Submitted by:

Bindu Neupane

 

 

 

 

 

 

 

Acknowledgement

I am very thankful to Heal Home Care for providing me this opportunity to carry out the case study on “Alzheimer’s”.

I warmly acknowledge to all staff for giving me golden chance. My deep gratitude goes to all the staff. I would like to express my heartfelt thanks to the patient party for providing me with all the information necessary to conduct this case study.

“A BIG thanks to everyone”

 

 

Introduction

My patient’s name is Ratna Devi Shakya, 99 yrs/female with the diagnosis of Alzheimer’s. The patient was under my close observation. I took this case “Alzheimer’s” for my case study because it is seen commonly and new for me as well.

 

 

Objectives

The objectives of during the case study are given below:

General Objectives

• At the end of the case study, we will be able to explain about “Alzheimer’s”.

Specific Objectives

At the end of the case study. I will be able to:

• Gain detailed knowledge about patient, patient’s disease condition and information about drugs.
• Create interpersonal relationship with patient and his party and able to share knowledge about disease condition.
• Provide nursing care to the patient despite of any age, gender, status or condition.
• Teach the patient and family the way to promote health to prevent from illness and complication.
• Provide health teaching to obtain good health.
• Evaluate patient’s progress and care provided throughout the period of hospitalization.

 

Informants

Name: Bindu Shakya

Relationship with patient: Daughter

 

History Taking

• History of present illness: Alzheimer’s
• Past of Psychiatric and medical history: No any past psychiatric and medical history

 

Treatment History

Tab. Admenta	5mg	BD
Tab. Aricep	5mg	BD
Tab. Metformin	5mg	BD
Tab. Levipil	5mg	BD
Cap. Urimax	0.4mg	BD
Tab. Sonate	500mg	BD
Tab. Pantop	40mg	BD

 

Family History

SN	Family	Age	Name	Occupation	Chronic Illness
1.	Son	55 yrs/M	Sunil Shakya	Out of country	——
2.	Daughter	50 yrs/F	Bindu Shakya	Teacher	——
3.	Son	35 yrs/M	Suresh Shakya	Out of country	——

 

Environmental History

There are 4 members in my patient’s house. There are 9 room in house well ventilated. There is a separate kitchen and they use gas for cooking. They drink filtered water. The type of toilet that they use is flush toilet and the type of drainage is pipe drainage.

 

 

Mental Status Examination

General Appearance and Behavior

• Patient seemed healthy and look according to her age
• Hygiene was maintained
• Dress up was appropriate to age
• Eye contact was not maintained

Speech

• Volume and tone of speech s absence
• Reaction time was abnormal
• Abnormal Volume and tone

Mood

• Patient looks happy

Thought

• No suicide thought or idea

Perception (Hallucination)

• No evidence of illusion and hallucination

 

Cognitive Function

Consciousness

• Patient is unconsciousness and not alert

Attention

• His attention was not present

Concentration

• Concentration was not sustained

Memory

• Patient memory was not intact

Abstract thinking

• Patient thinking is not intact

Insight

• Insight is not present

Judgement

• Judgement was illogical

 

Developmental Task

My patient “Ratna Devi Shakya” is a 99 years/female, and she belongs to old age. According to Erik Erikson`s stages of psychosocial development my patient belongs to “Integrity vs. Despair”.

S.N	According to Book	In my patient
1.	Adjust to decreasing Mental Status strength and health changes.	absent
2.	Decide where and how to love out the remaining years	absent
3.	Maintain contact with children, grandchildren, and other living relatives, finding emotional satisfaction with them.	Present
4.	Establish explicit affiliation with members of own age group	Absent

 

 

Disease Profile

• Alzheimer’s

Alzheimer’s disease is a progressive disease that destroys memory and other important mental functions. It’s the most common cause of dementia – a group of brain disorders that results in the loss of intellectual and social skills. These changes are severe enough to interfere with day-to-day life.

In Alzheimer’s disease, the brain cells themselves degenerates and dis, causing a steady decline in memory and mental function.

 

Cause

• Unknown

 

Sign and Symptoms

• Changes in personality and behavior
• Planning & performing familiar tasks
• Disorientation and misinterpreting spatial relationships
• Memory
• Making judgements and decisions
• Speaking and writing
• Thinking and reasoning

 

Diagnosis tests

• History taking
• Mental Status and neurological exams
• Blood tests
• Mental status testing
• CT-Scan
• MRI
• Positron emission tomography

 

Management

• Medical Management
• Nursing Management

 

Complication

• Memory and language loss
• Impaired judgement
• Pneumonia and other infections
• Injuries from fall

 

 

Lab Investigation

Biochemistry

S.N	Test Name	Result	Normal Range
1.	Sugar (F)	54*	60-110 (mg/dl)
2.	Sugar (PP)	72*	<140 (mg/dl)
3.	Urea	34	15 – 45 (mg/dl)
4.	Creatine	1.1	M= 0.9-1.3 F = 0.6 – 1.1 (mg/dl)
5.	Uric Acid	3.9	M = 3.5 – 7.2 F = 2.6 – 6.0 (mg/dl)
6.	Sodium	122*	135 – 146 mEq/l
7.	Potassium	4.13	3.5 – 5.2 mEq/l
8.	Amylase	26	22-80 IU/I
9.	Calcium	9.2	8.4 – 10.8 (mg/dl)
10.	Phosphorus	3	2.7 – 5.5 (mg/dl)

 

Thyroid Function Test

1.	Free T3	5.36	3.10 – 6.80 pg/ml
2.	Free T4	14.99	12 – 22 ng/dl
3.	TSH	3.80	0.27 – 4.20 µlu/ml

 

 

Nursing Care Plan

Nursing Diagnosis

• Altered in body temperature related to the infectious process and cerebral edema.
• Acute pain related to Meningeal Irritation.
• Nutritional imbalance less than body requirement related to anorexia.
• Disturbed sleeping pattern related to insomnia.
• Activity intolerance related to dizziness.

 

 

Defining Characteristics	Nursing diagnosis	Nursing goal	Planning	Implementation	Rational	Evaluation
Subjetive: Patient said that “I don`t feel to do anything.”   Objective: Patient seem sad, tired and dizziness	Activity intolerance related to dizziness	Patient well regain his activity within 2-3 hours.	I will – -Assist the general condition of patient -encourage patient to perform recreational activity -Assist patient`s party to perform light exercise. -Maintain good Inter-personal relationship with patient	-General condition was assessed through observation. – Playing therapy; game(badminton), exercise (Mental Status training) was performed. – Light exercise was performed to the patient i.e., Mental Status training -By asking question i.e., what is your name? I maintained good Inter-personal relationship with patient.	-To know the general condition of the patient. -To regain his daily activity habit. -For body relaxation. -To refresh or divert the mind of patient	My goal was fully achieved as patient regain his activity within 2 hours

 

 

Assessment	Nursing Diagnosis	Nursing Goal	Planning	Implementation	Rational	Evaluation
Subjective data: My patient said “I have a headache.”   Objective data: Patient look restless and uncomfortable	Acute pain related to meningeal irritation.	Pain will be reduced within 2hours	I will…. Assess the general condition of the patient -Assess level and characteristics of pain -Place the patient in comfortable position -Elevate head of bed at 30 degrees. -Provide rest in the room to a minimum. -Administer medication as prescribed.	-General condition of the patient was assessed through observation -Pain was assessed through pain rating scale appropriate to its age -Patient was placed in a comfortable position through the support of visitor. -Head of bed is elevated at 30 degrees. – Promote rest by keeping stimulation in the room at minimum. -Medication was don as prescribed.	-To get general information and faster planning -To know the characteristics of pain. -To decrease pain -To decrease Intra cranial pressure -To relieve anxiety. -To relieve the pain	My goals were fully met as pain was reduce

 

 

Drug Card

Drugs

Tab. Admenta	5mg	BD
Tab. Aricep	5mg	BD
Tab. Metformin	5mg	BD
Tab. Levipil	5mg	BD
Cap. Urimax	0.4mg	BD
Tab. Sonate	500mg	BD
Tab. Pantop	40mg	BD

 

Admenta

It belongs to a group of medicines called anti-dementia agents used to treat moderate to severe Alzheimer’s disease.

Mechanism of Action

It is believed to be the blockade of current flow through channels of N-methyl-d-aspartate (NMDA) receptors.

Use

• Improves learning
• Improves memory
• Managing Alzheimer’s disease
• Make easier to carry out daily activity

Side Effect

• Dizziness
• Headache
• Confusion
• Diarrhea
• Sleepiness

 

Aricep

To treat mild to moderate dementia in Alzheimer’s disease, a progressive illness that gradually affects memory and thinking.

Mechanism of Action

A new reversible of the enzyme acetylcholinesterase.

Use

• Help nerve cell to communicate
• Increase amount of acetylcholine
• Improve memory
• Improve awareness

Side Effects

• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Weight loss
• Sleeping trouble

 

Metformin

It is a biguanide anti-hyperglycemic used in conjunction with diet and exercise for glycemic control in type 2 diabetes mellitus.

Mechanism of Action

Suppression of gluconeogenesis and the improvement of glucose uptake and insulin sensitivity.

Use

• Prevent kidney damage
• Blindness
• Nerve problems
• Decrease amount of sugar

Side Effect

• Diarrhea
• Nausea
• Vomiting
• Sweating
• Fast heartbeat

 

Levipil

It is an anti-epileptic medicine used to treat seizures (fits) in epilepsy.

Mechanism of Action

Its mechanism of action is modulation of synaptic neuro transmitter release through binding to the synaptic vesicle protein SV2A in the brain.

Uses

• Seizures

Side Effects

• Headache
• Cold
• Dizziness
• Nausea

 

Pantop

It is used to treat certain stomach and esophagus problems.

Mechanism of Action

Pantoprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+) ATPase enzymes at the secretary surface of gastric parietal cell.

Uses

• Heartburn
• Acid reflux
• Gastro-esophageal reflux disease

Side Effects

• Headache
• Diarrhea
• Dizziness
• Nausea or vomiting

 

 

Religious Beliefs

My patient’s name is Ratna Devi Shakya, 99 years/Female. He is from Sanobharang. She is from the city, so during my interview when I asked my patient party about superstitious beliefs or wrong perception. She said that she did not believe in such a superstitious belief. When she or her family suffer from any kind of disease, they refer hospital for checkup or treatment.

 

 

Health Teaching

I provided health teaching to my patient’s party on following topics:

• Encourage patient to intake nutritional food i.e., fruits, vegetables, etc.
• Encourage patient to intake plenty of water to prevent dehydration.
• Use medicine regularly as prescribed by doctor.
• Provide knowledge to the patient about the disease condition.
• Encourage patient in recreational activity to prevent from dizziness.
• Encourage patient to perform light exercise by walking for refreshment.

 

 

What I learned from Case Study

Case Study is the comprehensive study of a selected patient and comparative study with books. During my case study, I learned a lot of knowledge about disease condition.

This Case Study has given me the chance to observe the patient and make me able to analysis is the disease condition and find out the different in book and patient.

This Case Study has also made me able to do management in a patient that in the book. I learned knowledge and information about his disease condition.

 

 

Conclusion

In conclusion as the Ratna Devi Shakya, 99 years/Female with the diagnosis of Alzheimer’s. During hospitalization he was diagnosed with Alzheimer’s. I applied a cure and there is presence of slight improving and improvement. I cared patient by applying advance technique such as; activity in tolerance, sleeping pattern, etc. I obtained comprehensive knowledge on the disease. It causes, sign and symptoms, diagnostic feature, management and complication.