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Evidence Informed Decision Making and Care for Dementia Patients (Case Study Sample)


NURS 1067 – Evidence Informed Decision Making Assignment
The purpose of this assignment is for students to learn to apply and value using current, relevant evidence to inform their nursing practice.
RNAO BPG on Delirium, Dementia and Depression: Assessment and Care (2016)
Case Study 6 – Ms. Patel
The RPN is working on a Medical-Surgical Unit and has noticed that they have been receiving residents from Nursing homes more regularly with a diagnosis dementia. The RPN notices that these residents with dementia often display responsive or aggressive behaviours because they are in an unfamiliar environment with unfamiliar faces. The RPN does not feel confident or comfortable in caring for clients with dementia. Today the RPN is assigned to Ms. Patel, a 72-year-old patient with dementia that has a bladder infection which requires IV antibiotics for one week. The RPN decides to refer to the Practice Recommendations on Dementia to enhance his/her knowledge and skills in caring for this patient with dementia.
Looking at the Practice Recommendations for dementia, choose THREE that you could utilize to help Ms. Patel.
For each of these three Practice Recommendations, please complete the following;
a) Describe what the Practice Recommendation entails and explain why you feel this Practice Recommendation is appropriate for this particular client’s situation.
b) Summarize or discuss the evidence which supports each of the THREE Practice Recommendations.
c) Describe how you would apply each of these THREE Practice Recommendations to this particular client’s situation.
d) Demonstrate evidence of Reflection or insight about what you learned from these Practice Recommendations or this RNAO BPG and how you might utilize this learning in your future practice as an RPN.
The following format is required for this assignment;
1. This assignment should be 3-4 pages in length, typed, double spaced, 12 font Arial.
2. Please use the following subheadings in your paper;
a. Practice Recommendations
b. Evidence for Practice Recommendations
c. Application of Practice Recommendations
d. Reflection about Learning – one paragraph overall about insight you gained from this assignment
3. Please ensure to include a Title page which clearly identifies which Case Scenario you have been assigned.
4. Follow APA format (7th) edition which means citing the specific RNAO BPG in text and in the Reference list at the end.


Case Study 6- Ms. Patel: Evidence-Informed Decision-Making Assessment and Care for Dementia Patients
Authors Name
Author Note
Case Study 6- Ms-Evidence-Informed Decision-Making Assessment and Care for Dementia Patients
Dementia can be defined as a disorder in the brain that impairs learning, memory, and cognitive functions. Based on the current nursing practices, the following practice recommendations are relevant to patients suffering from dementia.
Practice Recommendations
The Registered Nurses Association of Ontario (RNAO) advises on the use of recommendation 1.5 that states, “Exercise caution in prescribing and administering medication to older adults and diligently monitor and document medication use and effects, paying particular attention to medications with increased risk for older adults and polypharmacy” (p.41) to patients suffering from dementia.
The second practice recommendation based on RNAO advice the use of recommendation 6.2 that state, “Assess the physical, functional and psychological status of older adults with dementia or suspected dementia, and determine its impact on the person and his/her family/ care partners using comprehensive assessment or standardized tools” (p.56).
The third practice recommendation is based on RNAO advice on the use of recommendation 6.3 that states “Systematically explore the underlying causes of any behavioral and psychological symptoms of dementia that are present, including identifying the persons' unmet needs and potential triggers. Use an appropriate tool and collaborate with the person his/her family/care partners and interpersonal team” (p.56).
Evidence for Practice Recommendations
Recommendation 1.5 suggests that Registered Practical Nurse (RPN) should use medication prudently on older adults suffering from dementia. Inappropriate medications have high risks of side effects on dementia. The RNAO panel also recommends that the health care providers should utilize both the Beer and STOPP/START criteria to reduce polypharmacy and potentially inappropriate medications. The RNAO panel recommends that RPN should carefully review all medications to be used in the treatment and care of older dementia patients, in cases dealing with polypharmacy the RPN require the intervention of a pharmacist review and lastly it recommends that the appropriate treatment using medication should begin with the least intrusive to the most intrusive intervention (NICE ,2012).
The RPN should also evaluate the metabolism of medication and how it interacts with other medications. Appropriate medication should consider the health conditions of patients and the physiological impacts it brings to the body (Trangle et al.,2016). Based on recommendation 1.5, the RPN should also weigh on the benefits of the pharmacological approach versus its harm.
Recommendation 6.2 based on RNAO entails the assessment of dementia as an important aspect in understanding adult patients. The assessment should be done by an RPN to evaluate how the condition affects the patient, the affected family, or the caregivers, the assessment information is very important in the diagnosis and determination of the best care plan and support (Development Group, 2010).
The practice recommendation advocates that the RPN should assess both the psychological, physical, and functional status of an adult patient suffering from dementia. By utilizing assessment tools which include; the mini-mental status examination, Montreal cognitive assessment, and Mini-cog, RPN can be able to capture both psychological, functional, and physical abilities of adult dementia patients (U.S. Preventive Service Task Force,2014). Based on the assessment tools, RPN should utilize the strength-based approach that does not dwell on patients’ deficits but rather focus on the remaining abilities to identify the needs of the patient and their goals. Given that family members are a vital aspect of care, assessment on them should also be done to determine how they are coping with dementia as they strive to offer support to their patients.
Recommendation 6.3 based on RNAO entails the understanding of underlying causes of psychological and behavioral systems related to dementia. Behavioral and psychological symptoms of dementia (BPSD) include mood changes, agitation, and disinhibition. Given the impact of these symptoms on the care and family level, an effective management plan should be put in place. Ineffective management can impact the family negatively, overuse of medication, and also lead to depressive isolation symptoms (Livingston et al.,2014).
Assessment of BPSD can be done on two approaches, the first approach is based on functional analysis that entails assessing the behavioral changes with an aim of the intervention. The approach is the best method as an alternative to the pharmacological approach in addressing agitation and aggression. The second approach is dementia care mapping that entails noting the factors that promote the well-being of patients and which environment triggers behavioral changes. The approach promotes long-term care for agitation in dementia (Livingston et al.,2014).
Application of Practice Recommendations
Ms. Patel a dementia adult patient with demonstrated cases of BPSD requires IV antibiotics for her bladder infection, As an RPN I should be able to assess how the antibiotic will be metabolized in the body and assess its impact with regards to her condition with the help from a pharmacist. To cope up with dementia patients, as an RPN I should be able to apply the recommendation 6.2 and come up with a strategy in coping up and also a care plan for support in handling Ms. Patel. To understand the underlying causes of agitation and aggression in Ms. Patel, utilization of Mini-cog and mini-mental status examination in

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