Scenario It is 20:30 on a Thursday evening when you are called to Marie, an 82-year-old female who lives in a residential care home and has fallen when self-mobilising to the toilet.
The senior carer on duty explains that Marie has advanced Alzheimer’s dementia and at times forgets to use her frame when walking. On arrival you notice that Marie is alert and is sat on the floor looking distressed and uncomfortable.
On examination you note that Marie’s right leg is shortened and rotated. She also has a 4cm abrasion to her right elbow. No other injuries are found. Marie’s observations are: •RR: 22, SPO2: 97%, HR: 108, BP: 152/81, Temp: 36.9, B.M: 7.0, ECG: unremarkable.
Marie appears frightened and resistant to your attempts at assessment and treatment. She states that she is “not going anywhere”. The carer states that Marie has a history of hypertension, Alzheimer’s disease and mild depression. Questions
1)Outline the pathophysiology of Alzheimer’s disease and discuss the ways in which this type of dementia may have an impact upon an individual’s cognition and understanding.
2)Outline and critically analyse your assessment and overall management of this patient with particular consideration of pain assessment and the administration of analgesia.
3)Outline and discuss the ethical and legal considerations that may be relevant to this case.
4)Describe and evaluate how you would adopt a person centred approach to this patient that maximises patient/clinician communication along with any appropriate care pathways, interprofessional working or referrals that may support the patient in this case.
