Reference no: EM133423080
Bernard is a 75 year-old man in the early stages of Alzheimer's disease. He often gets confused and does not know what day or season that it is. He is restless during the day and spends most of the day sleeping in his chair. At night he is usually awake and can be found wandering around the house.
He cannot remember if he has had anything to eat all day and often says he does not feel hungry. The fridge freezer is full of ice cream and chocolate bars that he will snack on prior to going to bed. His lovely daughter-in law has been cooking his favourite foods and putting them into frozen dinners for him with clear instructions of how long to warm them up in the microwave. He often cannot remember any more even how to use the microwave and will call his son long distance for instructions every night about how to work the microwave.
The temperature in the house is often too high because he feels cold and will turn the heat up and then cannot remember how to re-set the thermostat. He gets upset if his wife tries to "play around with it" since he is the "man of the house". He cannot remember how to turn the lights or stove off so each night he will go around the house unplugging everything.
He has been losing weight, looks pale and his mucous membranes are dry. His lips are pink and extremities warm to touch and capillary refill is normal. He has a productive cough every morning of thick blood-tinged yellow sputum. He has a puffer for his asthma but refuses to use it because he says that it "makes his food taste like metal".
His wife has to help him with basic daily hygiene care and remind him to brush his teeth, which he will not do unless reminded. Recently he has been having episodes of diarrhea and his wife says it is from him eating too much chocolate.
He is often incontinent of urine but will go to the bedroom sometimes and remove his wet clothing and hide them in the back of the closet. He gets extremely agitated if someone notices that he has been incontinent and refuses to move off of his favourite green chair.
His wife says she thinks he is embarrassed so she just lets him sit in his soiled trousers until bedtime. Recently she has noticed a reddened area on his coccyx area. He has also had a rash on his arms and legs that his wife thinks is from the new laundry soap that she is using.
He has recently lost his dentures and is having trouble eating solid foods. He is blind in the right eye and seems to be bumping into furniture more often. He refuses to use a cane as a "matter of pride" and says he "can walk just fine on his own 2 legs".
During a recent visit from his son and daughter-in law, who is a nurse, they both notice how much his health has deteriorated and make the difficult decision that it is time to find a long-term care facility for him and his wife. Several nursing homes will not take them together as a couple and insist that they would need to be on separate floors due to the fact that his wife is healthy and does not require the same amount of care. Bernard and his wife during this time of trying to find a home where they can be together, spend most of their days just sitting and holding hands and expressing that they do not feel they should have to "get a divorce" just because Bernard needs additional care.
Eventually, a beautiful private retirement home is found that does recognize that the need for "sexuality and intimacy does not decrease with age"......and so Bernard and his "favourite wife" as he calls her get to live happily together.... until his life comes to an end. After multiple strokes, he passes peacefully away with his wife and son at his bedside.
Developing Care Plans
Think about Bernard and his health conditions. What needs are affected by his situation? How can you use the content studied so far in this course to help you have a better understanding of Bernard, his family and the nursing care he would benefit from to optimize his health?
We will explore and discuss in class how the nurse can help meet his priority needs (what are they?) and recognize how the interrelationships of the needs impact Bernard's story.