Nutritional insufficiency related to cognitive impairment (dementia) as demonstrated by weight of 45 kilograms, poor consumption of food and drinks, and emaciated appearance. 2. Impaired physical mobility related to cognitive impairment as demonstrated by unsteady gait. 3. Alteration of protective mechanisms related to malnutrition as evidenced by paper thin skin and recurrence of urinary tract infection. 4. Risk of infection in urinary tract related to poor hygiene as demonstrated by very red and sore genitalia and history of urinary tract infections. 5. Risk of injury to skin related to malnutrition as demonstrated by emaciated appearance and paper thin skin. 6. Risk of accident related to cognitive impairment (dementia) as evidenced by unsteady gait. Other nursing diagnoses that may be derived related to dementia are: (1) Impaired Verbal Communication related to cerebral impairment as demonstrated by altered memory, judgment, and word finding; (2) Bathing or Hygiene Self-Care Deficit related to cognitive impairment as demonstrated by inability to complete ADLs; and (3) Impaired Social Interaction related to cognitive impairment. Justification This study cited several identified nursing diagnosis, both actual and risk problems, taking into higher priority the actual problems related to nutrition and safety. Nutritional insufficiency related to cognitive impairment (dementia) is on the top of the list as it is under the basic physiologic needs of human. According to Maslow, the basic physiologic needs related to survival must be met first. This includes oxygen, water, food, sleep, shelter (Rosdahl and Kowalski, 2008). Therefore, as Mrs. Archer fails to eat and drink adequately, she is depriving herself on the fulfilment of...
The author of the essay "Clinical reasoning case study" begins with the description of the case study and short overview of the dimentia. "In the given situation, several problems regarding Mrs. Archer’s health status arise. The height was not mentioned to have a clearer view on the patient’s body mass index but the photo shows a dishevelled thin woman with sunken eyelids who appears weak and cold. It was stated that she is currently suffering from early stage of dementia manifesting her inability to perform basic activities of daily living such as eating and maintaining personal hygiene". The author discusses justification and sets the goals of the treatment. In the end he evaluates outcomes and gives his recommendations and prognosis. By the end of the six weeks nursing care, Mrs. Archer will be able to demonstrate progressive weight gain or stable body weight. Evaluation criteria will include some if not all of the following:
1. Complete six weeks weight monitoring record showing progress on patient’s weight heavier than 45 kilograms.
2. Creation of a meal plan according to patient’s preference and in congruence with her energy expenditure and metabolic rate.
3. Able to consume meals served with only few, if not totally absence, of leftovers.
Elderly, especially those suffering with cognitive impairment, most of the time lacks self esteem and autonomy therefore, in any intervention, one must be sensitive enough to act and speak with them as individuals with dignity and independence.