Comprehensive Assessment of Patient with Dementia

Vectrexevo · Oct 30, 2011

hi! i am a nursing student and just had my first day of clinicals. i feel kind of thrown into everything and am having trouble devising a plan of attack for day 2!
my assignment is to complete a gordon's functional health pattern assessment (11 categories of health) on a 81 yo male with dementia. he also has chf, copd, sleep apnea, type 2 diabetes, peripheral vascular disease.
i don't really know how to communicate with the patient to get the questions on our assessment form answered. i tried asking the patient some general questions and got only yes or no answers. i am supposed to determine:
how his disease has affected his sexuality (really?!)
what his spiritual beliefs are and if they impact his illness.
what he values most in life.
how he adjusts to stressors
what his erickson's age related developmental stage is.
i am at a loss. i have never had experience with patients with dementia, have limited knowledge about how cognizant the patient is. the staff at the extended care is not helpful, and the instructor just told me to ask questions. i am trying to figure out how to approach these questions/phrase them.
any help would be appreciated :)

how his disease has affected his sexuality (really?!) i have dementia and you want me to remember the last time i got my freak on.... lololol

make stuff up, this is total waste of time... i know, i'm a bad influence. some of the stuff you can get out of your book. the question's i have is do you get to see this pt again? do you have to do your assessment on this pt? what are your peer's doing, maybe you can get ((steal)

xtxrn, ASN, RN · Oct 30, 2011

Hi! I am a nursing student and just had my first day of clinicals. I feel kind of thrown into everything and am having trouble devising a plan of attack for day 2!
My assignment is to complete a Gordon's Functional Health Pattern Assessment (11 categories of health) on a 81 yo male with dementia. He also has CHF, COPD, sleep apnea, type 2 diabetes, peripheral vascular disease.
I don't really know how to communicate with the patient to get the questions on our assessment form answered. I tried asking the patient some general questions and got only Yes or No answers. I am supposed to determine:
How his disease has affected his sexuality (REALLY?!)
what his spiritual beliefs are and if they impact his illness.
What he values most in life.
How he adjusts to stressors
What his Erickson's Age Related developmental stage is.
I am at a loss. I have never had experience with patients with dementia, have limited knowledge about how cognizant the patient is. The staff at the extended care is not helpful, and the instructor just told me to ask questions. I am trying to figure out how to approach these questions/phrase them.
Any help would be appreciated :)

OK....you got the short straw, eh? :)

I agree that the sexuality question is kinda out there :eek:

One thing you can do is ask questions in a yes/no format....no open ended stuff since you're not getting anything anyway :)

Example:

Re: spirituality- Mr. Mayhem, did you like going to church/synagogue/temple/mosque? (pick one....there should be a line on the face sheet of the chart that has 'religion' or 'religious preference' somewhere- so that will help narrow it down) If yes, keep asking questions that he can answer yes or no to.... nothing like "what is your view of spirituality?"... he may not have a view out his window

With things he values- again, check the chart- see if any family members have given any info about him- or look at employment- he's obviously retired- but some charts say what he did.... you can ask some questions about "did you like_____?" "Do you have kids? Do you have grandkids? Do you like to visit with friends?..... easy stuff. If dementia patients get rattled, they either get agitated, or just make stuff up. (my mom did that- and usually wanted to talk to the dog since she didn't ask questions :rolleyes: ).

With the developmental stage, you're going to need to talk with the nurse/PCT/CNA and see how much help he needs with ADLs.

But the biggest thing is to ask the questions so he CAN answer them with yes or no :)

Good luck. :up:

lizecole · Oct 30, 2011

The question's I have is do you get to see this pt again? Do you have to do your assessment on this pt? What are your peer's doing, maybe you can get ((steal)

I do get to work with the patient, for two more days. I have to complete the assessment, and then write a care plan for either Risk for impaired skin integrity, or Impaired skin integrity. I can't really make stuff up because we are the 4th group of students to work with these patients, so my teacher has already read 3 assessments on this guy. I don't want it to be incongruent.

I am trying to devise a plan of attack for my next clinical day, so I don't feel quite so overwhelmed! Thinking about how to get a completely immobile guy up and into the shower is scary enough! (He has to be transported by an EZ Lift, and is 280#, 5'11")

I definitely have the most challenging patient, everybody else has cute little old ladies that you just have to listen to their stories and encourage them to eat.

@xtxrn, thanks! that's helpful :)

nurseprnRN, BSN, RN · Oct 31, 2011

if you got the most difficult patient, be thankful-- your instructor sees potential in you and will be willing to assist you reach it. seriously. you will see a lot of patients in your career who will be unable or unwilling to tell you much, and this is the first step in learning how to observe, collect data from other sources, and make nursing judgments on what you learn. and how to keep on observing, being creative in your ways to observe, and more. we all get there.. you're just starting. congratulations.

as to the formerly snarky remarks about sexuality in an 81-yr-old, even c dementia, you'd be surprised. my sweet husband is 76, and without giving tmi, we are quite content with our marital relations. we have every expectation of continuing for as long as we live, goddess willing. :heartbeat we do get a kick out of the reactions we get from teens and twenty-somethings if we stop at the beach for a long slow smooch. "ooooh, yuck, old people kissing!" they have nooooo idea (insert lecherous smilie here- is there one?). sexuality does not stop after (insert your particular prejudice age or medical diagnosis here). when do you think you'll lose interest? never let your own prejudices or preconceptions get in the way of seeing your patient's life in its own right.

i had students in a snf and got the same eye-roll from one when i told her, yes, you have to ask about that in your nursing assessment. i lurked outside the room while she girded her loins to figure out how to ask the question. i was actually not too unhappy at all with her solution: "ummm, how old do you think you have to be before you stop thinking about sex?" she was astonished at the answer, from an 84-yr-old: "you'll have to ask somebody older'n me."

this prompted a very enlightening discussion in postconference about sexuality throughout the life span, with the added perspective from classmates of several different decades. sometimes demented people become a bit more disinhibited and this increases their sexual feelings-- or at least their expression of them. this could be delightful, embarrassing, or intrusive, depending on the target audience; nursing will help families, other residents, and themselves deal with this.

LadyinScrubs, ASN, RN · Oct 31, 2011

Sexuality and getting older and/or sexuality in pt with AD - I had to laugh. Last week I had to do some quick foot wornk with a AD client who originally was from Italy and consideres himself an Italian lover. As I was about to leave was able to get between me and the door. He was not a threat and I had to chuckle. He believed he was still a 30 years old and had the body and sex appeal that went along with the age.

Pts with AD have go through various stages until they die. Before they enter into the last stages of AD (in which they will forget everyting), the pt's social/ mental social governor is not working. They can ask, say, and/or do many things, which can include sexual related needs/activities.