated in order to find out which factors are making Mr. David Geoffrey agitated and overwhelmed. Generally, it is recognized that patients with dementia feel agitated in the presence of smoking or too many noises. Therefore, it can be said that the environment of the residential aged care plays an important role in the wellbeing of the patients with dementia. On the other hand, according to Witlox et al. (2010), it is recognized that the dementia patients feel agitated when the speaker uses lots of punctuations and phases that cannot be followed by them. Therefore, the speakers (staffs or care givers) need to make short and simple sentences while talking with Mr. David Geoffrey and help him out. The support of significant others Mr. David Geoffrey is an 88 years old dementia patient who was first admitted to the hospital for his urinary tract information. Later he was admitted to the residential aged care. Throughout this procedure, it is recognized that his family members were very supportive and helped him to take care of his health. However, it can be said that they need to be more careful and take more significant steps to help him. Such as, they family members need to visit him more frequently and use small and simple sentences to engage him in conversation. However, it is found that the family members were leaving their photographs and messages for him, which is indeed a significant step to help Mr. David Geoffrey. Future Planning After evaluating the present condition of Mr. David Geoffrey, it can be said that an extensive planning needs to be done in order to help Mr. David Geoffrey in future. The physical and psychosocial condition of Mr. David Geoffrey is deteriorating continuously. Therefore, the family members and the doctor need to make a proper future plan to help Mr. David Geoffrey lead a better life. According to Goodman et al. (2010), the future planning of a dementia patient may include legal planning, financial planning, developing a care team and end of life planning. Having a proper legal planning is important for a dementia patient to ensure their social security. The legal planning of Mr. David Geoffrey should include making necessary updates in existing legal documents, developing proper legal plans for the property. Developing a financial planning to maintain the costs of dementia treatment could be proved as beneficial. In addition, a care team can be developed with the close family members and care givers to ensure the security and privacy of Mr. David Geoffrey. Conclusion Dementia is considered as a curse to the society. It is recognized that a person who is affected with dementia have to go through two kinds of changes. After analysing the case study of Mr. David Geoffrey, these two kinds of changes are found as very prominent. First, Mr. David Geoffrey is suffering from a gradual failure of the mental power, which may include reasoning and comprehension, ability to make right decisions and memory. The brain started reacting slowly and makes them less efficient to make judgments, calculate numbers, follow and understand complicated sentences, and taking decisions. Secondly, it is recognized that Mr. David Geoffrey is going through a change of social and psychological environment. In most of the case, it is noticed that the patient becomes the victim of social stigma and lose self-control. However, in this case, Mr. David Geoffrey had the full attention of his family and not necessarily suffered from social isolation or social stigma. On the other han d, the interventions are taken to help Mr. David Geoffrey are proved as beneficial to help him in order to lead a better life. However, it can be expected that the family should be more careful in future and spend more time with him in residential aged care in order to reduce his behavioural symptoms and improve the quality of his life style. Reference Clegg, A., Young, J., Iliffe, S., Rikkert, M.O. and Rockwood, K., 2013. 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