CASE STUDY SCENARIO An older Latin American woman is admitted to the emergency d
CASE STUDY SCENARIO
An older Latin
American woman is admitted to the emergency department (ED) by ambulance. The
paramedics inform the staff that they were notified by an anonymous source
regarding an older woman who “looked lost” in the neighbourhood. When
they arrived, they found her bleeding from scrapes on the palms of both hands
and the anterior aspects of both knees. She would not tell them her name or
where she lived, and she was mildly combative, batting them away from her as
they approached. She has no identification. In the ED she is disoriented,
agitated, and suspicious of attempts to assess her. You observe that she has
poor personal hygiene. She is wearing two different coloured socks, and her
shirt is inside out. She has extensive bruises circling her wrists and a large
bruise on her left neck. Her gait is stable with no limb rigidity or flexor
posturing. She denies any knowledge of her own health history, exclaiming,
“I’m as healthy as a bat, and I can take care of myself!” After you
place the woman in a quiet room and offer her some water, she begins to relax.
You ask to clean her skinned hands and knees and she agrees. At that time, a
middle-aged man and woman come into the room, exclaiming, “Mother, this is
the last straw! Will this never end? We are just going to have to take drastic
measures!” To which the patient replies, “Who are you?” The man
explains that the woman is his mother, E.S., age 75, who has lived with him and
his wife for the past 3 years since she started a fire in her home, which is in
another province. He says that she has dementia that is thought to be
Alzheimer’s disease (AD). His wife had to quit her job as a salesclerk 2 years
ago to care for E.S. because she required 24-hour monitoring. E.S.’s son tells
you that they have tried everything to keep E.S. from wandering, but this is
the third time she has been picked up in the neighbourhood by the police or the
paramedics. He says they must have forgotten to lock the door to her room after
they removed her dinner dishes.
Questions 1. When discussing E.S.’s Alzheimer’s Disease (AD)
with her son and daughter-in-law, you use knowledge of the pathophysiology of
AD to help them understand the problems with diagnosis and treatment of the
disorder. Explain at least 2 of the pathophysiological finding’s that are
characteristic of AD?
2. Explain how a definitive diagnosis of AD is made.
3. List and explain
at least 3 ways in which AD differs from delirium?
4. You suspect that E.S.’s son and daughter-in-law are
having difficulty coping with the care of E.S. and that she might be abused.
Identify at least 3 factors from the scenario that lead you to this conclusion.
Discuss the nursing responsibilities related to elder abuse.
5. E.S.’s son says he
is worried about getting AD himself, since he has heard it can be genetic. He
says he is becoming more forgetful at his age of 57, often going into a room
and not remembering until a short time later why he went there. What would your
best response to him be at this time?
6. E.S. is to be
discharged from the ED to return home with her family and receive follow up
care from a home health nurse. Before they leave, you discuss her care with
them. List and explain at least 3 possible appropriate instructions for her
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