Reference no: EM132847720

In the winter after his visit to the gerontologist, Mr. Wallace begins experiencing increased agitation and wandering in the afternoons and evenings. One afternoon at the adult day care center, Mr. Wallace slips out the door undetected. By the time the day care providers realize he's gone, he has left the grounds and is wandering the neighborhood. The day care providers call Ms. Wallace and 911, and a search for Mr. Wallace commences. Ms. Wallace and two police officers find Mr. Wallace 2 miles from the day care center. He has no idea where he is or how he got there. He has taken a fall, and his face and hands are covered in scrapes.

• The officers radio for an ambulance as Ms. Wallace attempts to talk to Mr. Wallace. He panics because he does not recognize his daughter, and he pushes her to the ground. He then throws punches at the officers when they prevent him from running away. The paramedics arrive and restrain Mr. Wallace. Once he is restrained, Ms. Wallace is able to calm him down. He is then transported to the emergency department, where you are the admitting nurse.

• Mr. Wallace is calm upon his arrival at the hospital, and you are able to treat his injuries without incident. You attempt to speak with him, but he indicates he is tired and promptly falls asleep. You use this opportunity to interview Ms. Wallace. She states that aggression has become common during her father's increasingly frequent periods of confusion. Sometimes he doesn't recognize her; other times, he mistakes her for his sister. He is also increasingly unable to use basic objects-such as pencils, toothbrushes, and combs-and relies on Ms. Wallace for many basic ADLs. In addition, he occasionally experiences urinary and fecal incontinence. Ms. Wallace is shaken by the day's events and the situation in general, and she begins to cry.

• When Mr. Wallace's gerontologist arrives in the ED, you inform her of these developments. She adds 20 mg of buspirone (BuSpar) three times daily (tid) to Mr. Wallace's treatment regimen to lessen his agitation and aggression. The doctor also tells Ms. Wallace that Mr. Wallace is starting to transition from moderate to severe Alzheimer disease, and she recommends that Ms. Wallace begin looking for a nursing home that specializes in the care of individuals with this condition.

Discussion 1: What are the priorities for Mr. Wallace's care to decrease his risk of wandering and injury during his remaining time at home?

Discussion 2: What independent interventions can you perform to address the caregiver role strain felt by Ms. Wallace?

Discussion 3: What additional information or education do you anticipate Ms. Wallace will need in light of the doctor's recommendation?

Discussion 4: Which of Mr. Wallace's symptoms indicate he is transitioning from moderate to severe AD?

Discussion 5: What steps can Ms. Wallace take at home to lessen the incidence and severity of Mr. Wallace's sundowning episodes?

Discussion 6: Why is it important for Ms. Wallace to find an institutional care situation for Mr. Wallace now rather than waiting until he reaches a more severe stage of AD?