Chapter 23 – Neurodegenerative Disorders “It is

Chapter 23 – Neurodegenerative Disorders “It is so hard to watch…He was lost to me so long ago!” Helen’s husband Sam had been slowly dying over a period of about 5 years from Alzheimer’s disease. As it progressed, he began to have what are called “behavioral disturbances.” He lashed out at those around him one moment and was affectionate the next. This was especially painful for his wife. During brief moments of lucidity, he would kiss her and tell her how much he loved her, but moments later would physically hurt her in some way. Most of the time he was completely disoriented, and the nurses caring for him charted Sam as “disoriented ´ 4” (person, place, time, and situation). After a long and steady decline in cognitive and functional ability, one day he simply stopped eating and drinking and he began to fail rapidly. We all knew that death was imminent. His wife carefully shared that while she was glad for him that he would no longer suffer, she whispered, “and it will bring an end to my suffering as well, is that terrible to think that??? He was lost to me so long ago…” If you were one of the nurses caring for Sam, how would your plan of care change over time? What strengths has Helen brought to the situation? Chapter 24 – Endocrine and Immune Disorders “There is nothing wrong with me, I am just a little tired!” Ms. P., an 82-year-old single woman, lives in a life-care community in her own apartment and has the reassurance of knowing her medical and functional needs will be taken care of, regardless of the extent of these needs. She is at present independent. She has been gaining weight steadily since she moved into the community and attributes that to the fact that she eats much better now that she joins others in the congregate dining room for meals. She has heart failure, mild arthritis, and diabetes, which she manages with diet, exercise, and oral medications. Although she says she feels fine, lately she has noticed some increased fatigue and that her toes are cold and somewhat numb. The great toe on her left foot seems to be discolored. Because of the lack of feeling, she often walks around her apartment barefoot because it seems to increase the sensation in her feet. She has not needed to use the health care center and goes to the clinic only to pick up her medication. Her niece stopped by last week to see her and called the clinic and spoke with the nurse. The niece reported that her aunt seemed a little confused and lethargic. The niece accompanied Ms. P. to the clinic, where the nurses checked her blood pressure and blood sugar and found them to be 170/80 mm Hg and 280 mg/dL, respectively. Ms. P. said, “Oh, I don’t think it is anything to worry about! I am just a little tired.” Of all of the symptoms that Ms. P. reports, which one should the nurse be most concerned about related to Ms. P.’s long-term health Of all of the symptoms that Ms. P. reports, which one should the nurse be most concerned about related to Ms. P.’s ability to live alone? Ch 25 – Respiratory Health and Wellness Has Mrs. Chu Been Undiagnosed? One of your assigned patients in the acute care hospital where you are working is being prepared for an elective hip replacement due to long-standing arthritis. In your assessment, you find that Mrs. Chu seems to become slightly short of breath when she is speaking. This had been attributed to her advanced age and heart disease, even though her heart disease is well controlled at the time. As you gently proceed in your assessment she admits that she has a cough that seems to “come and go a lot” and that she is no longer doing many of the things she used to do because she is easily fatigued. When you inquire she tells you that she was a heavy smoker but that was “many years ago.” What is your nursing priority in caring for Mrs. Chu at this time? Are end-of-life topics appropriate when caring for someone with COPD?

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