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Peter Dawson, an Aboriginal elder, is a new resident at Beachwood Aged Care. He had been finding managing his daily activities more challenging and his family had concerns for his safety. He has been diagnosed with multi-infarct dementia. As with many indigenous people, he also suffers from cardiovascular disease – atherosclerosis and hypertension. He as a daughter who comes to see him 2 or three times per week. She is supportive and is involved in Peter’s care planning. She holds the authority to make health decisions on Peter’s behalf if he becomes unable to make his own informed choices. Although he is frail, he is able to manage his personal care with only prompting to remind him to perform daily hygiene routines. He is talkative, enjoys playing cards and sharing stories about his life and culture. He has settled in well to his new surroundings and has made his room pleasant and homelike with photos of his grandchildren, tributes to his favourite football team and some amazing aboriginal artwork. Upon admission, The RN performed an oral health assessment with Peter and assessed his natural teeth and an upper partial denture and concluded his oral health ‘healthy’ therefore a referral to a dentist was not needed. Based on this, the RN wrote up an oral health care plan for Peter as self-managing’. Peter has a good appetite generally and loves sweet foods and often buys chocolates and lollies from the mobile trolley shop each week. He also enjoys his coffee with three teaspoons of sugar with a sweet biscuit regularly throughout the day. He has been a resident now for nearly 3 years. Over the past several months, Peter’s mental status appears to be declining. He is gradually losing weight, has not been as talkative or as interactive as he had been when he first arrived. Staff have been slow to respond to the changes Peter is experiencing and as a result he had not been receiving the increased assistance required to perform his daily hygiene and oral care. You notice he is not eating his normal diet, preferring to stay in his room and has not been drinking much. He has also begun having frequent episodes of incontinence. Peter’s behaviour has suddenly and uncharacteristically changed, he has become confused and uncooperative with staff. He has further declined also with his personal hygiene, and won’t let you help him and often yells at you to ‘get away’ when you try, and he won’t open his mouth for you to inspect his teeth, gums and partial denture. You note the halitosis and the blood stains on his toothbrush. He has strong body odour, from lack of hygiene and you note his pad has dark offensive smelling urine. You have been asked to try to obtain a urine specimen and conduct an oral health assessment. 1. What factors contributed to the rapid change in Peter’s behaviour? 2. Evaluating Peter’s urinary symptoms: What might the observations noted of Peter’s urine, that is, dark and offensive smelling, indicate? What test can you perform to investigate possible urinary tract or kidney problems? Complete the table below that sets out what can be measured in a urinalysis and what an abnormal finding may indicate: 3. What it measures/normal result What it can indicate/abnormal result specific gravity pH protein glucose ketones blood leukocyte esterase nitrite bilirubin urobilinogen 4. The doctor has ordered a MSU for MC&S. What does MSU stand for? Describe the procedure for collecting this type of specimen. Explain how the MC&S testing processes are conducted and the information they provide. 5. Multi-infarct dementia can be classified in two major categories: Large-vessel disease small vessel disease. 6. The “three D’s” of geriatric psychiatric and cognitive changes are delirium, depression, and dementia. Define each term and explain how it is diagnosed.

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