Delirium, Dementia and Depression - Delirium - Mr. Johns Case Study - Nursing Assignment Help

Assignment Task

PBL 2: Delirium—the case of Mr Johns
Mary Jo returns to work on the medical ward in a general hospital after having some days off. At handover she hears that Mr Johns, a 70-year-old male admitted for cardiac investigations because of bradycardia and shortness of breath, required restraint overnight because of his unpredictable behaviour and aggression towards staff. Overnight Mr Johns had been confused, calling out and attempting to wander. He was also incontinent, and had urinated onto a chair. He had interfered with his telemetry and staff were unable to get his cooperation to do his cardiac enzymes. He benefited from oxygen via nasal specs but again interfered with the equipment. The night registrar had approved sedation and restraint and the treating doctor is to review him today. This surprises Mary Jo as she had admitted him four days ago and had found him and his wife, Betty, who is his carer, to be very amiable and cooperative. The staff are judgmental about Betty Johns and describe her as interfering and behaving yesterday as if ‘she was losing the plot too’. Mr Johns had scratched the night nurse on the face and she is still upset by this and says, ‘I didn’t get Mrs Johns to come in even though she said she would come if we needed her. I didn’t want to put up with her having a go at me too!’.
Mr Johns was allocated to Mary Jo and the second-year student on placement. The student was not very pleased about this as she did not want to be attacked as the night nurse had been, and she thought there were ‘more interesting cases’ on the ward.
Mary Jo’s nursing admission and assessment recorded the following: Mr Johns is a retired accountant (past 7 years) living in his own home with the support of his wife.
Referral: Dr Marks; cardiac insufficiency for investigation.
Past medical history: early dementia – Alzheimer’s type – diagnosed
12 months ago. Nil other significant.
Medications: anticholinesetrase inhibitor, occasional aperients, and paracetamol for joint pain. Takes multi-vitamin supplement daily.
Self-care: ADLs achieved with direction from wife.
Elimination: routinely continent; however, may need prompting to toilet himself if he does not self-initiate within three hours of last urination. Bowels usually open twice daily; last observed yesterday.
Skin integrity: intact.
Falls risk rating: 8.

questions
• What actions should Mary Jo take immediately?
• What are the best practice guidelines on restraint procedures? What risks must be considered?
• What are the pharmacokinetics of haloperidol? What are the pharmacokinetics of benzodiazepines?
• What do you make of the night nurse’s decision not to call Mrs John’s in?
• What advice could be given to the student to avoid becoming injured?
• What are the responsibilities of the nurse who was harmed and how will he be supported?
• What do you make of the assumptions being made by the student?
• Is it possible that Mr Johns was just experiencing nightmares?

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