Case Analysis And Problems With Dementia Nursing Essay

Case Analysis And Problems With Dementia Nursing Essay Dementia is a progressive and irreversible decline in mental function1. Lewy Body Dementia (DLB) is a form of degenerative dementia characterised by the presence of Lewy Bodies which are clumps of alpha-synuclein and ubiquitin protein in neurons2. These are only detectable in post-mortem brain biopsies2. The manifestations of dementia present themselves clinically as progressive cognitive decline which impairs day-to-day social and motor functioning. This central feature of DLB is essential for the initial diagnosis of the disorder and the initial evaluation of a patient with dementia must establish the presence of cognitive impairment and provide a measure of its severity. Three core features which are significant in the diagnosis of DLB and distinguishing it from these other disorders are2: 1.  Ã‚  Ã‚  Fluctuations in both mental cognition and relative levels of attentiveness. The severity and duration of these episodes vary among patients, however, generally, severity increases with time. 2.  Ã‚  Ã‚  Visual Hallucinations characteristically detailed and well-formed; significant in differentiating DLB from Alzheimers disease as they are relatively rare in the latter disorder. 3.  Ã‚  Ã‚  Spontaneous features of Parkinsonism, such as tremors. At least two of these core features must be present to conclude that there is DLB3. Suggestive features of the disorder include rapid eye movement (REM) sleep behaviour disorder, repeated falls and transient loss in consciousness. In the absence of a core clinical feature the presence of one or more of these suggestive features may help in the diagnosis of DLB. The differential diagnosis for DLB is mainly Alzheimers disease, Parkinsons disease or other dementia syndromes. However, in Catherines case the presence of a number of core and suggestive features strongly indicate DLB. In relation to Catherine, there are many indicators present which qualify her for diagnosis with the disease. Not only does she exhibit some of the core features mentioned previously but it is also evident that she is suffering from some of the more suggestive, but equally as debilitating, aspects of the disease. It is evident on examination that Catherine is experiencing fluctuations in cognition as her verbal responses are often difficult to comprehend and are unreliable. These memory lapses, along with aggressive responses, are known symptoms of dementia2. She has had some vivid visual hallucinations previously which may be a mitigating factor in her continuous falls, another suggestive feature of the disorder2. Catherines husband faces many challenges as her primary caregiver. Caregiver burden is defined as the high levels of stress and anxiety associated with the provision of care to another person suffering from some kind of illness4. Catherines husband is likely to suffer from caregiver burden as he is the sole provider of care and his closest source of relief is his daughter who lives some distance away. He faces challenges in communication and in managing Catherines behaviour and struggles with his own physical fitness while also trying to care for his wife. He is likely to suffer emotionally as result of the demands placed upon him as a result of Catherines unwillingness to avail of respite care services. Catherine presents many challenges to the healthcare system in that she is aggressive towards members of staff with whom she is unfamiliar. This impedes upon the quality of her care as nursing staff appreciate her condition but are unable to manage it on an acute ward. The problems with her memory make interactions difficult as she does not remember her surgical treatment and becomes aggressive and agitated at times. It is likely that as the disease progresses these factors will become more serious and incapacitating, leaving her husband with no choice but to admit her to a long-term care facility. Societal Context It is difficult to quantify the prevalence of Dementia in Ireland and in various countries due to variances in how we define and ration dementia and also due to methodological variances in conducting studies5.  However there remain some factors such as age and gender which show consistencies across studies. It has been found that Alzheimers disease is more common in women, and that prevalence of dementia can double with every 5 years of increase in age6. The Alzheimer Society of Ireland (ASI) estimates that there are currently more than 44,000 people suffering from some form of dementia in Ireland7. It is shown that the prevalence is higher in females than males with 20,000 females and 14,000 males found to be suffering in 2002 and the incidence is expected to increase dramatically in the coming years in correspondence with the aging population in Ireland.  By the year 2036 the ASI estimates that there will be over 100,000 people with dementia8.   Studies have shown there are a number of risk factors associated with dementia. Along with age and gender, genetics and BMI have also been linked closely with dementia. One study found that normal-weight women had a greater risk of developing dementia than women with a higher BMI than them9. It has also been found that those with higher BMI  have  a decreased risk of cognitive decline10. Cholesterol levels have also been linked to the cause of dementia in that high levels of high density lipoprotein have been associated with a decreased risk of Alzheimers disease11. There are a number of known support groups in this country for relatives of patients with  dementia7. For example, The Alzheimer Society of Ireland provides  a range of services to people with Alzheimers disease and other forms of dementia. The Carer and Family Support Groups operate throughout Ireland, usually meeting on a monthly basis7. This support network offers a vital opportunity for carers and family members to share experiences, information and practical advice in a supportive environment and would be of significant benefit in Catherines case to provide her husband with an outlet from the constant pressures associated with her disease. The Irish Government does offer some financial support to people suffering from dementia but it appears not to be enough. There are a number of schemes which provide home care to patients, however a  new report  illustrates that Ireland  spends only half the OECD (Organization of Economic Cooperation and Development)  average on dementia services12 despite the fact we rival any other European Country in relation to the growth of dementia. According to the report for every 18,500 euro cut, four people with dementia will  lose  any service provided by the government12. This would be detrimental in Catherines case as she may eventually rely heavily on the government for support. Healthcare Quality and Patient Safety The treatment of Dementia is focused towards specific disease manifestations as there are no definitive treatments available. To effectively treat Dementia, patients and families should be involved as soon as the diagnosis is made. The availability of information, good health services, and support should be provided to help patients and their families to cope with dementia. The behavioural and psychological symptoms of dementia have been a difficult management area for neurologists and psychiatrists alike. The key to proper management is the correct identification of each symptom and the underlying precipitating cause. The proper management is not only rewarding in terms of responsiveness in an otherwise incurable and progressive disease, but also improves the quality of life of the patients and the caregivers. The management of dementia begins with a thorough assessment to search for underlying causes of behavioural changes. Non-pharmacological approaches should be used prior to medication use. These interventions include music, light, changes in level of stimulation and specific behavioural techniques. The type of dementia, individual symptom constellation and the tolerability of the patient will help to determine what medication should be used13. Cholinesterase inhibitors treatment for people with DLB is commonly used in clinical practice, especially for patients that exhibit neuropsychiatric symptoms. The use of antipsychotics for agitation and aggression has shown consistent efficacy and it is the most studied pharmacological intervention14. Pharmacotherapy must be monitored closely for both effectiveness and side effects, with consideration of medication withdrawal when appropriate. Studies show that anti-dementia medicine neither cure, arrest nor delay the onset of the disease, but are helpful in symptom relief14. There is an urgent need to develop more efficacious medications for the treatment of dementia15 as in the long-term we know that a diagnosis of dementia is a sentinel event that signifies progressive loss of independence and increasing demands on caregivers. In this case, the biggest barrier to Catherine receiving adequate healthcare is herself and the uncooperative and aggressive nature of her condition. Her husband and family cannot fully support her needs therefore she needs to be admitted to a long-term care facility. Her wishes to continue living in her own home may prevent her from getting the care she needs. Also, the fact that her husband must make the decision could be considered a barrier as he is unwilling to put her into long-term care, where the stability may help her. Individualised rehabilitation approaches targeting relevant and personally-meaningful aspects of everyday functioning have demonstrated significant benefits in single-case and small-group intervention studies16. Cognitive rehabilitation is a relatively new approach to improving well-being for people with dementia and their families, but at present only preliminary evidence regarding efficacy is available16. However, this preliminary evidence suggests that cognitive rehabilitation does have the potential to bring about changes in behaviour, enhance well-being and maintain involvement in daily life. Psychosocial interventions of this kind can be provided alongside pharmacological treatment, and it is possible that these two approaches can complement one another to optimize benefits for the person with dementia17. There are a great many questions still to be answered, but the existing evidence provides a valuable basis for further development of this approach. Ethical Considerations There are a number of ethical issues to address in Catherines case. As DLB progresses, it gradually renders people incapable of tending to their own needs, thus their decision-making capacity is compromised and caretakers must step in and make decisions for them. Catherine suffers from dementia and requires constant care. In preventing Catherine from independently getting in and out of bed, several ethical issues are involved. Her caretakers can only effectively tend to her and ensure her safety by compromising her right of autonomy for the sake of beneficence18 i.e. doing this for her own well-being in order to provide her with adequate care. Also non-maleficence18 is a factor in this situation i.e. they must ensure she does not get harmed while moving about unsupervised In Ireland, under the Mental Health Act of 2001, certain conditions must be must be met before someone is involuntarily admitted to a long-term care facility19. Fundamentally The patient must be eligible to be involuntarily admitted The Person sending the patient must send in application for the patient That Person must fit certain requirements. After application, a registered medical practitioner must do an examination on the patient and if he/she is satisfied, he/she writes a recommendation for the involuntary admittance of the patient in an approved centre. Catherine definitely fits the requirements of the patient to be involuntarily admitted as she is actually suffering from a mental disorder20 and her caretakers may be considered unfit to take care of her. While her husband wants to respect her wishes he is physically unable to provide the level of care that she needs, even with his daughters weekly assistance. It is obvious that she requires constant monitoring as evident by her repeated falls. Therefore, after a mental health assessment it is likely that she be recommended to live in such a facility with more appropriate care21. Healthcare providers are only able to advise patients and their family members on the best course of treatment and management plan available, suggesting alternatives are still within their boundaries. However, the final choice always resides with the patient and his/her family members22. Disputes which may arise become a tough issue for health care professionals to resolve, as all circumstances need to be taken into consideration before a decision can be reached23. Word Count: 1989 Search Strategy As part of our search strategy we used resources from the library and those online.   We found books and journals in the library useful for sourcing background information about Lewy Body Dementia. Online we used medical search database, Medline and PubMed. We had to tailor our search criteria to suit the particular section of the report we were writing.   To further refine our search findings we used the advanced search and used the limits option. If our search yielded too few findings, we learnt to change our keywords and to broaden our search area. For example when Dementia is searched PubMed reveals 119494 options, however if dementia AND Ireland is searched 404 results are revealed. To further refine this search we used Limits whereby we limited the findings to trials that had links to the free article online, were in English and were conducted on humans. This searched revealed 60 findings. It is also useful to use sources that have been referenced by other authors and we found that once you found one or two good trials, they usually had referenced some other sources that matched your search criteria. This cut down on the searching through irrelevant articles and proved better use of our time.   All in all we found the internet very useful for sourcing our references and in particular we found PubMed and Medline user friendly once we understood how to use them properly.

Hawkins V Clayton Case Summary

Hawkins v Clayton [1988] HCA 15; (1988) 164 CLR 539 (8 April 1988) High Court of Australia Case Title: HAWKINS v. CLAYTON [1988] HCA 15; (1988) 164 CLR 539 F. C. 88/012 Medium Neutral Citation:[1988] HCA 15 Hearing Date(s): 1987, May 13 1988, April 8 Decision Date:20 June 2011 Jurisdiction: High Court of Australia Before:C. J Mason J. Wilson J. Brennan J. Deane J. Gaudron Catchwords: Negligence – Duty of care – Solicitor – Will held by solicitor – Failure to inform executor of death of testator and of contents – Whether duty to do so – Loss to estate caused by executor's ignorance of death – Measure of damages.Limitation of Actions – Tort – Accrual of cause of action – Running of time – Commencement – Breach by solicitor of duty of care to inform executor of testator's death – Loss to estate caused by executor's ignorance of death – Limitation Act 1969 (N. S. W. ), s. 14(1). Legislation Cited: Limitation Act 1969 (N. S. W. ), s. 14(1) Wills, Probate and Administration Act 1898 (N. S. W. ), s. 150 s. 32 of the Wills, Probate and Administration Act s. 61 of the Wills, Probate and Administration Act Cases Cited: Central Trust Co. v. Rafuse (1986) 31 DLR (4th) 481, at p 521Bowen v. Paramount Builders (1977) 1 NZLR 394, per Richmond P. , at p 407 Central Trust Co. v. Rafuse (1986) 31 DLR (4th) 481, at p 521 Bowen v. Paramount Builders (1977) 1 NZLR 394, per Richmond P. , at p 407 Voli v. Inglewood Shire Council [1963] HCA 15; (1963) 110 CLR 74, at p 85 Midland Bank v. Hett, Stubbs and Kemp (1979) Ch 384, at pp 402-403 Hedley Byrne & Co. Ltd. v. Heller & Partners Ltd. [1963] UKHL 4; AC 465 Marshall v. Broadhurst (1831) 1 C & J 403 [1831] EngR 151; (148 ER 1480) Balch v. Symes [1823] EngR 362; (1823) Turn & R 87, at p 92Aebly's Will (1941) 29 NYS 2d 929, at pp 931-932; affirmed (1941) 31 NYS 2d 664 Georges v. Georges [1811] EngR 446; (1811) 18 VesJun 294 (34 ER 328) Lord v. Wormleighton [1822] EngR 477; (1822) Jac 580, at p 581 [1822] EngR 477; (37 ER 969) Estate of Harvey (1907) P 239 Goods of Shepherd (1891) P 323, at p 326 Hollis v. Smith (1808) 10 East 293, at p 295 (103 ER 786, at p 787) Meyappa Chetty v. Supramanian Chetty (1916) 1 AC 603, at pp 608-609 Ryan v. Davies Bros. Ltd. [1921] HCA 53; (1921) 29 CLR 527, at p 536) Pinchon's Case [1572] EngR 289; (1611) 9 CoRep 86b, at p 88b [1572] EngR 289; (77 ER 859, at p 863)Texts Cited: Sir James Stephen, A History of the Criminal Law of England (1883) Parties: Representation – Counsel: File number(s): DECISION The case of Hawkins V Clayton was the result of a breach of duty by the solicitors of the testator, Mrs Brasier, and to the executor of the estate, Mr Hawkins. The solicitors were in custody of Mrs Brasier’s will and seemingly were not aware of the testators death for some time as they had written letters to her regarding her will in September 1978 and August 1979 with no respo nse.After the commencement of the action taken up by Mr Hawkins, he had passed and his widow and executor continued the action as she had become Mrs Brasier’s executor by devolution. Mr Hawkins and his family had lived with Mrs Brasier as a â€Å"tenant† in her home at Blakehurst, sometime during August 1973 Mr Hawkins and Mrs Brasier had had a disagreement and the Hawkins family had left the Blakehurst house. It was determined that Mrs Brasier had spoken with Mr Hawkins about his appointment as executor but had not confirmed it once the will was written.After August 1973 Mrs Brasier had contact the solicitors to make a new will but had not carried out the changes and the solicitors had not had any instructions from her since. After the death of Mrs Braiser, her nephew, Ronald Lamb had taken up residence in her house and had not paid any rent or maintained the property. Mr Lamb had contacted the solicitors and had represented to them that Mr Hawkins had disappeared and requested payment out of the estate for funeral expenses.Some years later, Mr Hardwick who had been handling the matter had retired and upon the retention of new solicitors from the Executor, had rendered an account for services provided to the estate. This case was heard in the High Court of Australia on appeal from the judgment handed down from the Supreme Court of New South Wales. In the judgment from the Supreme Court, it was found that the Statute of Limitations had barred the solicitors from being found guilty of a breach of duty of care.The High Court Judges had not reached a unanimous decision regarding the duty of care owed to the executor. Mason C. J and Wilson J found that there was no duty of care owed to Mr Hawkins and suggested the appeal be dismissed, on the other hand; Brennan, Deane, Gaudron JJ had found that there had been a breach of the duty owed to Mr Hawkins, and that the Limitations Act would not affect any claim of such a breach as the breach did not occur a t the time of the death of Mrs Braiser but from when the Solicitors found out of her death.There was argument that the resultant damages incurred by Mr Hawkins was caused by his ignorance of the will and his failure to administer the estate it was however found that the damages were indeed caused by the lack of the solicitors to promptly notify Mr Hawkins of his interest in the estate and his role as executor. Brennan, Deane, Gaudron JJ ordered that damages be paid by the respondents though as the damages had not been quantified, they all agreed that the parties should discuss and agree to the amount of damages payable, if the parties could not agree to an amount, the Supreme Court of NSW would determine the costs owed.The final orders as found in the judgment are as follows: 1. the appeal to that Court be allowed with costs; 2. the judgment of Yeldham J. be set aside; 3. in lieu thereof judgment be entered for the plaintiff for damages to be assessed; 4. the action be remitted for determination by a judge of the Supreme Court; and 5. the defendants to pay the plaintiff's costs to be taxed.

Analysis Of The Book Carte Blanche Essay - 1479 Words

An autobiography is by definition a personal account of the events that happened in a person’s life. How the writer records these events are subjective? giving the author ‘carte blanche’ to enhance reality, interweave creativity and imagination to produce a more interesting, readable and compelling story. These are all elements I considered when drafting ‘Time to let go.’ This narrative is not a direct recollection of my personal experience. But, interprets a devastating chain of events that happened to my son’s friend, and the effect this tragic accident had on a mother. I wanted to tell this story with as much sentiment and compassion as possible. Therefore, I relied on a variety of ‘creative elements’ to coalesce understanding, memory and imagination. To bring together the feelings and emotions of every mother’s worst nightmare, the death of a child. This critical commentary will reflect on the techniques used in creating, crafting and structuring this narrative. 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