James is a 74yo Caucasian retired Federal

James is a 74yo Caucasian retired Federal Magistrate with English ancestry. He was formally diagnosed with dementia two years ago and had previously overcome prostate cancer following prostatectomy, radiation and chemotherapy. He lives in his home with his wife Trish. They have 4 adult children. A son, Sam, who lives in London, a daughter, Sally, who lives in Sydney, and another in Melbourne, Jenny. Their youngest daughter, Jo, lives two streets away with her husband David. James and Trish have a Labrador called Lucy whom James is very attached to. Their daughter Jo also has a Labrador, Milly, close in age to Lucy. James loves to walk to the local shops daily and go out for dinner with family and friends. One of his closest and best friends also lives two doors down from him. James and Trish still drive and have a car each. Trish has Type 2 Diabetes and is on insulin. Jo is a Registered Nurse and David used to be an Army medic and is now a Paramedic with St James. They are very involved in Jo’s parents’ life. They see each other most days. David walks the dogs usually twice a day and James and Trish “babysit” Milly when Jo and David are at work. rior medical history reveals that James has sleep apnoea. He has trialled multiple CPAP machines and finally purchased one but does not like it so he does not use it. He wakes up around 10am, does not go to bed until late (usually around 11pm or midnight) and has multiple naps during the day. He thinks that is normal for man his age and is quite happy how things are currently. Additionally, James has been experiencing back pain for quite some years. When Jo suggested he go to the physio, he refused to continue going stating “it costs too much money”. Jo had been noticing a further decline in her father’s cognition for quite some time. He has been getting increasingly forgetful and he gets irritable when Jo points this out to him. When she tried to speak with her mother, Trish would deny any issues with James, stating that Jo is overreacting. Both Trish and James became quite secretive about their health conditions and any interactions with doctors. By accident, Jo found out that her father had undergone an MRI. She was very upset and demanded to find out the results. Everyone kept brushing her off and inadvertently, her husband David slipped up and it became obvious that he knew more than he had told his wife. Jo was upset at figuring out that everyone was “keeping her in the dark”. She tried to contact her siblings to discuss the matter. Her sisters could not identify any issues with their dad. Even when all the children and grandchildren visited over holidays, her siblings stated they could not see any difference in their father’s behaviour. Trish even complained to her other two daughters that Jo was being intrusive and treating James “like a child”. Sally tried to tell Jo to maybe back off a little which Jo did not take very well. James tends to walk some. James tends to walk somewhat fast but refuses to use the walking stick he was told to, stating “it’s only for old people”. However, on his way to the supermarket last Tuesday, James tripped, fell and hit his mandible over the curb. He fractured it in three places. As he was close to home, both his daughter and wife were called and attended the scene. An ambulance was called. His initial observations were: HR is 101 -regular RR: 23 SpO2: 98% BP: 154/90 T: 36.9 GCS: Fluctuating 13-15. James was transported to a local hospital by St James Ambulance. Initially, he was so swollen that doctors could not intubate through the mouth and had to go through his nose. James underwent maxillofacial surgery, and his jaw was wired for three weeks. When in hospital, and before he could be discharged home, the family had to learn how to care for the metal plates in his mouth (similar to braces) requiring daily adjustments and care of elastic bands. His wife, Trish, was quite overwhelmed and Jo was required to be the second “carer” for this. James was in a rehabilitation centre for 6 weeks prior to discharge home and remains somewhat unsteady on his feet with a shuffling gait. On discharge from rehabilitation, James was on the following medication: Perindopril – 4mg/OD Mane Rosuvastatin – 10mg/OD Mane Paroxetine – 20mg/OD Nocte Esomeprazole – 20mg – OD Mane Paracetamol – 1330mg – TDS Temazepam – 5mg – PRN In addition, he takes some vitamins and supplements that Trish gives him just to keep her happy. James was discharged home three days ago. He ignored everyone’s advice and decided to go the local shops without using the Zimmer frame he was given in hospital, only taking his walking stick. Halfway to the shops he become overwhelmed and appeared confused. He was walking in circles, muttering to himself, looking for somewhere to sit. A passer-by assisted James and called an ambulance, and he was transported to the local ED. Address the following questions from the perspective of your role as a:A student RN in ED. Formulate 5 Nurse-led – a. Interventions b. How to monitor these interventions c. how to evaluate them What is James’s locus of control Identify all the stakeholders Which defence mechanism(s) does James use? .Where does James to be at on the transtheoretical model of change and why?

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