1
Dementia
UNFOLDING Reasoning
William “Butch” Welka, 72 years old
Primary Concept
Cognition
Interrelated Concepts (In order of emphasis)
• Pain
• Mood and Affect
• Psychosis
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23% ✓
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
, 2
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II and
dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He is now a resident
of Pineville Estates, a local long-term care facility the past four months because his dementia progressed and his wife
Rita was unable to care for him. When Rita visited Butch this morning, she reports to the nurse that he is more confused
and is concerned because Butch is easily angered. Butch insists that he sees his friend Roger, who served with him in the
Navy, is in the room, but he died ten years ago. Rita approaches the nursing station with tears in her eyes and states,
“What is happening to my husband? This just isn’t like Butch to act like this! Please do something to help him!”
Personal/Social History:
Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to visit
Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch believes he is at
Pineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were alone. Rita was just
awarded guardianship due to his declining mental status.
1. What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk
Potential)
RELEVANT Data from Present Problem: Clinical Significance:
History of heart failure, COPD, All these conditions affect the vascular components of the body
HTN, DM II and dementia and increase the risk of stroke. COPD and HF can also cause
Has been hospitalized for him to not receive enough oxygen and blood flow to the brain
exacerbation of heart failure three which could cause the dementia to advance at a quicker rate.
times the past six months. End stages of HF S&S include confusion and impaired thinking.
Angry, confused, and hallucinating COPD could be the cause of the HF exacerbations.
S&S of end stage heart failure and is also a S&S of vascular
dementia.
RELEVANT Data from Social History: Clinical Significance:
Married for 51 years Has support at home
3 adult children that visit regularly Has family that visit routinely, routine is important for dementia
Wife visits daily patients
Thinks he in rehab Has continued support at the hospital
Wife awarded guardianship Could be upset when he finds out why he is in the hospital
Wife is the person in charge of decisions related to his care
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
, 3
2. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD 1. Fluticasone/salmeterol 1. COPD Long Acting 1. Will demonstrate a
• Hypertension diskus 1 puff every 12 Beta-2 decreased inflammation
• Heart failure hours agonist/Corticosteroid and histamine response
• Diabetes type II 2. Albuterol MDI 2 puffs combination inhaler; in lung tissues AEB
• Dementia every 4 hours PRN anti-asthmatic; anti- increasing ability to
shortness of breath inflammatory exchange gases.
3. Lisinopril 10 mg PO 2. COPD Autonomic 2. Will decrease acute
daily nervous system agent; exacerbations of COPD.
4. Atenolol 25 mg PO BID Beta-adrenergic 3. Will decrease
5. Furosemide 20 mg PO agonist hypertension AEB
daily (sympathomimetic); decreased BP
6. Hydrochlorothiazide 25 Bronchodilator 4. Will manage HTN in
mg 1tab PO daily (respiratory smooth combination with other
7. Metformin 1000 mg PO muscle relaxant ) anti-hypertensives AEB
BID 3.HTN Long-acting stable BP readings
angiotensin converting 5. To decrease edema
8. Glyburide 10 mg PO
enzyme inhibitor; caused by HF, decrease
BID HTN AEB decreased
antihypertensive
9. Memantine 5 mg PO 4. HTN & HF (off label swelling and stable BP
daily use) Cardio Selective- levels
Beta blocker; 6. Will demonstrate
antihypertensive reduced reabsorption of
5. HF Electrolytic and water and decreased BP
water balance agent; and water retention
loop diuretic; which can cause edema
antihypertensive. AEB less edema
6. HF Electrolytic and 7. Will demonstrate
water balance agent reduced BS reading
thiazide; diuretic; AEB decreased levels of
antihypertensive. BS
7. DM 8. Will demonstrate
Antihyperglycemic; reduction in blood
biguanide glucose AEB FSBS
8. DM Second readings
generation 9. Will demonstrate a
sulfonylurea; reduction in dementia
antihyperglycemic S&S AEB decreased
9. Dementia N-methyl- glutamate
D-aspartate (NMDA)
receptor
antagonist/antidementi
a
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
Dementia
UNFOLDING Reasoning
William “Butch” Welka, 72 years old
Primary Concept
Cognition
Interrelated Concepts (In order of emphasis)
• Pain
• Mood and Affect
• Psychosis
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23% ✓
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
, 2
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II and
dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He is now a resident
of Pineville Estates, a local long-term care facility the past four months because his dementia progressed and his wife
Rita was unable to care for him. When Rita visited Butch this morning, she reports to the nurse that he is more confused
and is concerned because Butch is easily angered. Butch insists that he sees his friend Roger, who served with him in the
Navy, is in the room, but he died ten years ago. Rita approaches the nursing station with tears in her eyes and states,
“What is happening to my husband? This just isn’t like Butch to act like this! Please do something to help him!”
Personal/Social History:
Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to visit
Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch believes he is at
Pineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were alone. Rita was just
awarded guardianship due to his declining mental status.
1. What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk
Potential)
RELEVANT Data from Present Problem: Clinical Significance:
History of heart failure, COPD, All these conditions affect the vascular components of the body
HTN, DM II and dementia and increase the risk of stroke. COPD and HF can also cause
Has been hospitalized for him to not receive enough oxygen and blood flow to the brain
exacerbation of heart failure three which could cause the dementia to advance at a quicker rate.
times the past six months. End stages of HF S&S include confusion and impaired thinking.
Angry, confused, and hallucinating COPD could be the cause of the HF exacerbations.
S&S of end stage heart failure and is also a S&S of vascular
dementia.
RELEVANT Data from Social History: Clinical Significance:
Married for 51 years Has support at home
3 adult children that visit regularly Has family that visit routinely, routine is important for dementia
Wife visits daily patients
Thinks he in rehab Has continued support at the hospital
Wife awarded guardianship Could be upset when he finds out why he is in the hospital
Wife is the person in charge of decisions related to his care
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
, 3
2. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD 1. Fluticasone/salmeterol 1. COPD Long Acting 1. Will demonstrate a
• Hypertension diskus 1 puff every 12 Beta-2 decreased inflammation
• Heart failure hours agonist/Corticosteroid and histamine response
• Diabetes type II 2. Albuterol MDI 2 puffs combination inhaler; in lung tissues AEB
• Dementia every 4 hours PRN anti-asthmatic; anti- increasing ability to
shortness of breath inflammatory exchange gases.
3. Lisinopril 10 mg PO 2. COPD Autonomic 2. Will decrease acute
daily nervous system agent; exacerbations of COPD.
4. Atenolol 25 mg PO BID Beta-adrenergic 3. Will decrease
5. Furosemide 20 mg PO agonist hypertension AEB
daily (sympathomimetic); decreased BP
6. Hydrochlorothiazide 25 Bronchodilator 4. Will manage HTN in
mg 1tab PO daily (respiratory smooth combination with other
7. Metformin 1000 mg PO muscle relaxant ) anti-hypertensives AEB
BID 3.HTN Long-acting stable BP readings
angiotensin converting 5. To decrease edema
8. Glyburide 10 mg PO
enzyme inhibitor; caused by HF, decrease
BID HTN AEB decreased
antihypertensive
9. Memantine 5 mg PO 4. HTN & HF (off label swelling and stable BP
daily use) Cardio Selective- levels
Beta blocker; 6. Will demonstrate
antihypertensive reduced reabsorption of
5. HF Electrolytic and water and decreased BP
water balance agent; and water retention
loop diuretic; which can cause edema
antihypertensive. AEB less edema
6. HF Electrolytic and 7. Will demonstrate
water balance agent reduced BS reading
thiazide; diuretic; AEB decreased levels of
antihypertensive. BS
7. DM 8. Will demonstrate
Antihyperglycemic; reduction in blood
biguanide glucose AEB FSBS
8. DM Second readings
generation 9. Will demonstrate a
sulfonylurea; reduction in dementia
antihyperglycemic S&S AEB decreased
9. Dementia N-methyl- glutamate
D-aspartate (NMDA)
receptor
antagonist/antidementi
a
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
