Nursing Care Plan for E.S., an Older Woman with Dementia and Wandering Tendency

QUESTION

An older Latin American woman is admitted to the emergency department (ED) by ambulance.
The paramedics inform the staff that they were notified by an anonymous source regarding an
older woman who “looked lost” in the neighbourhood. When they arrived, they found her
bleeding from scrapes on the palms of both hands and the anterior aspects of both knees. She
would not tell them her name or where she lived, and she was mildly combative, batting them
away from her as they approached. She has no identification.
In the ED she is disoriented, agitated, and suspicious of attempts to assess her. You observe that
she has poor personal hygiene. She is wearing two different coloured socks, and her shirt is
inside out. She has extensive bruises circling her wrists and a large bruise on her left neck. Her
gait is stable with no limb rigidity or flexor posturing. She denies any knowledge of her own
health history, exclaiming, “I’m as healthy as a bat, and I can take care of myself!”
After you place the woman in a quiet room and offer her some water, she begins to relax. You
ask to clean her skinned hands and knees and she agrees. At that time, a middle-aged man and
woman come into the room, exclaiming, “Mother, this is the last straw! Will this never end? We
are just going to have to take drastic measures!” To which the patient replies, “Who are you?”
The man explains that the woman is his mother, E.S., age 75, who has lived with him and his
wife for the past 3 years since she started a fire in her home, which is in another province. He
says that she has dementia that is thought to be Alzheimer’s disease (AD). His wife had to quit
her job as a salesclerk 2 years ago to care for E.S. because she required 24-hour monitoring.
E.S.’s son tells you that they have tried everything to keep E.S. from wandering, but this is the
third time she has been picked up in the neighbourhood by the police or the paramedics. He says
they must have forgotten to lock the door to her room after they removed her dinner dishes.
Nursing Care Plan
1. Identify nursing diagnoses (actual) based on the case study scenario and create
a comprehensive Nursing Care Plan.
2. Include 1 short-term goal and 2 long-term goals in your planning/goals section. Make
sure your goals are SMART!
3. Ensure to include evaluation criteria (how will you evaluate if the goals were met).
Good Luck

ANSWER

Nursing Care Plan for E.S., an Older Woman with Dementia and Wandering Tendency

Nursing Diagnoses

Risk for injury related to disorientation and wandering behavior.
Impaired social interaction related to cognitive decline and communication difficulties.
Self-care deficit related to poor personal hygiene and inability to meet basic needs.
Anxiety related to disorientation, agitated behavior, and unfamiliar environment.

Short-Term Goal

Within one week, the patient will demonstrate improved safety by exhibiting reduced wandering behavior and a decreased risk of injury.

Long-Term Goals

Within three months, the patient will engage in meaningful social interactions with family members and healthcare providers.
Within six months, the patient will demonstrate improved self-care abilities, including maintaining personal hygiene and meeting basic needs independently.

Interventions

Ensure a safe environment by implementing fall precautions, including bed alarms, non-slip footwear, and removing tripping hazards.
Implement a wandering prevention strategy by using door alarms, securing exits, and utilizing electronic monitoring systems.
Establish a structured daily routine with consistent meal times, activities, and rest periods to reduce agitation and promote a sense of familiarity.
Use clear and simple communication techniques, including providing reassurance, using visual cues, and speaking in a calm and patient manner.
Collaborate with the interdisciplinary team to develop and implement a personalized care plan that addresses the unique needs and preferences of the patient.
Provide education and support to the patient’s family on strategies to manage wandering behavior, including the importance of secure home environments and the use of community resources such as support groups or respite care.

Evaluation Criteria

Short-Term Goal: Evaluate the reduction in wandering behavior through documentation of incidents, including the frequency and severity of episodes.
Long-Term Goal 1: Assess the patient’s engagement in social interactions through observation and family reports, noting increased participation and meaningful connections.
Long-Term Goal 2: Evaluate the patient’s self-care abilities through direct observation and assessment of personal hygiene practices and ability to perform activities of daily living independently.

By implementing this comprehensive nursing care plan, we aim to enhance the safety, well-being, and quality of life for E.S. while supporting her family in managing her wandering tendency and cognitive decline associated with Alzheimer’s disease. Regular evaluation and reassessment will allow for modifications to the plan as necessary to meet E.S.’s evolving needs and optimize her overall care and outcomes.