From the Guidelines
Skilled nursing interventions for this 96-year-old female patient with dementia should prioritize a comprehensive approach to manage her complex medical conditions, focusing on medication management, vital sign monitoring, prevention of complications, and promotion of physical activity and mobility. The nurse should administer and monitor the effectiveness of her medications, including Aricept 10mg daily for dementia, Zoloft 25mg at bedtime for mood, lisinopril 10mg daily for hypertension, famotidine 40mg daily for gastric protection, ferrous sulfate 325mg daily for anemia, vitamin D monthly, and nephrocaps for kidney support. Regular vital sign monitoring is essential, with special attention to blood pressure due to her hypertension and CKD, as highlighted in the study by 1. The nurse should perform quarterly lab collections as ordered, with particular focus on potassium levels given her history of hyperkalemia. Skin assessments and repositioning every two hours are crucial since the patient is bedbound to prevent pressure ulcers. Hydration and nutrition monitoring will help prevent dehydration and malnutrition, and the nurse should encourage adequate food intake and provide adequate support, as recommended by 1 and 1. The nurse should also implement fall prevention strategies, provide cognitive stimulation appropriate for her Alzheimer's condition, and coordinate care with physical therapy to support mobility goals, as emphasized in the study by 1. Regular assessment of pain, mental status changes, and medication side effects is important, as is education for family caregivers about medication administration, positioning techniques, and signs of complications requiring medical attention. Some key interventions to support adequate food intake include:
- Help with shopping and meal preparation
- Supervision during meals and verbal prompting
- Feeding assistance and increased time spent by nurses during feeding
- Energy-dense meals and texture modification, as outlined in the study by 1. Additionally, the nurse should consider the patient's individual needs and preferences when providing care, and involve family caregivers in the care process to ensure a comprehensive and supportive approach, as recommended by 1. By prioritizing these interventions, the nurse can help improve the patient's quality of life, reduce the risk of complications, and promote overall well-being.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Skilled Nursing Interventions
The patient, a 96-year-old female with a history of CKD, HTN, Alzheimer's, and high cholesterol, requires skilled nursing interventions to address her current health status and improve her quality of life. The following interventions can be considered:
- Monitoring of medication compliance, vitals, and lab collection as ordered, every 3 months, to ensure the patient's safety and effectiveness of treatment 2
- Assessment of the patient's functionality, goal setting with the patient, establishment of an individualized plan, and engagement of patients in physical and daily activity to optimize functional status 3
- Implementation of person-centered care, emphasizing the importance of assessing needs and planning effective care, to address the patient's specific needs and preferences 2
- Collaboration with other healthcare professionals, such as physical therapists, to increase the patient's strength and mobility through therapeutic exercises
Medication Management
The patient is currently taking several medications, including Aricept (donepezil) 10mg daily, which is a selective acetylcholinesterase inhibitor used to treat Alzheimer's disease. Studies have shown that donepezil can be beneficial in improving cognitive function and behavioral symptoms in patients with Alzheimer's disease 4, 5. The skilled nurse should monitor the patient's response to this medication and report any concerns or adverse effects to the prescribing physician.
Functional Status and Mobility
The patient's functional status and mobility can be optimized through multicomponent interventions that include assessment of functionality, goal setting, establishment of an individualized plan, and engagement in physical and daily activity 3. The skilled nurse can work with the patient and other healthcare professionals to develop a plan that addresses the patient's specific needs and promotes functional status and mobility. Patient and caregiver perspectives on measuring functional status should also be considered, including preferences for method of screening and assessment, wording of questions, and provider communication style 6