Mr. A is an 85-year-old man with a history of dementia. He is a resident of a long-term facility. Mr. A’s frequent incontinence necessitates the development of therapeutic communication to facilitate activities of daily living (ADL) care and frequent skin hygiene. The nurse caring for Mr. A for the first time soon learns that talking slowly and softly is the most effective way of focusing the client’s attention and prompting him to follow basic instructions such as turning side to side. The nurse feels uneasy about speaking to Mr. A as if he were a child in some ways. However, the nurse finds that this manner of speech keeps Mr. A calm and that he responds well to praise and compliments and that he is very helpful to the nurse in assisting with his own care.

On the second day of caring for him, the nurse notes that Mr. A is more agitated and needs frequent reorientation regarding where he is. The nurse needs the assistance of another person to hold Mr. A’s arm steady while  assessing his blood pressure since Mr. A keeps pulling his arm away yelling “no.” At one point in the day, Mr. A tells the nurse, “There was a little boy in the room a minute ago. Where did he go?” The nurse knows there was not a little boy in the room, but does not know how to respond. The nurse ignores Mr. A’s comment and redirects his attention to what is on television. When saying good-bye to Mr. A at the end of the second day, the nurse is disappointed that Mr. A does not seem to recognize the nurse or  remember that the nurse has been caring for him for the past two days. The nurse is saddened to see him so confused and is emotionally exhausted after two days of responding to his frequent changes in behavior.

Questions.

1. The nurse caring for Mr. A overhears another nurse state, “Well, of course he is confused. He is 85 years old.” Describe how should Mr. A’s nurse respond?
2. Discuss the main characteristics that define delirium and dementia. Compare and contrast the principal difference between the diagnoses of delirium and dementia?
3. Describe priority care strategies for caring for this confused client: validation, redirection, and reminiscence.
4. Explain the main reason why Mr. A may state, “There was a little boy in the room a minute ago. Where did he go?” Which of the above strategies (in question 3) would be most effective in responding to his statement?
5. Identify three nursing diagnoses appropriate for Mr. A’s plan of care?
6. Discuss four key importance of nonverbal communication when communicating with a person who is confused and agitated.

Points to consider: Co-existing conditions Urinary incontinence

Pre-existing condition: Progressive dementia over the past seven years

Socioeconomic: Lives in a long-term care facility; wife passed away five years ago; he has no children