Mr. Aponi has a history of dementia. His dementia limits his ability to respond appropriately to questions and at times Mr. Aponi is easily agitated and resistant to nursing care. He refuses to take his medications, spitting them back out, gripping the bedside rail when the nurse tries to turn him, and yelling out for his wife to save him

Client Profile

Mr. Aponi has a history of dementia. His dementia limits his ability to respond appropriately to questions and at times Mr. Aponi is easily agitated and resistant to nursing care. He refuses to take his medications, spitting them back out, gripping the bedside rail when the nurse tries to turn him, and yelling out for his wife to save him.

Case Study

Mr. Aponi is an 85-year-old man with a history of dementia. He is a resident of a long-term care facility. Mr. Aponi’s frequent incontinence necessitates the development of therapeutic communication to facilitate activities of daily living care and frequent skin hygiene. The nurse caring for Mr. Aponi for the first time soon learns that talking slowly and softly is the most effective way of focusing the patient’s attention and prompting him to follow basic instructions such as turning side to side. The nurse feels uneasy about speaking to Mr. Aponi as if he were a child in some ways. However, the nurse fins that this manner of speech keeps Mr. Apoin calm and that he responds well to praise and compliments and that he is very helpful to the nurse in assisting with his won care.

On the second day for caring for him, the nurse notes that Mr. Aponi is more agitated and needs frequent reorientation regarding where he is. The nurse needs the assistance of another person to hold Mr. Aponi’s arm steady while assessing his BP since Mr. Aponi keeps pulling his arm away yelling “No!”. At one point in the day, Mr. Apoin tells the nurse, “There was a little boy in the room a minute ago. Where did he go?”. The nurse knows there was not a little boy in the room but does not know how to respond. The nurse ignores Mr. Aponi’s comment and redirects his attention to the television.

When saying goodbye to Mr. Aponi at the end of the second day the nurse is disappointed that Mr. Aponi does seem to recognize the nurse or that the nurse has been caring for him for the past 2 days. The nurse is saddened to see him so confused and is emotionally exhausted after two days of responding to his frequent changes in behavior.

1. The nurse caring for Mr. Aponi overhears another nurse state, “Well of course he is confused. He is 85-years-old.” How should Mr. Aponi’s nurse respond?

2. Describe some strategies when caring for a confused patient

3. What are three nursing diagnoses appropriate for Mr. Aponi’s plan of care?

ANSWER

Optimizing Care for a Confused Patient with Dementia: A Case Study on Mr. Aponi

The nurse caring for Mr. Aponi should respond to the statement by another nurse with empathy and understanding, while also providing a more comprehensive perspective on Mr. Aponi’s confusion. The nurse can say something like, “Yes, age can be a contributing factor to confusion in some cases. However, it’s important to remember that there are other factors at play as well, such as Mr. Aponi’s history of dementia. Dementia is a progressive condition that affects cognitive functioning, memory, and perception. So, his confusion is not solely due to his age, but rather a result of his underlying condition.”

By providing this response, the nurse acknowledges the impact of aging on cognitive function but also highlights the significance of Mr. Aponi’s dementia in contributing to his confusion (Langa, 2018). This response helps promote a better understanding among healthcare professionals about the complex nature of dementia and its effects on individuals, regardless of their age.

When caring for a confused patient, several strategies can be implemented to provide effective and compassionate care. These strategies aim to promote a safe and supportive environment while maximizing the patient’s quality of life. Some of these strategies include:

 Establishing a structured routine: Maintaining a consistent daily routine can help reduce confusion and provide a sense of predictability. Regularly scheduled activities, meals, and rest periods can help orient the patient and provide a sense of security.

 Using clear and simple communication: Communication with a confused patient should be clear, concise, and adapted to their level of understanding. Speaking slowly, using simple language, and allowing time for the patient to process information can enhance communication and promote comprehension.

Providing reassurance and validation: Patients with confusion often experience feelings of anxiety and frustration. Offering reassurance, using positive reinforcement, and validating their emotions can help alleviate distress and enhance their sense of well-being.

 Ensuring a safe environment: Safety measures should be implemented to prevent falls and injuries. This includes removing tripping hazards, using bed alarms or chair alarms, and providing adequate lighting. Regular monitoring and supervision are essential to prevent accidents.

 Encouraging engagement in meaningful activities: Engaging the patient in activities that are familiar and meaningful to them can help maintain cognitive function and reduce agitation. This can include reminiscence therapy, music therapy, and gentle physical exercises.

 Collaborating with the interdisciplinary team: Working collaboratively with the interdisciplinary team, including physicians, psychologists, occupational therapists, and social workers, ensures comprehensive care for the patient (Rosen et al., 2018). Each team member can contribute their expertise to develop individualized care plans and interventions.

Nursing diagnoses appropriate for Mr. Aponi’s plan of care can include:

 Impaired Memory: This diagnosis reflects Mr. Aponi’s difficulty in remembering recent events, recognizing familiar individuals, and maintaining attention and focus (Davis & Weisbeck, 2016). Interventions can include establishing a structured routine, using memory aids (such as visual cues or written reminders), and engaging in cognitive stimulation activities.

 Disturbed Thought Processes: This diagnosis captures the alterations in Mr. Aponi’s cognitive function, including disorientation, delusions (seeing a little boy), and confusion. Interventions can include using clear and simple communication techniques, providing reassurance and validation, and promoting a calm and supportive environment.

 Risk for Falls: Given Mr. Aponi’s confusion and agitation, he may be at an increased risk of falls. This diagnosis highlights the need for implementing safety measures such as removing hazards, using bed or chair alarms, and providing assistance during ambulation.

By addressing these nursing diagnoses in Mr. Aponi’s plan of care, the nurse can focus on specific interventions that aim to improve his memory, manage his disturbed thought processes, and mitigate the risk of falls.

References

Davis, R. L., & Weisbeck, C. (2016). Creating a Supportive Environment Using Cues for Wayfinding in Dementia. Journal of Gerontological Nursing, 42(3), 36–44. https://doi.org/10.3928/00989134-20160212-07 

Langa, K. M. (2018, June 26). Cognitive Aging, Dementia, and the Future of an Aging Population. Future Directions for the Demography of Aging – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513075/ 

Rosen, M. J., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D. R., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298