Chapter 29 Care of Individuals With Neurocognitive
Chapter 29 Care of Individuals With Neurocognitive DisordersLinks to an external site. Pat is an 83-year-old retired nurse who was diagnosed with major neurocognitive disorder 3 years ago. Her other diagnoses include hypertension and osteoarthritis. She had a hip replacement 6 years ago and also has pain in her shoulders and knees from the osteoarthritis and some limitation of movement that affects her mobility. She lives with her daughter who has brought her to the clinic for a medication check. Her daughter tells you, the nurse, that things have not been going well. Pat has been verbally and physically abusive to her when she tries to bathe and dress her. She hits her and screams “You’re hurting me.” The daughter says that her mother was a very fastidious person and always wanted to look nice so she can’t understand why she resists bathing and dressing. The daughter tries to give her mother a shower at least every other day but the battles have gotten so bad that she hasn’t been able to keep this schedule. The daughter tells you that her mother never took showers, preferring either a tub bath or sponge bathing at the sink. However, the shower is more convenient for the daughter and her mother cannot get in the whirlpool tub at her house. She is concerned over her mother’s appearance and deeply hurt that her mother has been so mean to her. Her mother has been a lovely woman and never acted like this before. She asks you what she can do and if her mother needs tranquilizer. What would you recommend? No, you do not recommend drugs. Chapter 31: Common Legal and Ethical Issues Mrs. Henry, 87 years old, is admitted to the medical/surgical floor of a community hospital with a fractured right orbit and ruptured eye globe. Her husband attends to her with care and concern, trying to anticipate her needs. He is active and appears much younger than his stated age of 85. The emergency department report states the cause of the injury as “fall at home.” Although Mrs. Henry is alert and oriented, she appears very thin, frail, and withdrawn. Her husband also voices concern that she seems confused at times. When the gerontological clinical nurse specialist arrives to do a basic intake, she reports to the nurses that she is concerned that Mrs. Henry has been abused. Her husband answers all the questions posed to his wife, and, as he does so, Mrs. Henry seems to withdraw even further from both him and the staff. Mr. Henry does not leave his wife’s side for hours. Finally, he leaves for a quick cup of coffee, and the nurse who had been providing care quickly goes into the room and asks Mrs. Henry what happened. She begins to cry and says that her husband hit her. She is immediately offered shelter and protection. She declines, saying that she has nowhere else to go but back home and that she will be okay. The husband returns to find the nurse talking to his wife privately and immediately gathers up her things, and they leave the hospital against medical advice. What are you legally mandated to do?
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