Need help with Short & Long Term Goals in Dementia Clients

  1. I am having a very difficult time trying to come up with goals for my dementia client care plans. I have a care plan for imbalanced nutrition: less than body requirements and now I need a plan for something other than physiological. My client is:
    ---94 years old
    ---wears glasses but has glaucoma and is legally blind
    ---has hearing aid but does not wear and can only hear if you speak directly into her left ear
    ---poor short-term memory
    ---disoriented to time & persons (intermittently)
    ---extreme fatigue--only wants to go to bed & sleep
    ---pressure ulcers on feet
    ---confined to wheelchair
    ---sometimes very agitated/sometimes very pleasant
    ---recent shoulder injury & pain
    ---urinary & bowel incontinence (or just uses diaper because she doesn't want to go to bathroom)
    ---acts out and asks to go home
    I wanted to use either---
    Impaired Verbal Communication R/T sensory challenge involving hearing & vision (or)
    Deficient Diversional Activity R/T sensory limitation (or)
    Anxiety (moderate) R/T move to nursing home
    I do not know what some very simple & reasonable short term and long term goals for this client could be(or any of the dementia clients I have had so far). I would really appreciate it if anyone can give me some ideas of realistic goals for my client.

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    About NewRN1Student

    Joined: Mar '09; Posts: 3
    from US


  3. by   netglow
    Hard to do these without meeting the patient.
    ... could try care animal visit (good for sensory stim. and reminiscence if had pets) this was a hit for my pt.
    ... could try just plain giving of self... try to have her reminisce on any topic, but keep it chatty, like vacations, grandkids, don't get too deep as you want to bring her out not have her withdraw. Sometimes you will get a lot of info that makes it then clear what your patient needs. Most LTC staff never have the time to just talk of course, and if no family visits these people decline fast and become miserable, just spending time with them is huge. If its a male, they like to talk about what they've accomplished in life, be very interested, they need that.
  4. by   Silverdragon102
    Moved to the general nursing student forum
  5. by   NewRN1Student
    Thanks for the suggestions. Those do sound like good interventions. I seem to be having trouble with actually wording any GOALS though. Any suggestions? I have only been working with client's a couple of weeks and all 4 of my client's have had dementia. This one is worse than the others plus has the sensory problems. I'm afraid that we will be out of the nursing home before I really learn how to come up with reasonable goals for these clients.
  6. by   netglow
    I'd suggest hunting down in your nursing dx book.

    ... powerlessness
    ... coping
    ... trust issues related things

    Lots of the crabby stuff is physiologically based, but lots is psych based... You are looking for "little glimmers" as success here. So if the patient senses contentment, or being acknowleged, or trust in you, that is a lot. If you are able to get them to spend even 10 minutes talking about an interest of theirs, you might notice less agitation, or being more aware of surroundings/people as evidence. Takes patience and time. Often it is just "giving in" a little, lets say, they would rather have a little nap before lunch and you have to do a full H to T, know this, and tell them that you know that works best for them and so you'll plan for that...
  7. by   Daytonite
    post #157 on this sticky thread gives you all the direction you need to write goal statements: CAREPLANS HELP PLEASE! (with the R\T and AEB)
    - careplans help please! (with the r\t and aeb)

    impaired social interaction r/t disturbed thought processes secondary to dementia aeb acts out inappropriately at group activities, poor short-term memory, disoriented to time & persons, emotionally unstable, fatigues easily and has hearing impairment.
    • goal: by ___ patient will participate in (daily/weekly) ____ group activity by sitting still and listening attentively. (you choose the group activity that is appropriate for this patient - if it is only that the patient sits quietly and makes no outbursts, that is a goal for him)
    • interventions:
      • assess his behaviors
      • interventions to get him ready and to the activities, positions him where he won't disturb others, have someone with him to encourage or watch his responses
      • supervise him
      • contact the doctor for a psych consult, if necessary (he may need medication to help control his emotional outbursts)
  8. by   NewRN1Student
    :typing Thank you so much for the help. I am so glad I found this Nursing Forum. I start reading all the great posts and all of a sudden the time has gone by and I haven't done my work--but learned a lot. I hope that someday I will actually know something so I can help someone else. Thanks Daytonite for the goal. This gives me a different way to think about setting goals. I will also read the other postings you mentioned. I sure do appreciate all the help!