The scenario I chose for this exercise is Scenario 1
In this sceario the patient is Mrs. Bryant, an 87 yr old retired school teacher now residing at a nursing home. At first she is evaluated as: pleasant, early riser, friendly and helpful to staff and other residents, enjoys watching birds and being in the garden. Mrs Bryant has three children but only one visits her on a regular basis. Mrs Bryant is also diagnosed with OsteoArthritis, Diabetes and Glaucoma and possibly Alzheimer's. She is on several medications -each a treatment for her illnesses. Mrs Bryant has begun to show a definite change in her pattern of behavior.
The three-step approach indicates that one should Identify, Understand and Adapt to any changes in a patient's behavior.
Identification of the change:
Mrs Bryant has been observed by staff and other residents as being often agitated, crying after watching a movie, wandering-searching for 'a lost child', disturbing the sleep of other residents by knocking at their door at night. Mrs bryant, although aware of her Diabetis, has started to eat inappropiate food-like cookies-and even hoarding them from others. Mrs Bryant has tried to hit a staff member after being confronted with unacceptable behavior. Understanding the reasons for the behavior:
Mrs. Bryant's change in behavior could be a result of medication-interaction. Some of the medications(Like Exelon) may be interfering with her other medications and need to be re-evaluated. The doctor has already recognized that her Diabetis medication needed to be changed but it may now be a source of conflict with the others. Thus, the need for closely monitoring her medical treatment.
Mr's Bryant's wandering, may be related to her need to 'go back' to 'known-familiar surroundings.' In her mind she is aware that where she is, at present, is not where she 'needs to be.' Her search for 'a lost child' may have been triggered by her watching the movie about children earlier. The 'lost child' she is searching for is her own child-whom she remembers but does not understand why he/she is no longer with her.
Mrs Bryant is showing definite traits of someone with Alzheimer's (the wandering, the inappropiate behaviors of hoarding, hitting, agitation, knocking on neigbhor's door at night), therefore, a proper diagnosis needs to be performed so that the appropiate treatment can be given to cope with the progression of the illness.
Adapting to the changes observed The way I would go about adapting to this new changes in Mrs. Bryant behavior would encompass the following: Speak with her physician and provide him/her with details of the current behavioral pattern and suggest a thorough re-examination of her 'probable' preliminary evaluation of Alzheimer's. I would also suggest a close monitoring of her current medications and possible interactions between them.
I would make an appointment with her family and discuss alternative means of keeping 'contact' with Mrs Bryant and her three children-as it appears that she is in a lot of grief over the loss of that contact. The contact could be through letters, cards, photos or telephone calls on a set schedule so that her loneliness is alleviated.
I would share with other staff members anything that I had observed which could shed light on her changes. By that I mean, letting them know that she might enjoy eating sugar-free cookies and how the y may have a 'supply' of those just for her. It would not only allow her to still enjoy a 'sweet' but perhaps stop her hoarding of the cookies from the other residents.
I would suggest making changes to her immediate environment. By that I mean that her room had some reference (wall appliques) of gardens and birds-as she loves both. That might give her the feeling that she is on a familiar environment and distract her attention from 'wandering'
There are many more ways of adapting to her changes which I can give but I think the ones listed above are the ones I would use first.
