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Miss Information

Learn how a nursing staff creates a tailored care plan to address routine distress in a dementia patient with aphasia and combative behavior. Strategies include communication techniques, activity scheduling, and caregiver support to improve patient and caregiver well-being.

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Miss Information

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  1. Miss Information Communication Case

  2. Presentation • 87 year-old female with dementia who is now routinely upset with caregivers • Aphasic • Usually combative with ADL cares • Angry at not going home in the late afternoon/early evening • Frustrated easily when trying to speak to staff

  3. Medical History • Arthritis pain • Heartburn • Right knee replacement • High blood pressure • Constipation • Incontinence • Depression • Skin cancer in the past • Hysterectomy

  4. Medications • Acetaminophen (Tylenol) • Ultram (Tramadol) • Prilosec • Lasix • Metoprolol • Potassium • Effexor • Senna, colace, fleets enema

  5. Assessment • All laboratories normal • Gait remains stable • No increased pain complaints • Appetite good • Sleeps well overnight • Naps in the afternoon • Attends activities the do not involve participation (singers, e.g.)

  6. Assessment • Mood screens are positive • However these are difficult to interpret due to aphasia • More context is given to the provider • No weepiness • No anxiety • Agitation focused on interactions with staff • She seems more functional than her cognitive screens would imply

  7. Nursing Management • Nursing staff conveys their plan to provider: • Communication is the key • Slow, step-by-step instructions • Make a series of photographs into a book showing common wants/needs • A person dressing, eating, bathing, etc. • Make a series of written questions as well • Use visual pain scales • Employ several caregivers in assessing depression • Especially those providing the most care

  8. Nursing Management • Nursing staff plan • Pay attention to her distress when she becomes agitated at the end of the day • Will engage her in activities prior to the later afternoon to help reduce her distress • Especially those that involve a minimum of verbal input from her • Remove her from areas in the late afternoon where she can see employees come and go at shift change, end of the day

  9. Outcome • Plan provides the provider more information • Reduced likelihood of added or changed doses of medication • Provided universal framework for caregivers to manage the problem • Led to fewer episodes of afternoon distress • More successful toileting, bathing, dressing • As long as guidelines followed • Care plan placed in her chart and MAR for all to see • Reduced distress of caregivers as well

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