ChancellorSnowMonkey7 Bernard is a 75-year-old man recently diagnosed with dementia, in…Bernard is a 75-year-old man recently diagnosed with dementia, in the early stages of Alzheimer’s disease. He and his wife Nora, age 73, are living in their home, a one-bedroom condominium apartment in Scarborough. Bernard and Nora have been married for 52 years. Bernard and Nora have come to a geriatric assessment clinic in their community to request home health support as Bernard has had some changes in his health condition and Nora is not sure how to help him. She says Bernard often gets confused and does not know the day or season. He is restless during the day and spends most of the day sleeping in his chair. At night he is usually awake and can be found wandering around the house.
Bernard comments that he thinks he has been losing weight in the past month. His wife says that his usual weight is 75 kg. His lips are pink and extremities warm to touch and capillary refill is 2 seconds. He looks tired and pale, and his mucous membranes are dry. He says has a productive cough every morning of yellow sputum. Nora says she notices his coughing more when he eats, but he stops coughing shortly after meals. On auscultation, his lungs have a few course crackles in the lower lobes. He does not have shortness of breath at rest, but he does have shortness of breath on exertion and fatigue if he walks up a flight of stairs.
Nora helps him with basic daily hygiene care and remind him to brush his teeth, which he will not do unless reminded. He sometimes goes two or three days without a bowel movement but recently he has been having episodes of diarrhea. Nora says it is from him eating too much chocolate. During the interview, Nora comments that the temperature in the house is often too high because Bernard feels cold and will turn the heat up and then cannot remember how to re-set the thermostat. He gets upset if his wife tries to “play around with it” since he is the “man of the house”. He cannot remember how to turn the lights or stove off so each night he will go around the house unplugging everything.
Bernard is often incontinent of urine and sometimes goes to the bedroom to remove his wet clothing, hiding them in the back of the closet. He says he feels the pressure to urinate, but the feeling comes on quickly and he can’t get to the toilet fast enough before it is too late, and he wets himself. He gets extremely agitated if someone notices that he has been incontinent. He often refuses to move off his favourite green chair and remains sitting in his urine-stained pants. His wife says she thinks he is embarrassed, so she just lets him sit in his soiled trousers until bedtime. Recently she has noticed a reddened area on his coccyx area.
Bernard has few of his own upper teeth and recently lost his lower denture. As a result, he is having trouble eating solid foods, so Nora has been giving him soups and juices. Bernard says that cannot remember if he has had anything to eat all day and often says he does not feel hungry. Nora reports that the fridge freezer is full of ice cream and soft chocolate bars that he will snack on prior to going to bed.
He is blind in the right eye and seems to be bumping into furniture more often. Sometimes he says he is a bit dizzy and off balance when he first gets up from his chair but has not fallen. He refuses to use a cane as a “matter of pride” and says he “can walk just fine on his own 2 legs”. Nora says he watches the television with the volume at “almost full level”, but Bernard says he hears without difficulty. During the assessment interview he requires several questions to be repeated by the nurse using a louder voice.
In the clinic, Bernard’s vital signs are T 36.1°C; pulse 92 beats/min, regular; respiration rate 22, regular, oxygen saturation 95% on room air and BP 126/84 supine, 110/62 standing. The nurse records his current weight at 72 kg and his height is 178 cm tall.ScienceHealth ScienceNursing
