A 79-year-old lady Mrs. Mary Mueni with mild Asthma lives in North London. As a group member of the Catholic Church, she is responsible for running the church activities and she was also responsible for seeing the co-coordinating activities for the resident association in the block of the flat where she used to live, it was the time when she was not well. She has been admitted to the hospital because of having a minor stroke attack; hence she got discharged having a speedy recovery. It has been observed that over the past years she had been a victim of the few residual difficulties, but faced some minor imbalances in the leg so she used to walk with the help of a tripod walking stick and easily got tired if she had to stay in the queue for the long time period. She finds difficulty in having healthy foods. It is due to the reason that she faced difficulties in kitchen and she is not able to cook good food. Due to this cause she tends to eat healthy food that progressively turns into a severe urine infection.
She has a daughter Annie, who is used to visiting her once at the weekend in order to help Mary to have a bath and to let her shopping done. Moreover, the carer also visits her every Tuesday and Thursday to help him with washing. However, both the caretaker and Mary’s daughter are worried about Mary as she is not participating actively and refused to participate properly in her daily activities. She used to spend all of her time sitting on the Chair as she is losing hope in her. Thus, the general physician visited Mary at her home and diagnosed her with Vascular Dementia and suggest she bring a nurse for caretaking and to assess her need.
The last Recorded Observation
The last recorded observations of Mary were stated in the given table:
| Particular | Observation |
| Blood Pressure | 160/70mm/Hg |
| Pulse Rate | 111 beats/min |
| Pain Score | 9/10 |
| Temperature | 38.9o C |
| Sats | 91% on 15 liters of Oxygen |
| Respiratory Rate | 31 breaths/minute |
| Blood Sugar | 6.8 mmol |
| Capillary Refill Time | 5 second |
Mary got a Minor stork attack but gets a speedy recovery. She has been facing the issue of imbalance in her legs which do not let her stay stand for a long period of time. Due to this terrible pain, she is not able to work properly and cooks food. Hence, she has been diagnosed with the issue of urine infection. She is not participating actively and refused to participate properly in her daily activities she has been diagnosed having an issue of Vascular Dementia and asked for district nursing to assess her needs.
Medical Prescription:
Prescription: 75 mg Aspirin orally once daily; Omeprazole 20 mg orally once daily; Salbutamol 100mcg 2 puffs twice a day; Beclametasone Diproprionate 200 mcg 2 puffs twice a day.
Case Study Hostile Nursing Care
By being diagnosed having an issue of Vascular Dementia and asked for district nursing to assess her needs. She had been serving from having and issue of a minor stroke, leg imbalance, urine infection, and vascular dementia. The role of a nurse is to assist the patients and makes them relax and content. In the case of Mary the distinct nurse has spent time with Mary and her daughter and discussed things with them in order to find out the issue. However, the nurse discovered some further issues in Mary as she often attempted diarrhea and sometimes she gets tied with the constipating issue because of not eating healthy. Mary used to spend most of his time in spending chair and it’s increasingly becoming comfortable for both Mary and her daughter. Due to continuous sitting on the chair her bottom area that sacral and is red and full of rash but have no sores. Moreover, the nurse has noticed the two small abrasions to her leg of normal size but it is not so disturbing to her but are seems to be scabbed and are healing. Her daughter continues by defining that it occurs rarely and heals very easily and quickly without getting any issues. Henceforth, nurse seems satisfied and happy that those wounds are not legged ulcers and are just simple bruises and cuts and nothing else, but she had clearly ensured that such wound required full care and need so few injuries may not be turned into any risky deterioration as she has a few veins varicose issues analyzed. On the second visit of a nurse at Mary’s home, she comes to conclude that Mary has been going through the issue of stress incontinence and she is sometimes founds to be moody but it is a general thing about getting older. She is often found in a condition of more breathlessness than normal as she goes around any populated area.
Practices and Interventions of Nursing
However, the paper is critically discussing the symptoms and signs of the final diagnosis of vascular dementia in Mary. The analysis of the study is based on the case of Mary who has been facing many issues that are counting down the light of hope in Mary. A 79-year-old lady Mrs. Mary Mueni with mild Asthma lives in North London. By being diagnosed having an issue of Vascular Dementia and asked for district nursing to assess her needs. She had been serving from having an issue of a minor stroke, leg imbalance, urine infection, and vascular dementia. The disease process of vascular dementia and the psychological behavior is analyzed which may become one of the major reasons for influencing the behavior of the patient. Therefore, such issues are essential to take under full consideration. Hence, in this paper, the exploration has been critically done in order to define the way to manage patients. It is done by considering the critical nursing intervention and assessment in order to ensure the best practices and interventions.
Urine Infection
It is one of the issues found in the case of Myra as she has been facing this issue due to unhealthy food. she faced difficulties in kitchen and she is not able to cook good food. Due to this cause she tends to eat healthy food that progressively turns into a severe urine infection. It is cited in the study (Urden, 2015) that urine infection is caused in the digestive system due to the excess amount of the bacteria caused by the (E. coli) bacterium Escherichia. However, this particular behavior is usually found in the digestive system. This infection may directly affect the bladder, kidneys, and tubes. The risk of having a such infection is high in women as they have been facing the issue of having such infection rate risk is about 50%. Some of its common issues may include the frequent urge to urinate, burning sensation when urinating, and painful sensation when urinating. In addition to this, it is stated that this problem needs to be treated at a specific time duration and it can be cured with the treatment of two to three days.
Vascular Dementia
It is denoted in the study (Park, 2014) that the vascular dementia is a very general term that uses to describe the issue with planning, reasoning, judgment, memory, and many of the other thought process caused as a result of brain damage due to impaired flow of blood to the brain. It can develop after having a stroke block in the brain but it is not necessary that the cause of vascular dementia is due to the stroke. The effect of strokes on thinking and reasoning is dependent on the location and severity of the stroke. Vascular dementia is also due to the reason of the brain being deprived of nutrients and vital oxygen, reducing circulation and blood vessels. 1 however, the risk of stroke and heart disease is increased due to having high blood pressure, smoking, and high cholesterol also increases the risk of having vascular dementia. Hence, the controlling of such factors may lead to a lower chance of having the vascular dementia
It is cited in the study by Butcher, (2018), that the symptoms of vascular dementia depend on the brain part where the blood flow has been impaired. The symptoms might define the most clear cut when they happened suddenly by following a stroke. In addition to this if the reasoning and thinking are changed in the mind it is clearly linked to the condition of stroke and might be represented as post-stroke dementia. Moreover, one of the other characteristics that represent vascular dementia symptoms might follow by a mini or series of strokes. In this aspect, the changes in the stroke are noticed downward from the previous function level. It has been analyzed from several studies that the symptoms of vascular dementia are usually due to brain change issues. In addition to this, sometime such situation may call by the doctors as the condition of mixed dementia
In this below-stated list several of the major symptoms of vascular dementia
- Having issue and trouble in paying concentration and attention
- The rate of confusion increases
- It reduces the ability to organize activities and thoughts
- It declines the ability to analyze a situation and the ability to develop and plan an effective communication
- It decreases the ability to decide what to do next
- The problems with memory started
- The issue of agitation and restlessness
- High rate of depression
- The frequent and sudden urge to urinate and the inability to control on passing urine
In the case of Mary, she has been facing the same issue of vascular dementia and she has been facing the issue of memory. She has been facing the issue of vascular dementia due to having a brain change issue. However, the process of vascular dementia and the psychological behavior is analyzed as one of the major reasons for influencing her behavior of Mary. she used to spend most of his time in spending chair and its increasingly becoming a factor in having memory problem that defines the condition of Vascular Dementia in Mary.
Physical Examination
Their diagnosis of Mary started with the physical examination. Hence, it has been analyzed that the issue of vascular dementia needs to be covered at an earlier basis in order to have a speedy recovery of Mary. The symptoms of Vascular dementia have been diagnosed in Mary and it is causing a severe imbalance in life. The vascular dementia system needs to be monitored specifically in order to raise hope in Mary. It declines their ability to analyze a situation and the ability to develop and plan effective communication for Mary, It reduces her ability to organize actions and thoughts in Mary. She has been facing issue and trouble in paying concentration and attention. Due to this consideration, it is essential to deliver proper treatment to marry in order to minimize this issue. The proper implication is needed to deliver by the nurses to Mary to bring her out of this terrifying situation. It would be conducive to minimize the issue of vascular dementia so it could enable Mary to thin effectively and concisely.
The finding Mary began with the physical examination. Subsequently, it has been examined that the issue of vascular dementia should be covered at the prior premise keeping in mind the end goal to have a fast recuperation for Mary. The indications of Vascular dementia have been analyzed in Mary and it is causing separate irregularities throughout everyday life. The vascular dementia framework should be screened, particularly keeping in mind the end goal to bring trust up in Mary. It decreases the capacity to break down a circumstance and the capacity to create and design a powerful correspondence for Mary; it diminishes the capacity to sort out activity and contemplations in Mary. She has been confronting issues and inconveniences in giving careful consideration. Because of this thought, it is fundamental to convey an appropriate treatment to wed keeping in mind the end goal to limit this issue. The correct ramifications are expected to convey by the medical attendants to Mary to bring her out of this unnerving circumstance. It is helpful for limit the issue of vascular dementia so it could empower Mary to thin adequately and briefly.
Vascular Dementia Affecting Mary
The finding of vascular dementia in Mary is affecting her mood badly as it is clearly diagnosed by the nurse. It is referred to in the examination of* Basch (2015), that the manifestations of vascular dementia rely upon the cerebrum part where the bloodstream has been debilitated. The side effects may characterize as the most obvious when they happened all of a sudden by following a stroke. What’s more, if the thinking and believing are changed in the mind it is plainly connected to the state of stroke and may speak to as post-stroke dementia. In addition, one of the alternate attributes that speak to the vascular dementia side effects may take after by the smaller than usual or arrangement of stroke. In this viewpoint, the adjustments in the stroke are seen descending from the past capacity level. It has been breaking down from the few concentrates that the side effects of vascular dementia are ordinarily due to having mind change issues. Moreover, at some point, such circumstances may call by the specialists as the state of blended dementia
Looking at Mary, she has been analyzing under borderline hypotensive. The BP reading of 160/70 mm/Hg and is clearly defined as the fluid volume trigger of having high BP. Therefore, the BP rate is need to be monitored accurately in order to reassure her. Moving towards the pulse rate of Mary which is recorded at 122 beats per minute since it shows the indication of dehydration as it indicated that the heart is attempting to have less volume of blood that causing harder and faster pumping. Hence, it is the reason for the high increased heart rate (Clarke, 2017).
The creator has utilized The Roper, Logan, and Tierney Model (1980) to devise a customized medicinal service for Mary as his condition may make him remain in the doctor’s facility for any longer length. The medical caretaker likewise should assume a key part in building up his care design (Standing, 2017). This model receives an all-encompassing methodology that suits the effect of Mary s morbidities on beady exercises. This model can distinguish upwards of twelve exercises: correspondence, disposal, washing, and dressing, eating and drinking, working and playing, dozing, breathing, articulation of sexuality, and versatility held in connection to the life expectancy and the reliance or freedom continuum. As per (Crowen, 2008), brought up the structure is oversimplified; notwithstanding, it gives a method for building up coherent methodical care in view of cooperation and shared coordination. It takes into consideration methodical gathering of data from a patient from horde points of view, for example, organic, mental, social, ecological, and political-economic. However, the nursing procedure is an efficient strategy for outlining and conveying nursing care which includes the accumulation of data, tolerant appraisal, arranging consideration and characterizing targets for nursing care, and additionally executing intercessions and assessing comes about.
It is denoted in the study of Conrad (2017) that an evaluation ought to be performed consistently, which is considered an essential period of the nursing procedure that must be done over and again. On account of Mary, the RLT Model in light of Activities of Living is favored. This model empowers human services experts to create appropriate care arrange that are adjusted to his needs. The creator of this contextual analysis observes this structure to be a perfect model for surveying understanding completely. It is additionally valuable for human services experts as it keeps them from passing up a major opportunity for any part of care (Roper et al, 2000).
The shortcoming of the RLT Model, it must be yielded that the evaluation is a long-drawn process and it requires investment to cover each of the twelve viewpoints. The creator opines that despite the fact that it is a perfect fit for the ward where Mary will be conceded, the alert must be practiced before utilizing it for all patients since it could be conceivable that Mary is conceded in a bustling ward; in the event that they evaluate all patients routinely utilizing this model, a few parts of the nursing procedure may be disregarded, causing extra work for the approaching staff.
Fever likewise identified with lack of hydration has been known to bring about unfavorable results including hypotension, tachycardia, and tachypnoeic and shortcoming (Ostland, 2018). Different side effects incorporate expanded narrow refill time and dry/broken lips. Mary. Flowing volume demonstrates that he needs a nearby checking of liquid contribution and additionally yield alongside hemodynamic.
Mary’s condition of cognizance (consciousness) has been assessed through CURB-65 and a score of 3, which shows that he is cognizant and is the threat of incapacity relating to awareness (Resuscitation Guidelines, 2015). Moreover, his psychological readiness ought to likewise be checked. Medical attendants ought to guarantee that he can convey sufficiently since pneumonia can influence mental status. Notwithstanding, the British Thoracic Society (B.T.S) (2009) states that variables like the seriousness of pneumonia and term of healing facility stay – cause 30-day and 1-year mortality of grown-ups who are 60 years old or higher.
Mary has been given a dose of 75 mg of Aspirin orally once daily. However, the use of Aspirin is done in high fever, flu, toothache, and headache. It is given to reduce pain. It is also used to minimize swelling. Mary has been facing the issue of swelling and pain in the leg due to the imbalance. This helps Mary in pain relief and swelling. However, it is denoted in the study (Basch, 2015) that the use of Aspirin is not effective in the cure of vascular dementia. In addition to this, the issue of vascular dementia is reduced by the proper care. In such a situation, it is essential to take care of the patients and provide them love and satisfaction.
Mary has been given a dose of Omeprazole 20 mg orally once daily; as this medicine is useful in the relief of the certain stomach problems. It is directed by the physician to Mary in order to have relief from the stomach problems. As directed by the nurse she has been facing this issue number of times and the main reason for this is that the nurse has analyzed that as she often attempted diarrhea and sometimes she gets tied with the constipating issue because of not eating healthy. However, there have been certain side effects analyzed for the use of Omeprazole including severe headache and abdominal pain, etc.
Mary has been given a dose of Salbutamol 100mcg 2 puffs twice a day as she is been a victim of Asthma. It is one of the best cures and relief from Asthma. It is an inhaler puffer and directed by the physician to use twice a day in order to stay safe from the asthma attack. However, the continuous use of Salbutamol leads in to severe allergy and dryness. In addition to this, most of its attack visualize in dry and cold sessions, therefore, the appropriate amount of puffs are required to inhale in such sessions as directed by the physician.
Mary has been given a dose of Beclametasone Diproprionate 200 mcg 2 puffs twice a day. It is also giving her to get relief from the short breath as a result of asthma. It is an inhaler puffer and directed by the physician to use twice a day in order to stay safe from the asthma attack. However, there have been certain side effects analyzed for the use of the Beclametasone Diproprionate such as dryness.
Conclusion
However, the paper is critically discussing the symptoms and signs of the final diagnosis of vascular dementia in Mary. The analysis of the study is based on the case of Mary who has been facing many issues that is counting down the light of hope in Mary. A 79-year-old lady Mrs. Mary Mueni with mild Asthma lives in North London. By being diagnosed having an issue of Vascular Dementia and asked for district nursing to assess her needs. She had been serving from having and issue of a minor stroke, leg imbalance, urine infection, and vascular dementia. She has been treated for such issues by having the medicine Prescription of 75 mg Aspirin orally once daily; Omeprazole 20 mg orally once daily; Salbutamol 100mcg 2 puffs twice a day; Beclametasone Diproprionate 200 mcg 2 puffs twice a day. In addition to this, she is properly visualized under nursing monitoring in order to deliver proper care to her. It is due to the reason that along with the proper medical prescription proper care and love is highly needed.
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