Reference no: EM133676167
Giani is due for discharge home from hospital following his total knee replacement on Friday, 3 days after his operation. The evening before, Jay arranges to pick up Giani from the side of the ambulance bay at the hospital at 10 am. Giani completes his discharge and heads to the meeting place. Jay does not arrive at 10 am. Concerned he won't be able to stand for long, Giani calls Jay to see how far away he is and finds that Jay is in the middle of making scones for morning tea with the next-door neighbour. Jay has no recollection of the arrangement to collect Giani. He says he thought Giani was not due for discharge for several days. Giani elects to catch an Uber home, rather than rely on Jay.
Giani has noticed that Jay has become more forgetful than usual. Initially Giani had put this down to the stress of opening the new business and the long days involved. He had thought Jay just needed a break and a good rest. When Giani arrives home, he finds Jay has forgotten the scones which are now burnt in the oven. Meanwhile, Jay is outside weeding their vegetable garden.
The following afternoon when Giani is due to see their GP for review of his knee wound, he suggests to Jay he should also see the GP about his forgetfulness. Although Jay is quite reluctant, Giani books the appointment and convinces Jay to see the GP as they are going there anyway. As Jay parks his 1964 Rover, he has a minor accident with another patient exiting the car park. He becomes irate, yelling and accusing them of backing into the front of his car. Giani took several minutes to calm Jay down and thought maybe this uncharacteristically short temper was one of his symptoms.
The GP, their long-time doctor, listens to Giani's concerns about Jay. The doctor sees that Jay is still emotional from the car incident and asks Jay whether he has noticed other changes in his mood or his usually calm demeanour. Jay admits he has been a lot more irritable lately and sometimes becomes anxious about the smallest things. The GP explains these could be behavioural symptoms of dementia and notes the impairment of ADLs (activities of daily living). He undertakes a series of tests and begins the initial steps for cognitive assessment, including a mini-mental state exam, and is alarmed at the results. He tells Jay and Giani to return 3 days later for another appointment and for more testing. It is apparent Jay has been masking his symptoms for a very long time.
1. How might a diagnosis of dementia change personal relationships?
2. A diagnosis of dementia is life changing. How should clinicians break life-changing news to patients?
3. What is the role of the Registered Nurse within the aged care assessment team (ACAT) in the case of a dementia diagnosis?
4. How would other health professionals be involved in the diagnosis, care planning and treatment?