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Symptoms and Effects of Dementia in Mr. David Geoffries

Discuss about the Dementia, Delirium and Depression.

This article is meant to create a clear relation between dementia, delirium and depression and how they are related to Mr. David Geoffries’ health situation in the case study. The case study Mr. Geoffries had been diagnosed with dementia and had past medical history of CVA. The diagnosis of dementia is made by the memory loss and communication difficulties that Mr. Geoffries faces (Cerejeira et al., 2012, p.73). Though dementia also causes communication difficulty, Mr. David got diagnosed 20years with cerebrovascular disease that greatly affect his speech and its one of dementia symptoms that Mr. Geoffries experiences when his grandson speaks on his behalf. Furthermore, Mr. David suffers from atrial fibrillation which also causes confusion, fatigue, and dizziness. He also suffers from Type 2 diabetes which is often caused by the lack production of insulin by the pancreas, moreover, he suffers from depression which is often caused by dementia if it is not treated early. He further suffers from glaucoma which causes severe pain of the eye and headaches that are due to the pains caused by the affected eye. Mr. David appeared confused and even hit out at the person who was trying to shower him which is a clear symptom of delirium (Voyer et al., 2012, p. 264). It is also observed that Mr. David is brought to the hospital due to incontinent in urine and feces which is mainly caused by recurring urinary tract infection, diabetes, old age and senile dementia (Bardsley, 2013, p.41). This article also addresses the interventions that the nurses are to undertake to make sure that Mr. David’s condition improves.

  1. Dementia

From the case study, it is evident that Mr. Geoffries suffers severely from these diseases which have caused communication difficulty and confusion. For instance, Dementia affects Mr. David in that it has created his memory loss and communication difficulty. Other signs and symptoms include confusion and disorientation which result in difficulty in problem-solving ability. The disorder is one of the primary reasons why the patient got brought to the hospital, and it is clear that dementia could be the most probable cause. Furthermore, on the psychological side dementia is known to cause depression, anxiety and inappropriate behaviors such as aggression when Mr. David hits out at the person who was trying to shower him and he reacts the same way to the nurses (Gitlin et al., 2012, p.2020).

  1. Delirium

Interventions for Mr. David's Treatment

This disease causes the reduction in awareness of the environment that the patients are within. For instance, due to the confusion and disorientation Mr. David's grandson acts as his guardian because his grandfather is unaware of the environment which he is within. Another symptom includes difficulty in speech, nonsense speech and trouble understanding what is getting communicated to the patient. These symptoms are evident when Mr. David lashes out at the person who was trying to shower him and when his grandson represented him in the hospital as his guardian because his speech was not sufficient (Lundström et al., 2012, p.164). Furthermore, delirium makes the patient feel restless and agitated; these are evident in Mr. David's case when he is restless and keeps wanting to get up from the chair next to his bed. Moreover, Mr. David gets personality and mood changes when he proves difficult to the staff who try to get him into the shower. The unpredicted mood shift that Mr. David experiences are due him suffering from delirium.

  1. Depression

Mr. David experiences depression because the doctor believes that he is disinterested in life other than food and his sleeping pattern. These are clear signs and symptoms of depression in that the loss of interest in life is because Mr. Geoffries has no social experience that could excite him. Furthermore, depression may cause decrease or increase in appetite and Mr. David's case it has increased his appetite because that is the only thing that he is interested. Moreover, the sleeping pattern of Mr. Geoffries has changed which is a clear indication of depression (Brown and Harris, 2012). The patient is also unsteady on his feet which proves that he is weak and this is another sign of distress. Therefore, when Mr. David hit out at the nurses who were trying to get him into the shower can be attributed to recession because he proved agitated which is another sign and symptom of depression. Moreover, Mr. David feels worthless because some of the staff members had been heard talking about him saying that Mr. Geoffries is like a baby and they also admonished him. These behaviors demonstrated by the staff members further proved devastating to the state of Mr. Geofferies as he got more depressed and felt neglected.

Mr. David is placed on antibiotics and the use of incontinence pads continues with an order of zinc cream application to the groin. The zinc cream is applied on Mr. David on the weepy or bleeding areas three times a day and whenever stooling occurs. It is also essential that when the next application happens, the zinc cream should not get scrubbed entirely. The stool should be gently stooled off and this should be done daily using oil to soften it and balance Mr. David’s skin pH level then the stool is gently removed with incontinence cleanser (Junkin, 2008). Also, Mr. David can be positioned semi-prone for about 30 minutes twice or thrice per day to expose the affected skin to the air, and this gets done so that the affected area may dry up which fastens the healing process. The care practitioner should also consider treatment that reduces moisture which gets done by using low air loss mattress and more frequent turning of Mr. David so that the affected skin may not get tampered. Moreover, Mr. Geoffries is given antibiotics because he is in pain due to the urinary tract infection which causes pain whenever he goes for a short call (Silver, 2017). Furthermore, the doctor considers prescribing respiridone for his aggression and an antidepressant because the doctor assessed Mr. David as being depressed. The doctor prescribed the respiridone because it is an antipsychotic drug which is used to treat restlessness, psychotic symptoms such as hallucination and aggression which are often present with people who have contracted dementia. The doctor also prescribes antidepressant drugs which are most used to reduce aggression and create a calm feeling for patients such as Mr. David who have dementia (Ames, 2016, p.2).

Physical and Psychosocial Interventions

Physical aspects may include performing various physical activities by the patient under the supervision of a professional health practitioner. These physical activities should be safe, and the training should at least take 30 minutes. Physical exercise is a certified useful method that improves the condition of dementia patients such as Mr. David. The physical exercise intervention would effective on Mr. Geoffries because it is often used on old individuals who are affected by dementia to improve their health and well-being (Zeng et al., 2016, p.168). Moreover, physical activity programs are helpful in that they help relieve dementia patients who have mild and moderate conditions such as Mr. David who is often aggressive and restless. Another significant purpose of physical activities is that they improve the structure and functioning of the brain which is key to enhancing Mr. David's situation because he experiences memory loss. From the case study, Mr. Geoffries’ son sometimes plays poker with him when he visits which help in brain structure and functioning. It is also seen that Mr. David is unsteady on his feet and physical activities can improve the balance, stride length and performance on his daily living activities (Zeng et al., 2016, p.168).

Psychosocial interventions have a purpose of improving the quality of life of the patient and maximizing it in spite of the existing challenges. This intervention uses various methods which include behavior-oriented approach, stimulation-oriented approach, and emotional-approach. Therefore, most psychosocial interventions are aimed at improving the cognitive skill and behavior of the patient following diagnosis of dementia (Vernooij-Dassen et al. 2010, p.1121). Psychosocial interventions help the patient and their family to come to terms with the fact that their loved one is affected by dementia. From the case study, Mr. Geofferies appears depressed and spends most of his time sleeping due to the infection rendering him dependent on the nurses.  Furthermore, this intervention helps Mr. David and his family to maintain their social life and relationship even after the diagnosis are made that he is affected with dementia (Guss et al., 2014, p.2). We can see that his family visits him frequently and even his son tries to play poker with him when he visits. Moreover, the family has placed photographs around the room of Mr. Geofferies, and they start a diary of their visits which is a significant example of psychosocial intervention. Another purpose of psychosocial response is to reduce stress and improve the mood of Mr. David and improve his memory and thinking. From the case study, we can see that this is effective in that Mr. Geofferies appears awake, happy and interacts with his children and grandchildren when they visit. Moreover, he is also able to answer closed-ended questions and has a good memory because he can remember his children and grandchildren.

Creating a Calm and Soothing Environment

It is essential to create a soothing and calming environment which is helpful in the recovery of patients with dementia. The essence of this is that the calm atmosphere will minimize the chances of confusion and help the dementia patients concentrate and rest. To create this calm and soothing environment the lighting and the effects of mirrors may need to be considered. Moreover, the colors and patterns used in decorating the room must also be put into consideration because some of the patients who have dementia hallucinate and this may affect them severely. Moreover, dementia patients find the noise annoying therefore the radio and television may be turned off so as give the patient a peaceful environment. From the case study, Mr. David used to sleep most of the time when he gets taken to the television room, and this could be because he was not pleased with the noise that was made by the television. The environment should also be free from shadows and reflections which may frighten the dementia patient. We can also see that the family of Mr. Geoffries makes an effort in placing photographs around his room and start a diary of their visits. The environmental consideration by the family helps in the recovery process of Mr. David who appeared to be enjoying spending time with his family. Another factor to consider is when the patient fails to visit the toilet when it is necessary, and this is crucial in that they should be checked medically (Bier, 2016). In this case, Mr. David failed to visit the toilet when necessary, and this made it possible for a medical check done on him where he was found to be infected by urinary tract infection.

Physical restraints often get used with the aim of minimizing the risk of harming the dementia patient or the patient hurting any other person in the medical facility. Most of the time the families and medical practitioners perceive this as the best way to minimize falls by the dementia patient and to control the inappropriate behavior of the patient (Peisah and Skladzien, 2014, p.11). When a patient exhibits inappropriate behavior the probability of them harming other people in the facility is high and this when the restraints get used. From the case study, the doctor is considering future use of restraints on Mr. Geoffries because he was aggressive to the staff who were trying to get him into the shower. The restraints prove necessary because the staff became fearful of Mr. Geoffries since he was aggressive and he could have harmed them. Moreover, the restraint gets used for people who are in their old age who have dementia because they may hurt themselves in the process of being aggressive (Peisah and Skladzien, 2014, p.11).

Person-centred care often involves crafting a patient’s care to their interest, personality, and abilities and this helps the patients to take part in what they enjoy.  The care technique can be useful in that it enables management of the behavior and psychological symptoms of the dementia patient. One of the most significant purposes of person-centred care is treating the dementia patient with dignity and respect and understanding their lifestyle and preferences which includes what they like and what they do not. From the case study, it is unfortunate that some of the staff lack respect for Mr. Geofferies in that they have been heard speaking about his saying that he is like a baby and also they admonish him (Mitchell and Agnelli, 2015, p.46). In spite of this, the nurses also lack interest in taking their time to understand Mr. David’s preferences hence they assume that he did not get orientated in time. Furthermore, they wheel Mr. Geofferies to the television though it is evident that Mr. Geoffries is disinterested and spends most of his time sleeping.

A person who has dementia sometimes get affected emotionally, psychologically and socially hence they require help from their family and friends who understand their condition. Therefore, the social environment and relationship of the dementia patient with other people are essential regardless of their age or mental state. From the case study, we can see that the family of Mr. Geoffries visit him frequently and even his son plays poker with him. Furthermore, his children and grandchildren interact, and he enjoys spending time with them. The family takes a step further to place photographs around the room of Mr. Geoffries and even start a diary of their visits. These steps were made by the family create a social and emotional part of Mr. Geoffries well-being because they prove to understand the condition that he has. It is also crucial for the staff to understand the personality and preferences of the dementia patient so that they may focus on what they enjoy doing and like. From the case study, the staff fails to understand Mr. David's situation and some staff members are heard saying that he behaves like a baby.

When communicating with a patient who has dementia, they may have trouble communicating, and people are advised to speak slowly and use more simple words that the patient may understand (Alzheimer’s Society, 2015, p.4). From the case study, Mr. David can answer closed-ended questions which are simple for him to respond. Sometimes, the patient may gradually become dependent and relay more on the care and support given by the family and the staff at the facility. It is often hard for some patients to adjust to this rate of dependency and it can be distressing to everyone from the family to the staff members. Mr. David also becomes increasingly dependent on the nursing staff for all activities on a daily basis, and this makes him restless; when he keeps wanting to get up from the chair next to his bed though his feet are unsteady.

The discharge of the patient from the dementia facility is only enabled when the doctor at the facility decides that the person is medically and mentally fit. Furthermore, every hospital has its discharge policy which is a public document that gives details on how the hospital administration arranges the discharge. The hospital discharge process includes the assessment of the treated person’s living environment with considerations on the people involved in supporting the treated patient. There is then the documentation of the care plan and a system for monitoring the recovery process of the patient. Lastly, the hospital discusses the date and time of discharge that the treated person will be allowed to leave the facility (Alzheimer’s Society, 2015, p.3). Moreover, the hospital should consider transportation of the recovering patient to his home or caregiver’s home. Most patients who have dementia have complex needs which need to get considered before safely being discharged. From the case study, we can see that the hospital made arrangements for Mr. David to have his medication ready which would ensure that he recovers fully from dementia. Furthermore, the family makes arrangements that Mr. Geofferies gets admitted to the residential aged care bed which is near the wife's home. It is evident that the family had prior arrangements of how Mr. David's condition was going to be managed post-hospital admission as required by the hospital.

Moreover, Mr. Geofferies' children then purchase a chair for their father which was going to enable him to move from the chair to the bed in the room whenever he wanted. The family adheres to the hospital discharge policy by making sure that Mr. Geofferies is comfortable at the residential aged care bed. The family also arrange how they are going to be visiting Mr. David as required by the hospital policy. It is also evident that post-hospitalization of Mr. Geofferies the residential aged care bed had a significant level of strain trying to care for the well-being of the patient. Mr. David suddenly becomes aggressive to the staff members after about three weeks at the aged care bed. Moreover, some staff members are heard saying that Mr. Geoffries is like a baby which proves that they had a hard time caring for the patient. The probable cause of this is that the family and the residential aged care bed did not keep in contact with the hospital after Mr. Geofferies was discharged (Mockford, 2015, p.21).

Conclusion

From the article, there is a great need for the family and friend support for the care and recovery of the dementia patient. We can also note that dementia affected patients have their daily routines affected by the disease because it makes them dependent on nurses for care. Moreover, the dementia is observed to cause memory loss and result in language difficulties which the family should be there to support the patient and represent them. The article also states the interventions that can be put forward to care for the patient and enhance their recovery process efficiently. In spite of that, the report identifies the care support steps that the family can undertake to ensure that the environmental considerations are adhered to for the quick recovery of the patient. There is also the discharge plan that was put in place by the family for Mr. Geoffries' care to ensure that he is comfortable and safe though they missed some essential steps in his post-hospitalization care. Therefore, it is necessary that the family keeps in contact with the hospital even after the patient gets discharged from the hospital.  

References

Alzheimer’s Society 2015, Hospital care. Retrieved from: https://www.alzheimers.org.uk/download/downloads/id/1819/factsheet_hospitalcare 

Alzheimer’s Society 2015. Understanding and Supporting a Person with Dementia. Retrieved from: https://www.alzheimers.org.uk/download/downloads/id/1808/factsheet_understandingandsupprotingapersonwithdementia

Ames, D 2016, Dementia Q&A: Drugs Used to Relieve Behavioural and Psychological Symptoms of Dementia. Retrieved from: https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA04-DrugsUsedToRelieve

Bardsley, A 2013, Prevention and management of incontinence-associated dermatitis. Nursing Standard (through 2013), 27(44), p.41.

Bier, D 2016, Improving Alzheimer’s and Dementia Care: Environmental Impact. Retrieved from: https://psychcentral.com/lib/improving-alzheimers-and-dementia-care-environmental-impact/

Brown, G.W. and Harris, T eds 2012, Social origins of depression: A study of psychiatric disorder in women. Routledge.

Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E 2012, Behavioral and psychological symptoms of dementia. Frontiers in neurology, 3, p.73.

Edgerton, AE 2010, Improving Physical Environments For Dementia Care: Making Minimal Changes For Maximum Effect. Retrieved from: https://www.managedhealthcareconnect.com/content/improving-physical-environments-dementia

Gitlin, L.N., Kales, H.C. and Lyketsos, CG 2012, Nonpharmacologic management of behavioral symptoms in dementia. Jama, 308(19), pp.2020-2029.

Guss, R., Middleton, J., Beanland, T., Slade, L., Moniz-Cook, E., Watts, S. and Bone, A 2014, A guide to psychosocial interventions in early stages of dementia. Leicester, UK: The British Psychological Society.

Harding, M 2017, Patient: Memory loss and Dementia. Retrieved from: https://patient.info/health/memory-loss-and-dementia

Junkin, J 2008, Incontinence-Associated Dermatitis Intervention Tool (IADIT): Skin Care for Incontinence Persons. Retrieved from: https://woundcareadvisor.com/wp-content/uploads/2013/05/IADIT.pdf

Lundström, M., Stenvall, M. and Olofsson, B 2012, Symptom profile of postoperative delirium in patients with and without dementia. Journal of geriatric psychiatry and neurology, 25(3), pp.162-169.

Mayo Clinic Staff 2017, Dementia: Symptoms and Causes. Retrieved from: https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013

Mayo Clinic Staff 2018, Delirium: Symptoms and Causes. Retrieved from: https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386

Mitchell, G. and Agnelli, J 2015, Person-centred care for people with dementia: Kitwood reconsidered. Nursing Standard (2014+), 30(7), p.46.

Mockford, C 2015, A Review of Family Carers’ Experience of Hospital Discharge For People With Dementia and the Rationale For Involving Service Users in Health Research. Retrieved from: https://www.dovepress.com/a-review-of-family-carers39-experiences-

Peisah, C., and Skladzien, E 2014, The Use of Restraints and Psychotropic Medications in People with Dementia. Retrieved from: https://www.dementia.org.au/files/20140321_Publication_38_A4_print%20version_Web.pdf

Silver, N 2017, What is Incontinence Associated Dermatitis and How is it Treated? Retrieved from: https://www.healthline.com/health/overactive-bladder/incontinence-associated-dermatitis

Vernooij-Dassen, M., Vasse, E., Zuidema, S., Cohen-Mansfield, J. and Moyle, W 2010, Psychosocial interventions for dementia patients in long-term care. International Psychogeriatrics, 22(7), pp.1121-1128.

Voyer, P., Richard, S., McCusker, J., Cole, M.G., Monette, J., Champoux, N., Ciampi, A. and Belzile, E 2012, Detection of delirium and its symptoms by nurses working in a long term care facility. Journal of the American Medical Directors Association, 13(3), pp.264-271.

Zeng, Z., Deng, Y.H., Shuai, T., Zhang, H., Wang, Y. and Song, GM 2016, Effect of physical activity training on dementia patients: A systematic review with a meta-analysis. Chinese Nursing Research, 3(4), pp.168-175.

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