Reference no: EM133914130

CASE STUDY SCENARIO

Mr. Wilson is a 78-year-old widower, seen today by an Advanced Practice Registered Nurse (APRN), the healthcare provider (HCP) at the community ambulatory care clinic. He is accompanied by his daughter, who is concerned about his increasing forgetfulness, anxiety, and wandering in the house at night. He has a history of coronary artery disease, hypertension, and NIDDM. He was diagnosed with Mild Neurocognitive disorder due to Alzheimer's disease one year ago.

Mr. Wilson's daughter moved into his home 6 months ago to help care for him. She works full time as an engineer for the city. Mr. Wilson has managed his ADLs and medication administration until this past month. His daughter purchased a pill organizer to help him remember to take his medication, and she leaves him prepared lunches when she goes to work, which he forgets to eat.

The nurse administers the Mini-Cog assessment tool. Mr. Wilson has poor short-term memory, is easily distracted, and is orientated to person and place only.

Mr. Wilson is upset about visiting the NP and he tells the office RPN that there is nothing wrong with him. The RPN notes that Mr. Wilson's face is flushed, and he is wringing his hands. He states that he does not know whey he is at the clinic. He stands by the door, shuffling his feet.

When Mr. Wilson goes to the bathroom, his daughter asks the nurse "My father just doesn't act like himself anymore. Why is this happening?"

One year later, Mr. Wilson has progressed from mild to moderate neurocognitive disorder due to AD. He has started to wander, and his daughter is worried he might wander out of the house and forget where he is and not be able to get home.

Mr. Wilson's daughter tells the nurse that he has been taking frequent naps during the day, has difficulty sleeping at night, and becomes afraid, particularly when the homecare nurse enters the room. The NP recognizes that Mr. Wilson's symptoms are consistent with the delirium sundowning phenomenon also known as "sundown syndrome".

1. Compare and contrast between mild (early onset) and severe (late stage) neurocognitive disorder due to AD.

2. What are some strategies his daughter needs to consider to address the wandering behaviour?

3. How would you explain "sundowning syndrome" to Mr. Wilson's daughter? What are some strategies she can use to help prevent "sundowning syndrome"?