Case Study-GERIA

I. Patient Profile:

Mr. R is an 81 year old recognized war veteran. He had a history of a head injury. He is over 6ft. tall with
a large build. After retiring he became sedentary and gained weight because of this he had eventually
developed hypertension and diabetes. He was prescribed with hypertensive medication and oral
medications to control the diabetes. About 3 years ago, Mr. R started struggling with his memory and
judgement, specifically writing a check for 40,000 dollars instead of 4,000 dollars, driving into a parked
car and getting lost in his neighborhood in his pajamas. He was diagnosed with Alzheimer’s dementia
but the doctors’ suspected it might be mixed dementia given the cardiovascular risk factors and history
of head injury. Despite his diagnosis, Mr. R still continued spending time in his workshop, listening to the
radio and socializing with friends. Since his dementia diagnosis Mr. R remained at home with his wife,
she helps him navigate his dementia diagnosis and manages his medical needs like administering
medications and monitoring his blood sugar but lately Mr. R’s needs has become too much for Mrs. R to
manage. His Diabetes became poorly controlled, requiring more frequent glucose monitoring and
insulin. He requires more assistance in toileting and dressing and has become suspicious and easily
angered. Once he pushed Mrs. R forcefully, and she almost fell down. The decision to move Mr. R in a
long-term care home has been made to best meet his changing needs. Upon moving to the care home,
he appeared restless and suspicious, he tells the staff to go away and call out for his wife. During
personal care he repeatedly asks for his wife. He also has no appetite.

II. Theory of Aging Related to the Patient:

III. Comprehensive Geriatric Assessment:

i. Physical

a. Presenting Complaint

He has been reported to being suspicious, easily angered thus becoming violent. He also has diabetes
that requires insulin and frequent monitoring of blood sugar. He also requires more assistance in
toileting and dressing.

b. Past Medical Health History

About 3 years ago, he began to struggle with his memory and judgement and was later on diagnosed
with Alzheimer’s dementia. Mr. R also has a history of a head injury during his career as a war veteran.

c. Medication Reconciliation

Due to his hypertension and diabetes, Mr. R was prescribed with Hypertensive drugs and oral
medication to control his Diabetes. His diabetes was poorly managed so now he needs insulin and
frequent glucose monitoring.

d. Pain

N/A
e. Advance Directives

Upon moving to the long-term care home, Mr. R has been looking for his wife at all times.

ii. Functional Test

a. Activities of daily living

Prior to his admission, despite his Alzheimer’s dementia diagnosis Mr. R still continued with his usual
routine like working in work shop, listening to the radio, and socializing with his friends but he just
remained at home with his wife most of the time. As time passed by, he became suspicious and angered
easily he also now required assistance in toileting and dressing.

b. Balance

No information about patient’s balance was provided.

c. Mobility

No information about patient’s mobility was provided.

iii. Psychological

a. Cognition/Mood

Mr. R has been reported to act suspicious and easily angered, it was also reported that he forcefully
pushed his wife once making her almost fall that was prior to his admission but upon his admission to
the care home he appeared restless and suspicious, he tells the staff to go away and call out for his wife.
During personal care he repeatedly asks for his wife. He also has no appetite.

b. Alcohol

No information about the patient’s Alcohol intake was provided.

iv. Social Assessment

a. Living Arrangements

Mr. R was originally living with his wife but due to the changes he currently experienced it has now been
decided that he be transferred to a long-term care home to be able to cater his changing needs where
there is a care team present.

b. Carer Stress

Mr. R’s main source of support is his wife. She would manage all his medical need for him, like preparing
his daily medications and monitoring his blood sugar but due to his increasing needs, it has become too
much for her to handle. He also became suspicious and easily angered and once he was also violent.

c. Social Supports

His main source of support is his wife, prior to his admission to the care home he also socializes with
friends.

d. Financial Supports
Mr. R was a war veteran, meaning he has served his country so he must be receiving a wide range of
benefits like disability compensation, pension, education and training, health care, home loans,
insurance, vocational rehabilitation and employment, and burial.

IV. Problem Prioritization

All Identified Problems with References.

Problem List 
Self-Care Deficit: Dressing/Grooming r/t Alzheimer’s Dementia (CGA Functional Test under
Activities of Daily Living)
Self-Care Deficit: Toileting r/t Alzheimer’s Dementia (CGA Functional Test under Activities
of Daily Living)
Social Isolation r/t Alzheimer’s Dementia as evidenced by Hostile Behavior (CGA
psychological test under Carer Stress)
Disturbed thought process r/t Alzheimer’s Dementia as evidenced by Memory loss
(Patient’s Profile)
Chronic Confusion r/t Alzheimer’s Dementia as evidenced by Memory Impairment and
Behavioral Changes (CGA psychological test under Carer Stress)
Wandering r/t Alzheimer’s disease as evidenced by persistent searching for people or
objects (Patient’s Profile)
 
b. List of Priority Problems  
 
Nursing Diagnosis  Rank  Justification 
Disturbed thought process r/t 1st 
Alzheimer’s Dementia as
evidenced by Memory loss
Chronic Confusion r/t 2nd 
Alzheimer’s Dementia as
evidenced by Memory
Impairment and Behavioral
Changes
Self-Care Deficit: 3rd 
Dressing/Grooming r/t
Alzheimer’s Dementia
    
 

(2) Nursing Care Plan

Evidence Base Practice