Level IV- Block D GROUP 4

NAME: Mrs. CM ADDRESS: 200 Pulo, San Rafael, Bulacan BIRTHDATE: November 5, 1924 AGE: 86 years old SEX: Female CIVIL STATUS: Married EDUCATIONAL ATTAINMENT: Grade 1 RELIGION: Roman Catholic NATIONALITY: Filipino NAME OF SPOUSE: Mr. OM INFORMANT: Granddaughter of Client

History of Present Illness Six years prior to interview, the client was living at Houston, Texas with her eldest daughters family. It is where she started to manifest unusual behaviors such as forgetfulness and incoherent in answering questions. According to the informant, the client stays in America for almost a year already when the manifestation began. On the 2nd year of her stay there, she started to ask her

daughter to bring her back to Philippines but her daughter didnt listen to her and neglect her mothers request. For 2 years, the client kept on begging her daughter to grant her request but she didnt listen. On the 5th year of her stay in America, the unusual manifestation began. She started to become so forgetful. Whenever shes asked, her answer is not coherent to the question. Then after 2days she also started to sing Bayan ko, nabuhay ka napasakdal sa dusa.

She started also to forget her daily routines such as taking bath on her, brushing her teeth on her own cooking, cleaning and more. Due to these changes, the client was brought to psychiatrist and after undergoing several test and examinations, she was diagnose to have Dementia Secondary to Alzheimers disease. They were advised undergo certain psycho therapies but due to the luck of time of the daughter, she just asked the doctor for prescription.

Her medications are Donepezil Hydrochloride (Aricept) and Memantine Hydrochloride. Since her oldest daughter doesnt have enough time to take care of her mother, she decided to bring her back to the Philippines as soon as possible. The client arrived in the Philippines last December 7, 2005 and she was brought to her 39 year old granddaughter to take care of her. Her medications were continuously given for almost 11 months but since no changes were observed, they decided to discontinue giving the medications.

. According to her granddaughter, the only thing that the client remembers is her name. she cannot even remember the name of her husband or even the name of her children. She still keeps on singing Bayan ko and is very fond of playing with the seam of her clothes. During the interview, the client is having her yearly checkup at Outpatient Department at Bulacan Medical Center. She has no complaint of pain and her vital signs are all within the normal range.

According to the informant, shes not aware about the past experiences of the client. She doesnt know whether the client has received complete dose of immunization or even the accidents and illnesses that the client had before. During the clients stay in the Philippines, she seldom acquires cough and colds, about once to twice a year only. She has no allergy to certain foods. Shes not taking any vitamins or supplements.

According to the informant, she doesnt know the diseases in the father and mother side of the client. Since they are to old already. She stated that the only thing that she knows that the grandmother of her client also had Alzheimers disease. All her siblings are already dead due to colon cancer, and cardiac arrest.

Circulation According to the informant, the client has a very sedentary lifestyle. She sits all day and doesnt have anything to do. Her blood pressure is 100/80 mmHg and her pulse rate is 75 beats per minute. The result of her capillary refill test is normal which is 2 seconds. She doesnt have any open wounds. The client is capable of walking even without assistance but will take her for so long before she could reach her destination.

During the interview, the client has cough and colds as evidence by presence of nasal secretions but there is no sign of difficulty in breathing that was noted. Her respiratory rate is 20 breaths per minute.

The client is capable of feeding herself with the use of her own bare hands. As long as it is serve in front of her. She cannot use utensils. She takes her breakfast at 7am, her lunch at 12pm and her dinner at 7pm. Her snacks is also served at 9am and 3pm which include 1 piece of bread and a cup of water.

Her usual meal is composed of 1 cup of rice, viand with soup and 1 pc. of banana sliced into bits. In terms of her fluid intakes, she can consume approximately 5-6 glasses of water per day. She doesnt drink any other kind of drinks aside from water.

The client cannot control her urination and defecation thats why shes always wearing diaper. Her granddaughter usually change her diaper once soak already every 3-4 hours. It is yellowish in color and very pungent. She usually defecate every afternoon and it is also her granddaughter who cleans her perineal area.

Her stool is foul smelling hard in consistency, yellowish to brownish in color and amounting to about 1 whole lakatan banana.

The client is unable to observe proper hygiene for herself. Her granddaughter bathes her thrice a week. The client doesnt brush her teeth since she doesnt have any, instead she have dentures which also brushed by her granddaughter. Her finger nails is trimmed once a week but she still has dirty finger nails during the interview.

According to the informant, she usually sleeps as early as 8:00 in the evening and wakes up at around 6:00 in the morning. There are times that she stays awake until 10 in the evening and during that time she just keep on singing until she get asleep. She usually take naps from 1pm until 3pm. Her bed has siderails for her safety since she sleeps alone in her room.

Since the client does not answer questions coherently, the usual pain and discomfort is not assessed.

The client has a very sedentary lifestyle. She is able to talk even without assistance but it would take her so long. She has kyphosis making it difficult for her to walk.

The client is flat affect most of the time but she easily gets happy whenever someone compliments her. She easily gets mad whenever somebody says bad against her. The client keeps on singing the patriotic song Bayan ko, nabihag ka, napasadlak sa dusa as if she really love and miss our country, Philippines.

The client doesnt remember anything except for her name. She doesnt answer question coherently and doesnt recognize any of her family member.

The client is a Roman Catholic. There are times that her granddaughter could hear her reciting the Lords Prayer in Tagalog but it is very rare. Due to her condition, she was not able to attend mass for alost 6 years already.

The client cannot recognize any of her children or grandchildren. She poorly interacts with others since she cannot answer questions coherently thats why shes always alone.

The client is living in a place where there are lots of trees. It is quite far from the road proper and it will take them 20-30 min before they could reach the town proper. They are near the school church and a sari-sari store. The client is living with the family of her granddaughter. It is clean in the area and has proper drainage in the area.

Blood Pressure: 100/800 mmHg Temperature: 36.9 degree Celsius Pulse Rate: 75 beats/minute Respiratory Rate: 20 breaths/minute

Upon assessment, the client is sitting on one of the chairs at the OPD of Bulacan Medical Center together with her granddaughter. Shes wearing a loose floral dress. Her appearance is really appropriate for an eighty-six year old woman. The wrinkles are very noticeable in her face and her uncombed hair is grayish to whitish in color. She is wearing a pair of dentures and she has bad breath.

Her body is skinny and it is slightly foul smelling. She has kyphosis. The client also has cough and colds as evidenced by presence of nasal secretions. She also has dirty fingernails. Shes not oriented to time and place and incoherent in answering the questions. She keeps on playing with the seam of her dress and there are times that shell sing Bayan ko.

-Tatlong beses lang siya nakakaligo sa isang linggo, ako na din ang naglilinis ng pustiso niya, hindi din sya nakakapagpulbos o pabango man lang as verbalized by the clients grand daughter

Objective: -Untidy -body odor -bad breath -uncombed hair -dirty fingernails

-Self care deficit related to cognitive impairment as manifested by Untidy, body odor, bad breath, uncombed hair and dirty fingernails Scientific Explanation This is a condition wherein the patient due to mental problems affecting behavior, was not able to perform self care activities.

-At the end of 30 minutes to 1 hour of health teaching, the clients granddaughter will: Understand the importance of good grooming Identify measures that will make the patient clean & free from body odor.

Explain the importance of good grooming for the clients health - To understand that good grooming is one way to lessen the occurrence of certain health problems especially for a geriatric client.

Instruct the clients granddaughter to: Bathe the client at least once a day. Put on deodorant, powder or cologne. - This is to make the client comfortable and to prevent any occurrence of body odor.

Teach the clients granddaughter to change clothes everyday. - To lessen the unpleasant body odor.

Instruct the clients granddaughter to perform oral mouthcare aside from cleaning her dentures at least 2-3 times a day. - To get rid of the bacteria that causes bad breath

After 30 minutes to 1 hour of applying nursing interventions, the clients granddaughter was able to understand the importance of good grooming & identified measures that will make patient neat & clean. The goal was MET as evidenced by the verbalization of: Sige po. Papanatilihin ko siyang laging malinis at maayospara makaiwas siya sa sakit. Papaliguan ko na din siya araw-araw, papalitan ng damit, lalagyan ng pulbos at tawas. Lilinisin ko na din yung bibig niya.

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BRAND NAME: Ebixa USUAL DOSAGE/ FREQUENCY: Oral Solution: 2mg/Ml Tablets: 5mg, 10 Mg USUAL ROUTE: PER OREM DRUG ORDER: 1mg BID

CLASSIFICATION: N-Methyl-D-Asparate (NMDA) Receptor Antagonist

ACTION: NMDA receptors, the persistent activation of which seems to increase alzheimer symptoms

Moderate To Severe Alzheimer Dementia

Contraindicated in patients allergic to drug or its components. Not recommended for patients with severe renal impairment

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Anxiety Edema Hypertension Conjunctivitis Anorexia Constipation Incontinence Urinary frequency Anemia

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Weight loss Arthralgia Coughing Dyspnea Rashes Falls

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Stroke Heart failure

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Explain the drug doesnt cure Alzheimers disease but may improve the symptoms. Tell patient to take with or without food Tell patient to report adverse effects. To avoid possible interactions, advise patient not to take herbal or OTC products without consulting prescriber.

BRAND NAME: Aricept

USUAL DOSAGE/ FREQUENCY: 5 mg once daily, can increase to 10 mg daily after 4-6 wk

USUAL ROUTE: PER OREM DRUG ORDER: 5mg OD

CLASSIFICATION: CHOLINESTERASE INHIBITOR ACTION: Thought to increase acetylcholine concentration by inhibiting the cholinesterase enzyme which causes hydrolysis of acetylcholine. May improve cognitive function in patients with mild to moderate Alzheimers disease.

Mild To Severe Alzheimer Dementia

Contraindicated in patients hypersensitivity to drug or piperidine derivatives and in breastfeeding women.

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Headache Insomnia Nausea Diarrhea Chest Pain Blurred Vision Urinary Frequency Dehydration Muscle Cramps

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Dyspnea Pruritus Influenza

Seizures

Monitor patient for evidence of active or occult GI bleeding Stress that drug doesnt alter underlying degenerative disease but can temporarily stabilize or relieve symptoms. Tell caregiver to give drug just before patients bedtime.

Advise patient to report immediately significant adverse effects or changes in overall health status and to inform health team that patient is taking drug before he receives anesthesia. Tell patient to avoid OTC cold or sleep remedies because of risk of increased anticholinergic effects.