Posted at 10.28.2018
For the purpose of this assignment the writer will provide an example of a patient; referring to her as Mrs. A, as the NMC says that we must respect individuals to confidentiality (Nursing and Midwifery council 2008). Mrs. A can be an older patient who has received a prognosis of vascular dementia.
Mrs. A is a 65 calendar year old lady that lives with her 68 year old sister. Mrs. A is a widow and has no parents or children of her own, giving her sister as her only immediate family. Over the last 30 years, Mrs. A co-owns and works in a successful card shop around with her sister. Ever since she was diagnosed with vascular dementia three months ago, Mrs. A begun noticing that her ram was deteriorating and she was beginning to weary in activities she had once loved. As a result of this, she decrease her hours at the shop from 5 days a week to 6 hours break up over 2 times. Mrs A found this particularly difficult as she experienced worked in that shop for over 30 years. Mrs A was previously a very unbiased woman and got take great pride in in her self-reliance. Previous to her analysis, Mrs. A got a good cultural life, with friends and colleagues a major emphasis in her life, but scheduled to her deteriorating memory space and feeling swings, Mrs. A has found retaining these fundamental romantic relationships more and more difficult. Mrs. A was referred to an area nurse after her sister brought her into their GP surgery carrying out a first-degree burn up to her hand. Mrs. A's health background included a long background of hypertension credited to 20+ years to be a heavy cigarette smoker and one prior Transient ischaemic problems (TIAs'). Ahead of her stop by at the GP, Mrs. A have been receiving minimal support regarding her vascular dementia medical diagnosis as it was regarded as in the "early stages".
Dementia is the word used to determine a number of symptoms that adjust the way the brain functions. These medical indications include, memory loss, issues with communication, compromised reasoning and difficulties with undertaking day-to-day activities. Dementia impacts just how somebody's brain works, therefore resulting in behavior which can prevent their ability to live a life separately and can also have an impact on social associations (Martin 2006).
Dementia is one of the most typical neurological conditions among the elderly in the western world. It is estimated that in the UK by themselves, there are 820, 000 people coping with a analysis of dementia, with the average age of starting point being over the age of 65years. However, additionally, it may develop in more youthful people where it is recognized as young - onset dementia (Alzheimer's Research Trust, 2010).
The type of dementia that will be discussed in this project is vascular dementia. Researchers have discovered that vascular dementia is the next most usual form of dementia after Alzheimer's disease, accounting for 20 to 30 per cent of instances. Vascular dementia is defined as a "disease with a cognitive impairment resulting from cerebrovascular disease and ischemic or haemorrhagic brain harm" (Nazarko 2011). Based on the Section of Health (2009), vascular dementia is the term used to describe a number of symptoms that lead to a progressive drop in cognitive and storage area function.
The brain requires a sufficient amount of bloodstream in order for it to operate properly (Beart 2007). Vascular dementia grows when the blood circulation that transports air and nutrition to the brain is "damaged by a clogged or diseased vascular system" (Salma 2008). This harm happens when skin cells die because of the fact that the bloodstream no longer has the ability to reach the mind cells proficiently. When there is an disturbance of the blood circulation to the brain, for even the shortest time frame, the distinctive functioning of the cortex - (which is the website in the brain responsible for language, storage area and learning) will be impaired. (Thomas 2001). The consequences and the rate of development in vascular dementia vary from one individual to another. Usually, symptoms associated with vascular dementia get started suddenly, for example after a stroke. Vascular dementia is dissimilar to other types of dementia due to the fact so it "often follows a stepped progression", with symptoms left over the same for a certain time frame and then slowly but surely getting worse (Ouldred 2010). Matching to Stacpole (2011), the following symptoms are typically linked to vascular dementia: visual flaws and misperceptions, seizure, durations of acute confusion, problems with continence and internal symptoms such as apathy. Several medical professionals prefer the term "vascular cognitive impairment (VCI)" to vascular dementia because it is more exact in explaining the fact that vascular thinking changes can range between gentle to severe. (Bamford 2010).
The two main types of vascular dementia are multi-infarct dementia and subcortical dementia. Subcortical VaD occurs due to small vessel disease "causing lesions in the deep white subject of the brain and where in fact the cortex of the brain is usually well maintained". Multi-infarct dementia (MID) is the most frequent kind of vascular dementia. MID is caused by a series of "mini-strokes" - also called Transient Ischaemic episodes (TIA's). (McKeith 2005).
TIA's are known to occur when the blood flow to a particular area of the brain puts a stop to for a brief period of energy. Transient ischaemic disorders are caused by a temporary lack of blood circulation (ischemia) to the mind as well as momentary impairments of awareness or perception; TIAs talk about the same fundamental aetiology as strokes: a disruption of cerebral blood flow but without actually creating any acute muscle death like that within a heart stroke. (Bamford et al. 2004).
A one transient assault or stroke show does not indicate the average person will go on to build up vascular dementia. However, if the average person has or has already established more than one heart stroke, transient ischemic assault, or has been diagnosed with small vessel disease, they may have an increased risk of producing vascular dementia. (Bryans et al 2003).
Risk factors of vascular dementia may include hypertension, atrial fibrillation, hypercholesterolemia, smoking and diabetes (Jolley 2009).
Although vascular dementia is one of the most frequent neurological conditions among the elderly in the western world, the exact cause still remains unclear. Vascular dementia is a disorder that cannot be reversed, the development of the disorder, can however be slowed. Using drugs, along with lifestyle changes to avoid more strokes from happening, can be a powerful way of slowing the development of vascular dementia. (Knapp and Prince; 2007).
The symptoms of vascular dementia are specific to each individual, thus highlighting the need for holistic medical assessment, attention and management. These symptoms may differ from; lack of memory; poor common sense and reasoning; apathy, distress and mood disturbances. (Judd et al; 2004).
There are major effects on the person scheduled to vascular dementia; because vascular dementia cannot be cured, it is known as a long-term neurological condition where the person and family have to come to terms with the initial diagnosis, which may be devastating. Living with a long-term condition has a substantial impact on a person's quality of life and poses particular obstacles for the individuals' members of the family and health-care providers. (Carers UK 2007).
With regards to Mrs. A, the district nurse that got over her care discovered that the identification of vascular dementia had induced her to feel as if she possessed no sense of self-worth, her self-identity have been taken away from her and from here on out there would have to be major lifestyle changes that Mrs. A, her sister and friends would have to abide by. Therefore for Mrs. A to achieve levels of restoration; also to live well in the occurrence or absence of her symptoms; the nurse had to give a major supportive role in the treatment of the lady with vascular dementia throughout this process to optimise her and her people' standard of living. (Keady 2004).
Dementia is a life changing prognosis, and the person and family should be recognized as holistically as you possibly can by the nurse and professional medical providers during identification. (Barber and Murphy 2011 ). Mrs. As' sister and good friends found it very hard to accept this life changing diagnosis especially in regards to her sister, as it proven to cause significant changes in their marriage; research shows the role of "informal carer" is almost never chosen, but thrust after family such as Mrs. A's sister as a consequence of incapacitating illness. (NICE 2006). However because of the bond between the two sisters, they managed to adjust with the support of the nurse and the health care team, and finally came to terms with the improved circumstances. This sweetheart and her family were backed in this change by a recommendation to relevant companies for counselling and other ideal support services.
This was ideal for Mrs. A's sister as she was not experienced in regular caring tasks, and was used to her sister being truly a strong impartial and self-reliant woman. The nurse responsible for Mrs. A's health care recognized this and observed that the sister required guidance and education to provide this health care, which assisted in lowering any stressors for Mrs. A and her sister, and a care of deal being put in place for Mrs. A. (Nain 2006). If indeed they both was not supported at an early on stage, rather than been given the usage of information and support, there might have been results of ill health, and stress for Mrs. A's sister, as well as creating more sick health for Mrs. A herself (Pews 2005).
The nurse also made a referral to local organizations so that Mrs. A's sister would have other people who were going through the same emotions and changes in their lives to talk to. These groups aim to support people living with dementia and those who care for them. By referring her to these support groups, the nurse aided in assisting Mrs. A's sister to keep up some type of freedom and time away from her caring tasks, as recent research shows that family members have a tendency to disregard their own communal life and health, after they become carers (Beart 2008). The nurse performed closely and supervised the girl with vascular dementia, and her family to give a support network, and treat them holistically, thus motivating an most effective environment for the approval of the diagnosis (Roy and Gillespie 2011).
There were also financial implications on the family, because of lack of earnings credited to changes in the Mrs. A's health. Her sister acquired to reduce her hours working in their shop greatly, in order to become a part-time carer. The nurse was supportive, as this experienced a major effect on the family as the sister started to have bouts of stress and stress within this era of change. The nurse helped in these things by referring these to the social work team for advice and guidance on welfare benefits and financial issues; this was a great relief for the two sisters and reduced the amount of financial pressure brought by the dementia diagnosis (Manthorpe and Iliffe 2007).
Mrs. A was given a specific and concise justification of vascular dementia, enabling her to maintain some freedom and enable her to make informed decisions involving her care and attention, where possible. By providing her with usage of relevant information, both during medical diagnosis and throughout the span of the condition, Mrs. A and her family (/friends) experienced as though these were understood and appreciated, this in turn significantly improved the grade of life for Mrs. A, throughout providing her options regarding her own care (Pinner and Bouman, 2003).
In order to provide Mrs. A with ideal health care the nurse noticed that providing continuity of care would be of great gain to her. Continuity of attention offers a patient with an even of trust and understanding, as well as reduction of medical mistakes and neglectfulness (Freemon et al; 2003). Mrs. A found that, having different nurses/ carers and other health care professionals to arrive and out extremely distressing, in the community setting. Finding the same doctor, nurse or carer on each visit can increase patient satisfaction, but however in reality in any professional medical practice or area, any nurse or medical practitioner will see that this might not be feasible at all times and prove to be very challenging. This can be due to lots of reasons such as staffing levels, sickness or holiday seasons (Anticipation 2009). The nurse responsible for Mrs. A's good care aided in the continuity of care to the best of her capacity, by effective case management of the girl and delegating the caseload effectively, and ideal communication with the nurses, communal work and family (Benison 2009).
Once the nurse acquired overcome the difficulties of prognosis and continuity of Mrs. A's health care, the nurse started to notice that at each visit Mrs. A appeared uninterested in something that had been said or that was happening around her. When the nurse had brought up these concerns to her sister and received verification that in-fact Mrs. A possessed lost interest generally in most things during the last couple of weeks; the nurse discovered this sign as apathy in vascular dementia.
Some of the techniques the nurse cured apathy in vascular dementia was to positively require Mrs. A, her family, and carers in the procedure process; this helped to reduce the misconception of lack of interest in any activities proposed to Mrs. A. The nurse also made a decision to educate Mrs. A's family and carer's about apathy; this helped them understand that apathy is not just "laziness" s or Mrs. A being difficult, but that the indication was in reality a part of vascular dementia (Levy et al; 1998). The nurse also guaranteed that other factors that would impact apathy such as; pain, inadequate sleep, disrupted sleep patterns, and exhaustion were managed effectively by using appropriate medication and/or therapy. (Braine 2010).
In final result, this essay has provided an understanding into the aetiology and pathophysiology of vascular dementia, and has described the two main types of vascular dementia, as well as describing how vascular dementia is a neurodegenerative diseases that unlike most kinds of dementia, follows a stepped development, with symptoms remaining the same for a certain period of time and then gradually deteriorating. This essay also demonstrates vascular dementia, can be a devastating and mind-boggling experience, to the individual and their family, and how it impacts the grade of life for the family, and not simply the average person with vascular dementia. Cases on which kind of implications possessing a "carer" role thrust after a member of family, is wearing the family member's self-worth and self-identity are also mentioned by the writer. This article highlights the value of nurturing and aiding the family, and not simply the individual, as a whole, and points out how this can be an incessant task.
One suggestion for future medical practice is made for all dementia training/ education to be implicated universally; this training should not be limited to only mental health nurses as dementia is becoming more prevalent in the western world. This education/ training should convey an emphasis on the importance for the nurse to have tangible interpersonal skills, constantly adding compassion during challenging times such as; throughout medical diagnosis, providing continuity of good care and throughout the many signs and symptoms vascular dementia presents. The nurse should promote patient and family empowerment and become an advocate for the coffee lover both as the NMC code (2009) state governments that nurses have a great responsibility and a responsibility of care; In the course of learning all the above skills, nurses should be trained that providing care and attention to an individual with dementia is very different from providing personal care to the elderly person who has almost all their cognition and comprehends what you are trying to say or do. The intersection of dementia makes even the simplest task a challenge. Dementia treatment is not simply "personal/social attention" only; or attending to hygiene and feeding requirements. Because the truth is it is not comfort but expansion that makes life worthy of living and people with dementia be capable of increase too, given the right treatment and conditions. Therefore, one of the main concentrates in dementia care and attention should be to promote an improved standard of living for the average person with dementia.