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 Each Covered in
Category/Subcategory Case 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% √
Physiological Integrity
• Basic Care and Comfort 6-12% √
• Pharmacological and Parenteral Therapies 12-18% √
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
, • 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 resident
of 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 at
Pineville 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.
What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• COPD Increased risk of pneumonia and serious complications
• Hypertension Untreated HTN leads to increased incidence of cardiovascular disease
• Heart failure Orthostatic hypotension should be checked
• Diabetes type II Increased risk for hyperglycemia and hypoglycemia
• Dementia favorite activities to develop memory should be included in care
RELEVANT Data from Social History: Clinical Significance:
Wife takes care of him His role is affected
3 adult children visit weekly Good support system
Age 51 Decline in musculoskeletal strength (Increased risk for falls)
Believes he is at Pineville Estate for rehab Orientation is affected
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD 1,2 1. Fluticasone/salmeterol 1. Corticosteroids anti-inflammatory to
• Hypertension 3,4,5,6 diskus 1 puff every 12 hours manage COPD
• Heart failure 3,4,5,6 2. Albuterol MDI 2 puffs 2. Adrenergic Relaxation of airway
• Diabetes type II 7, 8 every 4 hours PRN shortness smooth muscles
• Dementia 9 of breath
3. Lisinopril 10 mg PO daily 3. Ace inhibitors Manage HTN and HF
4. Atenolol 25 mg PO BID 4. Beta blockers Manage HTN and HF
5. Furosemide 20 mg PO 5. Loop diuretics Manage HTN and HF
daily Manage HTN and HF
6. Hydrochlorothiazide 25 6. Thiazide diuretics
mg 1 tab PO daily Increased sensitivity to
7. Metformin 1000 mg PO 7. Biguanides
insulin
BID
8. Sulfonylureas 8. Lowers blood sugar by
8. Glyburide 10 mg PO stimulating insulin release
BID 9. Manages dementia
9. N-methyl-D-
9. Memantine 5 mg PO symptoms
aspartate
daily antagonist
One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if
applicable), which disease likely developed FIRST that created a “domino effect” in Butch’s life? Hypertension
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
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 Each Covered in
Category/Subcategory Case 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% √
Physiological Integrity
• Basic Care and Comfort 6-12% √
• Pharmacological and Parenteral Therapies 12-18% √
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
, • 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 resident
of 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 at
Pineville 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.
What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• COPD Increased risk of pneumonia and serious complications
• Hypertension Untreated HTN leads to increased incidence of cardiovascular disease
• Heart failure Orthostatic hypotension should be checked
• Diabetes type II Increased risk for hyperglycemia and hypoglycemia
• Dementia favorite activities to develop memory should be included in care
RELEVANT Data from Social History: Clinical Significance:
Wife takes care of him His role is affected
3 adult children visit weekly Good support system
Age 51 Decline in musculoskeletal strength (Increased risk for falls)
Believes he is at Pineville Estate for rehab Orientation is affected
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
• COPD 1,2 1. Fluticasone/salmeterol 1. Corticosteroids anti-inflammatory to
• Hypertension 3,4,5,6 diskus 1 puff every 12 hours manage COPD
• Heart failure 3,4,5,6 2. Albuterol MDI 2 puffs 2. Adrenergic Relaxation of airway
• Diabetes type II 7, 8 every 4 hours PRN shortness smooth muscles
• Dementia 9 of breath
3. Lisinopril 10 mg PO daily 3. Ace inhibitors Manage HTN and HF
4. Atenolol 25 mg PO BID 4. Beta blockers Manage HTN and HF
5. Furosemide 20 mg PO 5. Loop diuretics Manage HTN and HF
daily Manage HTN and HF
6. Hydrochlorothiazide 25 6. Thiazide diuretics
mg 1 tab PO daily Increased sensitivity to
7. Metformin 1000 mg PO 7. Biguanides
insulin
BID
8. Sulfonylureas 8. Lowers blood sugar by
8. Glyburide 10 mg PO stimulating insulin release
BID 9. Manages dementia
9. N-methyl-D-
9. Memantine 5 mg PO symptoms
aspartate
daily antagonist
One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if
applicable), which disease likely developed FIRST that created a “domino effect” in Butch’s life? Hypertension
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
