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Discussion

Student's Name

Institutional Affiliation

Course Number and Name

Instructor's Name

Due Date
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Discussion

Discussion#1

Question One

An older adult in my care who has a sudden onset of confusion will influence my

diagnosis by helping me in narrowing down the condition from which they are suffering.

Confusion in older adults is usually a sign of delirium, but it can also indicate severe depression

or psychosis. However, until an alternative cause of the condition is established, a patient should

be treated for delirium. Delirium is a condition that can be reversed with treatment of the

underlying medical condition. The presence of one or more medical conditions is one of the risk

factors to check for while examining a patient suspected of delirium. Any medical conditions

that necessitate hospitalization, particularly in critical care or after an operation, raise the risk of

delirium, as does being confined in a nursing home.

A history of stroke is among the medical conditions that raise the risk of delirium. Stroke

survivors are a distinct category of patients who can acquire delirium because the abrupt brain

dysfunction associated with stroke is a brain disease. According to Shaw et al. (2019), having

delirium after surviving a stroke is quite common, affecting one in every four people. Patients

with Parkinson's disease (PD) are also at a higher risk of experiencing delirium (Lombardo et al.,

2020). PD is a risk factor because patients normally experience a change in environment,

infections during hospitalization, and taking medications such as dopamine agonists.

Another risk factor to look for is infections. If infectious microorganisms enter the brain,

they can stimulate microglia, specific immune cells in the brain. When microglia become

stimulated, they have the potential to produce brain inflammation. This inflammation is

hypothesized to play a role in dementia development by inducing nerve cell death. A history of
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depression, the use of high-risk drugs, immobility, sensory impairment, dementia, and decreased

daily living activities are the other risk factors of delirium.

Question Two

Patients suffering from delirium do not act themselves and frequently exhibit behaviours

difficult for a professional nurse to manage. These behaviours include hallucinations, being

easily distracted by unimportant things, disorientation, poor memory, trouble understanding

speech, rambling speech, and difficulty speaking or recalling words. Patients may also lose the

capacity to keep the same level of concentration on a given issue, engage in aggressive

behaviour, or be unusually quiet and distant. Among these behaviours, the most difficult for me

to handle would be aggressive behaviour, poor memory, rambling speech, and loss of

concentration.

Aggressive conduct in delirium patients is not only challenging to handle, but it also

poses a risk to both healthcare professionals and patients (Wharton et al., 2018). A delirium

patient's combative behaviour can escalate to committing bodily injury to a caregiver and

themself. This behaviour can take various forms, including verbal and physical violence, with

many inconsistencies that make it difficult to distinguish outwardly aggressive actions from

resistant or protective behaviours. Poor or impaired memory of recent events can be difficult to

manage, especially when it interferes with care delivery. Nurses depend on the ability of a

patient to grasp and remember treatment instructions. For example, a nurse may urge a patient to

take antibiotics for an infection, but the patient may forget to take the antibiotics or fail to check

the written prescriptions.

A nurse may also struggle with the rambling speech of a delirium patient because it is

usually filled with words that are confusing and do not make sense. This speech makes
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conversing with a patient difficult, reducing understanding of the patient's situation. The loss of

concentration is also a difficult issue for a nurse focused on patient recovery. It is difficult for a

nurse to offer interventions when a patient cannot maintain attention for more extended periods.

The result of this is poor patient outcomes.

Discussion#2

Question One

If I awoke in a critical care unit with both of my hands restrained following a car

accident, I would first be happy that I was not dead. Being alive after an accident is usually a

positive sensation because anything might happen after the event. However, I would also exhibit

a range of emotions, including fear, anger, hope, and even frustration (“Intensive care: Patients,”

2018). I would be frightened to see both of my hands tied. Anger will then creep in, wanting the

caregivers to let me loose. All these will amount to frustrations asking myself why this is

happening to me and wondering what I could have done to avoid being in such s situation.

However, I will be hopeful of recovering from my condition and returning to my normal life.

I would want the nursing personnel to explain what happened after the accident and why

my hands are tied. It is always important for a nurse to provide information about a patient's

condition with sincerity. Informing the patient about their situation keeps them calm and helps

them focus their energy on the recovery process. My dread, wrath, and irritation would be

relieved if the nursing staff explained what had happened and why my hands were restrained. I

would also want the nursing staff to explain what they are doing to guarantee my recovery. They

should clearly state the likelihood of me recovering and how long it is going to take. Sharing

such with a patient is important because it prepares them psychologically and enables them to set
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their minds on recovery. Furthermore, I would want the nursing staff to inform my family about

my condition.

Question Two

Men with an overgrown prostate gland or benign prostatic hyperplasia (BPH) have

urinary incontinence (UI) or unintentional urine flow. UI is induced by an overactive bladder, an

abnormality produced by BPH. This condition causes the bladder muscles to contract

spontaneously without warning and often results in a strong urge to urinate. If one cannot hold

their urine, UI follows. If a man has urinary incontinence due to prostate enlargement, I would

first recommend a diagnosis be done. Running a diagnosis will help rule out prostate cancer

which has the same symptoms as BPH although not related. If the indications are mild to

moderate and not too troublesome, home treatment may suffice to keep the condition under

control. I would advise the patient to initiate diet change avoiding foods and drinks that trigger

UI, such as alcohol, tomatoes, and spiced food (New, 2019). The patient should also manage

their weight if overweight and start engaging in Kegel exercises. These exercises are an effective

approach to cure UI because they help strengthen pelvic muscles.

However, the symptoms of BPH might be severe. In this case, I would recommend more

aggressive treatment options. The patient can take alpha-1 blockers, hormone reduction

medications, and antibiotics that help reduce BPH symptoms. Alpha-1 blockers relax bladder

muscles and help reduce the size of the enlarged prostate. Medications such as dutasteride and

finasteride lower the hormone produced by the prostate gland, resulting in a smaller prostate

gland and, as a result, a reduction in BPH symptoms. In the event, medication fails to produce

the desired results. I would recommend that the patient undergo surgery. The procedure known

to work well for most men is transurethral resection of the prostate (TURP) (Young et al., 2018).
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This procedure removes part of the prostate gland or all of it. When removed, a patient will no

longer experience Urinary incontinence.

Discussion#3

Preventing Dementia Wandering

Dementia impairs people's capacity to recognize familiar places and persons owing to

memory loss. It is normal for an individual living with dementia to wander, feel disoriented, or

lose track of their position, which can occur at any stage of the disease. Older patients wandering

off is prevalent in a long-term care institution where they may mistake rooms, jeopardizing other

residents' safety and privacy. Caregivers in charge of these patients must develop strategies to

manage such behaviour and ensure the safety and privacy of the residents.

If I were in charge of an elderly patient with wandering behavior, I would create an

autonomous wander management system. Such a system would be programmable and only allow

certain residents to access certain rooms while restricting others. In the case of the older adult

who wanders into rooms of female residents, I would fit doors to these rooms with sensors. This

strategy would ensure that these doors automatically close when the older adult approaches and

restricts him from entering. I would also deploy a one-of-a-kind tracking gadget to alert or notify

me of the patient's real-time whereabouts. If the older adult begins to go out of limits, I will be

notified quickly and will be able to politely redirect him before he enters the rooms of female

residents. This strategy will prevent unpleasant encounters and perhaps dangerous situations

between the older adult and female residents. The other technique is to identify and address the

causes of wandering behavior. I would closely watch the older adult and ensure that, over time, I

discover a pattern. For example, I would purpose to establish at what time the older adult
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wanders into female rooms. I would then proceed to ensure m with the patient during this

particular time.
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References

Intensive care: Patients. (2018, August). Healthtalk.Org. https://healthtalk.org/intensive-care-

patients-experiences/emotional-aspects-of-recovery

New, B. P. H. (2019). Can Diet and Supplements Treat BPH (Enlarged Prostate)?. Men's Health.

https://prostate.net/can-diet-and-supplements-treat-bph-enlarged-prostate/

Lombardo, M., DiPiazza, A., Rippey, K., Lubarr, N., Clar, E., & Azmi, H. (2020). Treatment of

Acute Delirium in a Patient with Parkinson’s Disease by Transfer to the Intensive Care

Unit and Administration of Dexmedetomidine. Journal of Movement Disorders, 13(2),

159. doi: 10.14802/jmd.20005

Shaw, R. C., Walker, G., Elliott, E., & Quinn, T. J. (2019). Occurrence rate of delirium in acute

stroke settings: systematic review and meta-analysis. Stroke, 50(11), 3028-3036.

https://doi.org/10.1161/STROKEAHA.119.025015

Wharton, T., Paulson, D., Macri, L., & Dubin, L. (2018). Delirium and mental health history as

predictors of aggression in individuals with dementia in inpatient settings. Aging &

mental health, 22(1), 121-128. doi: 10.1080/13607863.2016.1235680

Young, M. J., Elmussareh, M., Morrison, T., & Wilson, J. R. (2018). The changing practice of

transurethral resection of the prostate. The Annals of The Royal College of Surgeons of

England, 100(4), 326-329. https://doi.org/10.1308/rcsann.2018.0054