Dementia
SKINNY 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
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%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
, Part I: Recognizing RELEVANT Clinical Data
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:
RELEVANT Data from Social History: Clinical Significance:
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 99.8 F/37.7 C (oral) Provoking/Palliative: “Standing and moving.”
P: 60 (regular) Quality: “Dull”
R: 16 (regular) Region/Radiation: “Lower back”
BP: 115/72 Severity: “4/10”
O2 sat: 96% room air Timing: “It is always there.”
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
SKINNY 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
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%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
, Part I: Recognizing RELEVANT Clinical Data
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:
RELEVANT Data from Social History: Clinical Significance:
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 99.8 F/37.7 C (oral) Provoking/Palliative: “Standing and moving.”
P: 60 (regular) Quality: “Dull”
R: 16 (regular) Region/Radiation: “Lower back”
BP: 115/72 Severity: “4/10”
O2 sat: 96% room air Timing: “It is always there.”
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
Copyright © 2019 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
