1
Dementia
UNFOLDING Reasoning
William “Butch” Welka, 72 years old
Primary Concept
Cognition
Interrelated Concepts (In order of
emphasis)
• Pain
• Mood and Affect
• Psychosis
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Covered
Each inCase
Category/Subcategory Study
• Safe and Effective Care Environment
• Management of Care 17- ✓
23%
• Safety and Infection Control 9-15%
• Health Promotion and Maintenance 6-12% ✓
• Psychosocial Integrity 6-12% ✓
, 2
• Physiological Integrity
• Basic Care and Comfort 6-12% ✓
, 3
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II
and dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He is
now a residentof Pineville Estates, a local long-term care facility the past four months because his dementia
progressed and his wife Rita was unable to care for him. When Rita visited Butch this morning, she reports to the
nurse that he is more confused and is concerned because Butch is easily angered. Butch insists that he sees his
friend Roger, who served with him in the Navy, is in the room, but he died ten years ago. Rita approaches the
nursing station with tears in her eyes and states, “What is happening to my husband? This just isn’t like Butch to
act like this! Please do something to help him!”
Personal/Social History:
Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to
visit Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch
believes he is atPineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were
alone. Rita was just awarded guardianship due to his declining mental status.
1. What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of
RiskPotential)
RELEVANT Data from Present Problem: Clinical Significance:
• History of heart failure, • All these conditions affect the vascular components of the
COPD,HTN, DM II and bodyand increase the risk of stroke. COPD and HF can also
dementia cause him to not receive enough oxygen and blood flow to
• Has been hospitalized for the brain which could cause the dementia to advance at a
exacerbation of heart failure quicker rate.
threetimes the past six months. • End stages of HF S&S include confusion and impaired
• Angry, confused, and hallucinating thinking.COPD could be the cause of the HF exacerbations.
• S&S of end stage heart failure and is also a S&S of
vasculardementia.
RELEVANT Data from Social History: Clinical Significance:
• Married for 51 years • Has support at home
• 3 adult children that visit regularly • Has family that visit routinely, routine is important for
• Wife visits daily dementiapatients
• Thinks he in rehab • Has continued support at the hospital
• Wife awarded guardianship • Could be upset when he finds out why he is in the hospital
• Wife is the person in charge of decisions related to his care
Dementia
UNFOLDING Reasoning
William “Butch” Welka, 72 years old
Primary Concept
Cognition
Interrelated Concepts (In order of
emphasis)
• Pain
• Mood and Affect
• Psychosis
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Covered
Each inCase
Category/Subcategory Study
• Safe and Effective Care Environment
• Management of Care 17- ✓
23%
• Safety and Infection Control 9-15%
• Health Promotion and Maintenance 6-12% ✓
• Psychosocial Integrity 6-12% ✓
, 2
• Physiological Integrity
• Basic Care and Comfort 6-12% ✓
, 3
• Pharmacological and Parenteral Therapies 12-18% ✓
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II
and dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He is
now a residentof Pineville Estates, a local long-term care facility the past four months because his dementia
progressed and his wife Rita was unable to care for him. When Rita visited Butch this morning, she reports to the
nurse that he is more confused and is concerned because Butch is easily angered. Butch insists that he sees his
friend Roger, who served with him in the Navy, is in the room, but he died ten years ago. Rita approaches the
nursing station with tears in her eyes and states, “What is happening to my husband? This just isn’t like Butch to
act like this! Please do something to help him!”
Personal/Social History:
Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to
visit Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch
believes he is atPineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were
alone. Rita was just awarded guardianship due to his declining mental status.
1. What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of
RiskPotential)
RELEVANT Data from Present Problem: Clinical Significance:
• History of heart failure, • All these conditions affect the vascular components of the
COPD,HTN, DM II and bodyand increase the risk of stroke. COPD and HF can also
dementia cause him to not receive enough oxygen and blood flow to
• Has been hospitalized for the brain which could cause the dementia to advance at a
exacerbation of heart failure quicker rate.
threetimes the past six months. • End stages of HF S&S include confusion and impaired
• Angry, confused, and hallucinating thinking.COPD could be the cause of the HF exacerbations.
• S&S of end stage heart failure and is also a S&S of
vasculardementia.
RELEVANT Data from Social History: Clinical Significance:
• Married for 51 years • Has support at home
• 3 adult children that visit regularly • Has family that visit routinely, routine is important for
• Wife visits daily dementiapatients
• Thinks he in rehab • Has continued support at the hospital
• Wife awarded guardianship • Could be upset when he finds out why he is in the hospital
• Wife is the person in charge of decisions related to his care
