Let’s watch the video of the care conference between the nurse and Margaret’s grandson, Joe.
Care Conference With Nurse and Grandson, Joe
Care Conference Follow-Up
Following the care conference, the nurse carries out the plan of care he discussed with Joe. He sent a fax to the Nurse Practitioner to request a dietitian consultation, requested recommendations (appendix 1) for medication, and assessment for Margaret at the next Nurse Practitioner next regular visit to the facility.
Test Your Knowledge: Diagnosis
Select the most likely diagnosis for Margaret.
Incorrect. A Urinary Tract Infection (UTI) in older adults with dementia, the primary sign of a UTI may be a change in cognitive status as the patient is not able to tell you about the typical signs of a UTI such as those seen in younger adults. The typical signs of a UTI are (1) pain or a burning sensation upon urinating; (2) the urge to urinate more frequently; (3) lower abdominal pain, and (4) fever. In addition, there may be no fever in an older adult. In Margaret’s case, her changes in behavior may have some signs of a UTI however; she also had a change in functional activity and weight loss, not typical of a UTI.
Incorrect. Individuals with dementia may experience changes in behavior with initial admission to a nursing care facility with a change in environment and routine. However, those behavior changes are more immediate and occur upon admission rather than over a period of days or weeks. The changes in behavior with Margaret were gradual and worsening over a 2 week time frame.
Incorrect. Delirium is an acute onset, state of confusion that results in disruptions in thinking and behavior, including changes in perception, attention, and mood and activity level. Delirium may be the result of an acute medical illness, stroke, brain injury, or an adverse medication reaction. Often in delirium, the state of confusion can vary within the day and may appear to come and go. In Margaret’s case, her changes in behavior have been gradual over a 2 week period and also involved weight loss and decreases in functional activities.
Incorrect. Dementia is a progressive condition with expect changes in memory and communication, physical activity and functional abilities that occur over time. Each person progresses at a different rat, depending on the source of the dementia: vascular, dementia with Lewy bodies, frontotemporal dementia, or Alzheimer’s. In addition, other factors such as age, comorbidities such as stroke, diabetes, side effects of medication and repeated infections may influence the progression of dementia. In Margaret’s case the changes we are seeing have occurred more quickly than expected due only to change in dementia.
Correct. Another diagnosis may have a better fit for the likely diagnosis for Margaret than UTI, Nursing Home Placement, Delirium, or Advanced Dementia. The other diagnoses listed above fit part of the changes we have seen in Margaret’s case, but don’t fit all her symptoms exactly. As an additional consideration, Margaret is having pain based on her PAINAD score that is in an unknown location. Further investigation and examination is warranted for a more likely diagnosis for Margaret.