Nurses as Leaders in Health Care Settings: Clinical Practice Situation
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Nurses as Leaders in Health Care Settings: Clinical Practice Situation


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62 years old male was presented in the clinical setting with the complaint of progressive memory loss under the influence of Alzheimer's dementia (AD). Patient was cognitively impaired and behaviourally disoriented. He was accompanied by his elder son in the clinical setting. The practicing nurse noticed language difficulty and impairment in executive functions in the admitted patient. Patient had recently fell as per the statement of his relatives. However, he was unable to recall the fall event and could not recall the incidence. He had a minor abrasion on his forehead. Patient reportedly experienced visuospatial dysfunction. He did not effectively respond against logical cues and gave abrupt answers to the questions related to his daily life. This gave an impression of the existence of severe cognitive deficit. Patient's language impairment evidently confirmed aphasia. Despite having psychosocial defects, the patient continued to deny these impairments and tried to convince the practicing nurse in relation to his normalcy. Patient worked in a reputed accounting company and took voluntary retirement 10 years back due to familial issues. He lives in a self-owned apartment in isolation. His 2 sons and 1 daughter reside at the nearby locations and visits him weekly for supporting his need. He does not have any full-time caretaker to facilitate his personal care and activities of daily living. Patient was treated by the family physician in collaboration with a psychologist for treating his dementia manifestations. He had been prescribed Namenda and Aricept by the treating physician. However, the patient reportedly did not comply with the prescribed medication dosages that predominantly proved to be the cause of his cognitive deterioration and aggravation of AD symptoms. He frequently reported headache, dizziness, vomiting, nausea, increased appetite, confusion, frequent bowel movements and urinary frequency. He also experienced debility, weakness, lethargy, and difficulty in movement.


His frequent falls while undertaking activities of daily living and personal care indicated his inability to perform self-care and substantiated the requirement of familial support for monitoring his day-to-day movements. The lack of grooming and self-maintenance had adversely impacted patient's personality and resultantly he experienced social isolation and disconnection from his relatives, peers, and friends. He reportedly experienced suicidal thoughts and did not wish to take external assistance to accomplish his personal care requirements. Patient's son explained his clinical history of hypertension and the fact that he was not taking his anti-hypertensive medicines since long. Vitals analysis revealed 150/60 mmHg blood pressure and a respiratory rate of 18 breaths per minute. Patient exhibited thinking difficulty, irritability, and aggression during the process of clinical evaluation. He did not cooperate with the nurse professional and resisted the physical examination. He appeared restless and exhibited concentration problem. Patient appeared talking to himself as well as an unknown entity and appeared hostile during clinical investigation that revealed his paranoid behaviour. Patient's son revealed his depression and hallucination pattern. The nurse professional noticed jumbled speech and incoherent muscle movements while evaluated the demented patient. Patient's state of confusion and memory loss was highly evident during the clinical evaluation. He appeared getting lost and wandering in his own thoughts that further revealed deterioration of his dementia manifestations. The nursing care plan utilized conventional methodology for symptomatically treating the AD condition. 

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