Activity Module 3 Lesson 1

Mr. Jose, 94 year old male. He speaks only English. According to the family, he sometimes
wanders around the neighborhood, but usually brought back since he can tell his address. He has
interrupted sleep, and will wake up in the middle of the night shouting “I’m late for work! It is
already 9 o’clock.” He cannot perform his activities of daily living, except feeding himself.

1. What stage of Alzheimer is Mr. Jose? Support your answer.

 Mr. Jose Alzheimer disease is on Stage 6 mid dementia, in this stage client will
start wandering and according to the family he sometimes wander around the
neighborhood. The client requires substantial assistance to carry out day-to-day
activities because he cannot perform several activities such as putting on clothing
properly, bath independently, to handle all aspects of toileting, and many more,
except feeding himself.

2. What will be your plan of care?

 Assessment
Subjective: “He cannot perform his activities of daily living, except
feeding himself”, according to the significant other.
 Diagnosis
Self- care deficit in bathing, dressing and toileting related to alternation in
cognitive functioning
 Nursing Goal/ Outcome Identification
 Identify individual strengths and skills of the client
 Adjust and assist with necessary adaptions to accomplish activities
of daily living.
 Demonstrate accomplishment task to the fullest extent of client’s
ability within a sufficient time.
 Inference
 Bathing self- deficit or also known as impaired ability to: access
bathroom, gather supplies, access water, regulate bath water, wash
or dry body.
 Dressing self- care deficit or also known as impaired ability to:
choose clothing, gather clothing, pick up clothing, put clothing on
upper or lower body, and fasten clothing. Impaired ability to: put
on/remove various items of clothing (e.g., shirt, socks, and shoes).
Impaired ability to: use zipper or assistive device, maintain
appearance.
  Toileting self-care deficit or also known as impaired ability to:
reach toilet, manipulate clothing for toileting, sit on or rise from
the toilet, complete toilet hygiene, and flush toilet.
 Planning
 After 3 weeks of nursing interventions, patient will be able to
perform self- care activities within level of own ability.

Nursing Intervention Rationale

Establish short-term goals with the Helping the patient with setting
patient. realistic goals will reduce frustration.
Guide the patient in accepting the Patient may require help in
needed amount of dependence. determining the safe limits of trying to
be independent versus asking for
assistance when necessary.
Present positive reinforcement for all External resources of positive
activities attempted; note partial reinforcement may promote ongoing
achievements. efforts. Patients often have difficulty
seeing progress.
Render supervision for each activity The patient’s ability to perform self-
until the patient exhibits the skill care measures may change often over
effectively and is secured in time and will need to be assessed
independent care; reevaluate regularly regularly.
to be certain that the patient is keeping
the skill level and remains safe in the
environment.
Implement measures to promote An appropriate level of assistive care
independence, but intervene when the can prevent injury from activities
patient cannot function. without causing frustration. Nurses
can be key in helping patients accept
both temporary and permanent
dependence.
Boost maximum independence. The goal of rehabilitation is one of
achieving the highest level of
independence possible.
Apply regular routines, and allow An established routine becomes rote
adequate time for the patient to and requires less effort. This helps the
complete task. patient organize and carry out self-
care skills.
DRESSING/ GROOMING
Provide privacy during dressing. The need for privacy is fundamental
for most patients. Patients may take
longer to dress and may be fearful of
breaches in privacy.
The need for privacy is fundamental The use of buttonhook or loop-and-
for most patients. Patients may take pile closures on clothes may make it
longer to dress and may be fearful of possible for a patient to continue
breaches in privacy. independence in this self-care activity.
Suggest elastic shoelaces or Velcro The closures eliminate tying, which
closures on shoes. can add to frustration.
Give frequent encouragement and aid Assistance can reduce energy
with dressing as needed. expenditure and frustration. However,
care needs to be taken so the care
provider does not rush through tasks,
negating the patient’s attempts.
Utilize wheelchair or stationary chair. Dressing requires energy. A chair that
provides more support for the body
than sitting on the side of the bed
saves energy when dressing.
Establish regular activities so the A plan that balances periods of
patient is rested before activity. activity with periods of rest can help
the patient complete the desired
activity without undue fatigue and
frustration.
Consider the use of clothing one size A large size guarantees easier dressing
larger. and comfort.
TOILETING
Assess and note prior and present The efficacy of the bowel or bladder
patterns for toileting; introduce a program will be improved if the
toileting routine that factors these natural and personal patterns of the
habits into the program. patient are taken into consideration.
Assess patient’s ability to verbalize Patient may have neurogenic bladder,
necessitate to void and/or capacity to is lacking concentration, or be able to
use urinal, bedpan. Bring patient to the verbalize needs in acute recovery
bathroom at regular or intermittent phase, but often is able to recover
intervals for voiding if suitable. independent control of this function as
recovery develops.
Provide privacy while patient is Lack of privacy may reduce the
toileting. patient’s ability to empty bowel and
bladder.
Give bedpan or put patient on toilet This eradicates incontinence. Time
every 1 to 1½ hours throughout day intervals can be prolonged as the
and three times throughout night. patient starts to verbalize the need to
toilet on demand.
Give suppositories and stool softeners. May be essential at first to help in
instituting normal bowel function.
Observe closely patient for loss of Patients may hurry readiness to
balance or fall. Maintain commode ambulate to the toilet or commode
and toilet tissue close to the bedside throughout the night due to fear of
for nighttime utilization. soiling themselves and may fall in the
procedure.
 Keep call light within reach and teach This facilitates staff members to have
patient to call as prompt as possible. ample time to help with transfer to
commode or toilet.
Aid patient in eliminating or changing Clothing that is not easy to get in and
unnecessary clothing. out of my compromise a patient’s
capability to be continent.
Consider utilization of commode or Patients are more successful in
toilet as early as possible. emptying bowel and bladder when
sitting on a commode. A number of
patients find it unfeasible to toilet on a
bedpan.
Recognize prior bowel habits and Supports in progression of retraining
restore normal regimen. Increase bulk program and helps in avoiding
in diet, fluid intake, and activity. constipation and impaction.
Educate family and significant others This displays caring and concern but
to promote autonomy and to intervene does not hinder with patient’s efforts
if the patient becomes tired, not to attain autonomy.
capable of carrying out task, or
become extremely aggravated.
Inform family members to allow the Reinstitutes feeling of independence
patient perform self-care measures as and promotes self-esteem and
much as possible improves rehabilitation process. Note:
This may be very hard and
discouraging for the significant other
or caregiver, depending on extent of
disability and time needed for the
patient to accomplish activity.
Promote independence, but intervene A suitable level of assistive care can
when the patient is not able to carry avoid harm with activities without
out self-care activities. causing disappointment.
Entertain patient input in planning Patient’s worth of life is improved
schedule. when wishes or likes are taken into
consideration in daily activities.

 Evaluation
 After 3 weeks of nursing interventions, goal met. Patient was able
to perform self- care activities within level of own ability.

3. What is the greatest challenge to Mr. Jose’s family? Given the above situation.
 The greatest challenge that the family of Mr. Jose have been experience is the
patience that specially needed in these times of grief. Patients behavior is may
 eventually change and the family must cope up with the changes to oversee
anything that comes and to know what should be done. Hearing the news of Mr.
Jose Alzheimer disease may have caused the feeling of being overwhelmed and
that the emotions suddenly erupt such as anger, frustration, fear, and the sadness.
With all of these emotions showing making them hard to discuss the decision that
has to make for instance the treatment, care, living arrangements, finances that
has to be done for the patient and may we also consider the end-of-life care.
During those times conflicts with the family will arise in which it is normal. The
anticipated roles and responsibilities of every member of the family will be
needed and that the conflicts shall be cleared through understanding their
capabilities.

4. Give strategies on how to ease the burden of care of the family.

 To ease the burden of care of the family every one of them must share the
responsibility, divide caregiving evenly, but a thorough list will help them
consider roles that match each family member's preferences, resources, abilities
and emotional capacity. As well as holding a meeting to discuss care and other
relevant issues. By meeting regularly, such as monthly, they can address a few
concerns at a time, avoid burnout with long meetings and be more prepared for
any changes in care. These can be done in person or via phone or video
conference. End family meetings with a clear understanding of what has been
agreed upon, what each person has agreed to do and what needs to be addressed in
the future. Along with communicating honestly, talk about your feelings in an
open, constructive manner during family meetings and informal conversations. If
you're angry or stressed, say so. Express your feelings without blaming or
shaming anyone else by using "I" statements. Listen to other family members
feelings too. Together with never criticize, there are many "right" ways to provide
care. Respect each caregiver's abilities, style and values. Be especially supportive
of family members responsible for daily, hands-on care. Working through
conflicts can help you move on to more important things caring for your family
member and enjoying your time together.