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Case Scenario #1

You are taking care of Mrs. Smith an 80-year-old client with a diagnosis of

Dementia. When you tell Mrs. Smith that it is lunch time, she insists that she has eaten

already and is no longer hungry.

1. How will you communicate with Mrs. Smith?

Dementia is defined as “an acquired loss of cognition in multiple cognitive domains

sufficiently severe to affect social or occupational function.” (Arvanitakis, 2019, p. 1). According

to Anantapong (2021), over 80% of people with dementia commonly experience eating and

drinking difficulties such as loss of appetite or problems maintaining their eating routine (p. 2).

In this scenario, Mrs. Smith losing her interest in eating causes of dementia, as a nurse, I will

communicate, maintain eye contact with her, and try not to put any pressure on her, then gently

remind her it is time to eat. Patients with dementia easily get distracted, so while speaking to

Mrs. Smith, ensure it is slow and clear enough to limit her distractions and help her focus on

what I am saying.

2. What would be your next step as a nurse?

After Mrs. Smith feels safe and less anxious, I will bring on her food and start

encouraging her to eat. If there is a report to acknowledge her favourite foods, then her meal

must base on what she likes most. Make her food look delicious and smell nice so that can help

her be hungry. According to Alzheimer’s Association (2019), in case there is no report about it,

and I do not know what she likes, preparing finger foods that are bite-sized and not hard to chew

or swallow, such as fish sticks, tuna sandwiches or teamed broccoli, so that Mrs. Smith can easily
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serve herself, which not only improves her interest in foods but also ensuring her safety since it

decreases the possibility of choking.

Case Scenario #2

You are assigned to Mr. Johnson, a 75-year-old client who is becoming deaf and has

an unsteady gait due to a knee replacement he had 2 years ago. You have entered his room

to begin your morning care, and he is facing the television with his back to you.

1. How will you approach Mr. Johnson and communicate that it is time for you as

the nurse to assist him with his care? (list 3 effective ways and explain your

answers)

According to Chaveiro (2009), deaf patients use the health system differently from

normal hearing patients, they report difficulties expressed as fear, mistrust, and frustration, in

case of that non-verbal language can be used as a form of communication with deaf patients,

even if not known sign language, they still can understand through gestures, facial and body

expressions (p. 148). Hence, in this scenario, to ensure Mr. Johnson will not be surprised and

avoid him being in fear since he focuses on the television and might not recognize me entering

the room, and gently touch his shoulder or arm to let him notice. Then, I will start speaking with

him, by using non-verbal language. The first approach is to use sign language, if Mr. Johnson

knows sign language, it would be great to communicate this way.

2. What are the nursing considerations and effective strategies to use when assisting

the client in moving around as the client has an unsteady gait? (list at least two nursing

considerations and two effective strategies)

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As Mr. Johnson has an unsteady gait which makes it difficult for him to walk and move

normally. As his nurse, the first thing I will consider when moving him is to prevent any risks of

falling that can happen. The effective strategy for this consideration is to check on the room’s

surroundings and ensure it is safe for moving him around. Moreover, while transferring him,

using body transfer mechanics should be appropriate, and I can call for another nurse to assist me

in moving him if needed.

Case Scenario #3

You have been assigned to care for a client with pneumonia who also contracted

Clostridium difficile, also known as C. difficile (C Diff). What appropriate personal

protective equipment (PPE) should be used when caring for this client? List all the

appropriate PPE and explain the correct procedures for donning and doffing PPE for this

case scenario.

Also, explain why this PPE should be used and any other considerations based on

this case scenario.

Pneumonia is defined as “an infection that inflames your lungs’ air sacs (alveoli). The

sacs may fill up with fluid or pus, causing symptoms such as a cough, fever, chills, and trouble

breathing.” (American Lung Association, 2021). Pneumonia can be spread by droplet

transmission, and it is considered a life-threatening disease. Besides, Clostridium difficile (C.

Diff) is “the leading cause of infectious nosocomial diarrhea” (Bouza, 2012, p. 5). The primary

mode of transmission for C. Diff is person-to-person and through the fecal-oral route (Cohen et

al, 2010). According to Johnson and Gerding (1998), C. Diff is a spore-forming microorganism,

it persists longer in the environment than other non-spore-forming bacteria, thus, it is a highly
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contagious disease. In this scenario, the appropriate PPE should be used to avoid a chain of

infection when the patient experiences both pneumonia and C. Diff includes an N95 respiratory

mask, face shield, eye protection, gloves, and gown. In this case, the procedures for donning PPE

are (from first to last): sanitize hands, put on an isolation gown, put on N95 respiratory mask,

face shield, eye protection and lastly, put on gloves. The procedures for doffing PPE are (from

first to last): first, take off gloves, then sanitize hands, take off the gown, sanitize hands again,

take off face shield, eye protection, N95 respiratory mask respectively and last thing is to sanitize

hand one more time. The appropriate PPE above should be used since the patient not only has C.

Diff but also pneumonia, as a nurse, I must avoid spreading infection by using all PPE listed

above, which protects against droplets that can spread infection caused by coughing or sneezing,

and contact precautions as well.

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