Nursing Case Study: Disorient With Kossakoff Dementia

Literature Review: The Effectiveness of the use of Sensory Therapy for Elderly Adults Diagnosed with Dementia.

While working as a Certified Nursing Assistant for 10 years, I have been working with

Kate is a 66-year-old lady, retired from her job as a nurse 10 years ago. She has lived alone since the death of her husband 7 years ago, and has one very supportive son who lives locally and visits 2-3 times a week. Kate was referred to the hospital by her doctor after presenting with an 18-month history of memory problems and it was decided that she should attend the day hospital for a period of six weeks to be assessed and to be involved in therapeutic activities whilst there.

There are many reasons that Mrs. Yowell may have impaired mental functioning (see Table 1). The first and easiest reason to rule out would be a urinary tract infection (UTI). A urine sample can show if there are white blood cells (indicating infection) present in the urine. The increased levels of bacteria in an elderly person’s body can cause toxicity which leads to the altered mental status (Midthun, 2004). Most noted changes are confusion, agitation and lethargy.

On this 9/3/15 worker visited the residence of Mr. Alvin Higgins, for the purpose of making first victim contact. Mr. Greg Nunn, RN with New Beacon Hospice greeted worker outside of the residence. Mr. Nunn stated he called the residence about 3 1/2 hours before arriving and Ms. Betty Griffith was not home. However, her daughter Gina Craven and her boyfriend, Kenneth Woods was at the home. When he arrived, the door was unlocked and Mr. Higgins was lying in his bed located in the living room. After being there for several minutes, Mr. Woods came into the living room and asked if he needed anything. Mr. Nunn told him no and Mr. Woods walked toward the back of the house. Medically Mr. Higgins diagnoses are late stage Alzheimer's. He is bedbound, hard of hearing, and unable to communicate.

No caretaker would leave their loved one in a facility with rude, unqualified, untrained, or even outnumbered staff members. This consideration is something Superior Residences of Brandon prides itself on, and with good reason to. The training of the staff at Superior Residences is top notch – the employees must undergo 16 hours of training prior to employment, obtain a certification in CPR, participate in monthly employee meanings, obtain certification in Alzheimer’s Level 1 and 2, and continuing education courses provided by the state. Also unique to this facility, all employees are cross-trained and are certified Resident Aides (RA’s), which means they can approach any worker, for example a janitor, with a question or need and that employee would be able to assist (Andrew, J., personal communication, October 28th, 2016). As Jill Andrew’s stated, there are at least 4 RA’s in the building at all times for 70 residents, and although there are no nurses required under the license, they do have 5 nurses on staff. Another principle unique to Superior Residences was their dual licenses, having both an Extended Congregate Care license, which allows residents to age in place (Andrew, J., personal communication, October 28th, 2016) and a Limited Nursing Services license, which enables the facility to provide a select number of nursing services.

Reporting party (RP) called CCIB to cross report that resident Gerald Gilliland (DOB: 4/22/41) reported that while he resided at this facility, unknown male staff locked him in a room against his will. It is unclear what room the resident was locked in because resident was unable to convey any details about the room. Resident then stated that it was all of the nursing staff who locked him in the room. Resident was hospitalized at Kaiser South Sacramento on 9/18/16 through 9/22/16 and is currently residing at Eskaton Greenhaven. RP stated that it is unclear if the resident has Alzheimer's or not. RP stated that the original reporting party is Sacramento Sheriff's Department (Report#16-286176) and RP will forward the SOC 341 to CCIB.

Alyssa, a 56 year old patient at LA Hospice has been admitted in December with a brain tumor, following having stage 3 lung cancer. Alyssa is currently getting radiation treatment along with chemo therapy. Alyssa and her husband John both do not have medical insurance, leaving them with using Medicare. Her functional status is having to use a walker if she has enough strength that day. Alyssa is forgetful from time to time having short-term memory. She has fallen several times in the past and has broken quite a few bones. The last time she had fallen was a week before getting admitted. A nurse or physician is watching her 24/7 every day. The nurse has to write down every symptom and change in her health every day. Alyssa’s overall goal is to be able to go back home and continue her treatment. Alyssa said “I know I can be strong enough to fight this battle, I have to for my husband.” Jenna the IDT talks with her husband about her situation. Jenna asks “Here at LA Hospice we

The resident faces the medical problem of being a dementia patient. The result of this has caused anger, physical assault and incontinence after restraining the resident. The social issues that are presented is Mrs Alston lives in an aged care facility that is not only sectioned for residents with high care needs but also other residents with the same degree of illness. Another problem is that she has been taking other people’s belongings.

L appears of stated age, average build and fair complexion. Whilst an inpatient she has refused some meals and snacks most days, stating that she is

Regular nursing homes need to adopt a program of this type with such a lenient approach. It is bad enough that these people are elderly and must be taken from their homes but they also suffer from different forms of dementia that must be confusing and frustrating for them. This program offers them the ability to live a much more normal life. Comer (2014) states that, dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night”, whatever your vice is, we’re your folks (pg. 492).

Michael, a 76 year old gentleman had a hip replacement after he was out with his dog and another dog put him on the floor, causing the right hip fracture; and on rehabilitation ward, looking forward to go home as he missed his dog. However, his daughter is concerned about his safety after leaving the rehab ward as he lives independently in a two levels house and at the moment he is using a walking frame and his mobility may be impaired as well his ability to cope, therefore she thinks that he may need to move into a residential home. He has an increased level of anxiety and delirium and he displays a

Ms. Drake has been diagnosed with morbid obesity and has difficulty caring for herself. The victim could do more but chooses not to and doesnt suffer from any mental imcapacities. On 10/07/15 the victim was discharged from Winston Medical Center and became angry. Ms. Winston wants to remain admitted to receive care from the hospital but refuses recommendations that have been made for nursing home care. The victim has wheelchair and wheel chair ramp accessibility at her home and her daughter also assists in making sure her basic needs are met. Ms. Drake is non compliant with the care she needs at this time. It is the hospital's professional opinion that the victim does not live alone and chose nursing home placement to help with her ADLs.

The patient is a 95-year-old female who presents to the ED accompanied by her nursing aide. The patient fell from an upright position at home while walking. She sustained an injury to her right elbow and claims that she did not lose consciousness. The patient's medical history is significant in that she is hard of hearing and she is legally blind I believe that she has had a retinal detachment in the past. The home health aide relates that the patient does not have any family members and is under a state agent whose name is Karen Sesto. Karen Sesto was contacted and she gave additional history stating the patient has been refusing 24/7 live-in help. She does not let people in the house, throws them out of the house, she finally agreed

Mrs. Green was 91 years old when this occurred and originally had many different neighbors come read for her, but now she no longer has any visitors. Her vision began to deteriorate and found it extremely distressing that she can no longer read properly. She felt that she has nothing live for and especially now that her pre-leukemic blood condition requires attention, she needs to accept transfusions from the hospital in order to survive. She dislikes the transfusions and tries to talk herself out of it, but the doctors always convince her that it is best for her. After a psychiatrist came and interviewed her, he established that she is in capacity of decision making