DEMENTIA CASE STUDY

 DEMENTIA CASE STUDY

2. Mr. Moses Nkamba is a 80 year old man. During the past four years, Mr.

Nkamba has demonstrated gradual, progressing memory impairment. The family

members found themselves close to physical exhaustion. He is brought to the

hospital with history of increased incontinence when he cannot find the toilet and

wonders away from home constantly.

a) Outline five (5) causes of Dementia

15%

b) Outline five (5) symptoms of Dementia other than the ones

mentioned above.

15%

c) Explain four (4) points in the nursing assessment that will be

vital in planning the nursing care of Mr. Nkamba

20%

d) Describe the nursing care interventions that would be

appropriate in meeting Mr. Nkamba needs

50%

a) Causes of Dementia (15%)

1. Alzheimer’s Disease:

   • The most common cause of dementia, Alzheimer's disease is a progressive neurological disorder that leads to memory loss, cognitive decline, and personality changes due to the death of brain cells and the accumulation of amyloid plaques and neurofibrillary tangles.

2. Vascular Dementia:

   • This type of dementia is caused by reduced blood flow to the brain, often due to strokes or other conditions affecting the vascular system. It can lead to cognitive impairments depending on the area of the brain affected.

3. Lewy Body Dementia:

   • This type of dementia is associated with abnormal deposits of a protein called alpha-synuclein (Lewy bodies) in the brain. It often presents with symptoms similar to Parkinson’s disease, such as movement difficulties, along with cognitive decline.

4. Frontotemporal Dementia:

   • Caused by degeneration of the frontal and temporal lobes of the brain, this type of dementia often leads to changes in personality, behavior, and language skills before affecting memory.

5. Mixed Dementia:

   • Mixed dementia is a condition in which abnormalities characteristic of more than one type of dementia occur simultaneously in the brain. For example, a patient might have both Alzheimer’s disease and vascular dementia.

b) Symptoms of Dementia Other than Those Mentioned (15%)

1. Aphasia:

   • Difficulty with language, including trouble finding words, difficulty understanding language, or using language inappropriately.

2. Apraxia:

   • Difficulty with motor activities despite having the physical ability to perform them, such as difficulty dressing or using utensils.

3. Agnosia:

   • Inability to recognize objects, people, sounds, shapes, or smells even though the sensory function is intact.

4. Impaired Judgment:

   • Difficulty making decisions or solving problems, which can lead to unsafe situations or poor decision-making.

5. Changes in Mood or Behavior:

   • Sudden mood swings, depression, anxiety, aggression, or withdrawal from social activities, which are common in individuals with dementia.

c) Nursing Assessment for Mr. Nkamba (20%)

1. Cognitive Function Assessment:

   • Evaluate the level of cognitive impairment using tools like the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). Understanding the extent of Mr. Nkamba’s memory, orientation, attention, language, and executive functions will help in planning care.

2. Assessment of Activities of Daily Living (ADLs):

   • Assess Mr. Nkamba’s ability to perform ADLs such as eating, dressing, bathing, toileting, and mobility. This will help determine the level of assistance he requires and identify specific areas where support is needed.

3. Behavioral and Psychological Symptoms:

   • Assess for symptoms such as agitation, aggression, wandering, sleep disturbances, and incontinence. Understanding these behaviors will guide interventions to ensure safety and comfort.

4. Safety and Environmental Assessment:

   • Evaluate Mr. Nkamba’s home and hospital environment for potential safety hazards. This includes checking for fall risks, ensuring that his surroundings are dementia-friendly (e.g., clear signage, easily accessible toilets), and assessing the risk of wandering.

d) Nursing Care Interventions for Mr. Nkamba (50%)

1. Promote Safety:

   • Environmental Modifications: Ensure that the environment is safe and secure to prevent falls and wandering. This includes installing locks on doors, using bed rails, and removing obstacles from walkways.
   • Supervision: Provide close supervision to prevent wandering and ensure that Mr. Nkamba is always within a safe and secure area. Consider the use of GPS tracking devices if appropriate.

2. Manage Incontinence:

   • Toileting Schedule: Implement a regular toileting schedule to reduce episodes of incontinence. Encourage Mr. Nkamba to use the toilet every two hours or based on his individual needs.
   • Incontinence Products: Use appropriate incontinence products such as adult diapers or absorbent pads to maintain skin integrity and comfort.
   • Hydration Monitoring: Monitor fluid intake to ensure adequate hydration while balancing the need to manage incontinence.

3. Support Cognitive Function:

   • Cognitive Stimulation: Engage Mr. Nkamba in activities that stimulate cognitive function, such as puzzles, memory games, or reminiscence therapy. Use familiar objects and routines to reduce confusion.
   • Orientation Aids: Use visual aids such as clocks, calendars, and clearly labeled signs to help Mr. Nkamba remain oriented to time and place.

4. Provide Emotional and Psychological Support:

   • Therapeutic Communication: Use calm, clear, and simple language when communicating with Mr. Nkamba. Be patient and allow extra time for him to process information.
   • Family Involvement: Involve Mr. Nkamba’s family in his care, providing them with education and support to help them cope with the challenges of dementia care. Encourage family visits and involvement in care activities.

5. Promote Physical Health:

   • Nutritional Support: Provide a balanced diet tailored to Mr. Nkamba’s preferences and needs. Offer finger foods if he has difficulty using utensils and ensure that meals are easy to chew and swallow.
   • Exercise: Encourage regular physical activity, such as walking or gentle exercises, to maintain mobility and overall health. Activities should be appropriate to his ability level.

6. Manage Behavioral Symptoms:

   • Behavioral Interventions: Address triggers for agitation or aggression, such as hunger, pain, or overstimulation. Use distraction techniques, music therapy, or calming activities to reduce distress.
   • Medications: Administer prescribed medications for dementia or associated symptoms as needed. Monitor for side effects and effectiveness, and report any changes in behavior or cognition to the healthcare team.

7. Skin Care and Hygiene:

   • Skin Integrity Monitoring: Regularly check Mr. Nkamba’s skin for signs of breakdown, especially in areas prone to pressure sores due to immobility or incontinence.
   • Personal Hygiene: Assist with bathing, grooming, and oral care as needed, ensuring that these activities are performed with dignity and respect for Mr. Nkamba’s preferences.

8. Palliative Care Consideration:

   • Comfort Measures: As dementia progresses, focus on comfort care, ensuring that Mr. Nkamba is free from pain and distress. Discuss palliative care options with the family as appropriate.

These interventions aim to provide holistic care that addresses both the physical and emotional needs of Mr. Nkamba while ensuring his safety and dignity.