CASE ABSTRACT

This is a case of a 72 years old male patient named MBT, diagnosed with multi-infarct dementia two
years ago and becomes bedridden since then.
The first symptom of Dementia was noted to MBT during his early 50s (1980). The change in
behavior and cognitive abilities were not that remarkable so it didnt cause any alarming reaction from the
patient and his family on this early stage. He was observed to easily get confused making wrong turn while
driving and got lost to places that he was familiar with.
In 1986, he was not able to reach an appointment and got lost for two days and one night. He
suddenly became disoriented and was able to recall only his home phone number during the second evening.
His daughter brought him home and his activity was restricted within the community since then. MBTs
neurological status continues to degenerate slowly. The member of his household, specifically his wife and
daughter had a very hard time accepting and adopting with the changes in his attitudes and behavior for they
still not really aware of the real organic cause and they were not even familiar about dementia and how it
could make a twist in the life of the patient.
For one to two years, MBT continued to be more disoriented, confused and showed
catastrophic reactions. He developed repetitive talking and inability to recall recent happenings. He even had
delusion of persecution directed to his household, which he easily got irritated and reacted violently without
any reasons at all.
Early 90s, his family decided not to allow him to go outside and confined at home. His world
was limited until at the carport. His symptoms continue to get worst. It started to be complicated with
perceptual problems of agnosia (inability to associate an object with its used) and apraxia (inability to use an
object) like unable to place slippers right and eating of papers instead of his foods. He began also to lose his
capability for personal hygiene, grooming and dressing, voiding and defecating at anytime in any place.
1994, his physical built started to deteriorate, he had difficulty in walking and coordination became
hard for him.
Thus, the next year (1995), MBTs world was bounded within his room. He preferred to sit on his
chair the whole day and refused to be move, causing him to develop bedsores and cellulitis on the thighs and
legs. At this time he was forced to be on his bed. The sores and wounds on his lower extremities healed but
this caused him to be stuck in bed, became depress to get up and walk.
Until one Sunday night (May 1996), he was noted to be drowsy to stuporous with labored breathing
and low-grade fever prompted her daughter to bring him to emergency room of Chinese General Hospital
and Medical Center. He was readily admitted for Multi-infarct Dementia secondary to Hypertension
complicated with Pneumonia, worst Stage.
It was at this time that the author of this documentation met him and his family and became her
patient during his confinement for more than one month. Since a large percentage of his brain was kept
affected by the multi-infarction. MBT remains conscious but not oriented in any respect. No remarkable
changes physically but because of his disorientation; he remains to be on restraints until today to prevent
accidental removal of contraptions attached to him.
His first confinement was really a battle for him and his family. He received high doses of various
antibiotics and anti-hypertensive drugs to arrest further infarction. He responded favorably to the treatment
but his Pneumonia continues to get worst prompted him to undergo tracheotomy to avoid further
complication from massive secretions and infections. He was then discharge, July 1996 still conscious but
incoherent with restrains on upper extremities, on NGT feeding and tracheotomy at room air.
After few months, November 1996, the family decided to return him to the hospital for gastrostomy
tube insertion to aid in his nutrition. With MBTs second confinement at Chinese General Hospital (CGH),
he became again the patient of the author, thus she followed him up at home for nursing care since then.
MBT was recently admitted again at Chinese General Hospital last November 29, 1998 because he
accidentally pulled out his mushroom-type gastrostomy tube and he even showed manifestation of early
Pneumonia. He stays at CGH for only four days and was discharged, still requiring complete care at home.

MBT is a lawyer by profession, married to AD (73), now a retired college professor at MCU. They
were given two children, the eldest, Lourdes (45), single, independent career woman, while their youngest
daughter, Wilma, died while she was still an infant because of a congenital heart disease. According to
Lourdes, the life of his father before he became bedridden was a very stressful one since he handled and
succeeded with different cases ranging from personal life legal problems to governmental and administrative
disagreements. He received a lot of pressure when he prepares for a case hearing and used to beat deadlines
for reports. The tensions on a court trial even added to his busy lifestyle. It was even aggravated by the
different threats to his life, from different people and families whenever he refused to compromise his
straightforward principles. He really had a lot of things to think of, accomplish and finish. Despite his
stressful lifestyle MBT takes time for rest and relaxation in a farm at Tanay. He spent a day there every
weekend, planting and enjoying, discovering more about nature. This is his way of recharging, meditating,
exercise; an escape to his busy world. His father was known to be active, independent and firm in making
decision yet loving, thoughtful and kind, ready to extend help and assistance especially to poor individuals
and families that need legal support. He doesnt have any serious diseases before except for circumstances of
elevated blood pressure, where in there was no medical consultation done not until his signs and symptoms
became prominent with dementia. He smokes one pack a day for more than 30 years and drink occasionally.
It was really a great trauma on the part of MBT family when the symptoms of dementia gradually
took over his character, a systematic, broadminded, affectionate husband and father slowly becoming an
irritable, violent, unreasonable individual. A hard fact that his family needs to accept and adjust despite their
confusion, shock and lack of understanding of the real impact of dementia.
The signs of dementia were noted to MBT as early as 1980, manifested by simple confusion and lack
of his ability to concentrate and remember. His BP then increasingly fluctuates from 160-180 systolic. No
extra health care was given until slowly the signs and symptoms continue to aggravate which later on leads
to numerous consultations and check up that finally the diagnosis of multi-infarct dementia was proven.
Throughout the course of MBTs sickness, his family especially his daughter is always of full
support to him. Caring for a patient with dementia is not an easy task as compared to other illness, since it
affects not only the physical aspects but also even the behavior and attitude of the patient. It requires not
only time and effort but even emotional and understanding of the family on the disease process.
According to Lourdes, patient daughter, Caring for my father requires not only our physical strength
but also our emotional, spiritual and social well-being. He is incapable of maintaining a balance between
these aspects and so we are the one that should extend and provide for this.
MBT was bedridden for more than years now, still incoherent and restrained but his family sees to it
that he received care he needed in all aspects of his life. His daughter makes it appoint that proper turning
and changing of his position be done at regular intervals of one and one-half to two hours every time to
prevent occurrence of bedsores. She also uses gel pads to pressure points like shoulders, hips, and back...
Linens and perennial area are kept dry. The family promptly consulted individual practitioner whenever they
observe even simple abnormal symptoms with their patient. His daughter believed, My father condition is
very vulnerable to complication, so I see to it that early management be given to him to arrest further
development of other illness. So when I noted him to have low-grade fever and increasing thick secretion. I
readily ask the doctors to see him. I dont want him to develop the worst Pneumonia like before. She further
added, I think we need to be more conscious about our turning schedules, we better avoid placing him
longer at his back especially at night. He might also need exercise on his extremities especially for his
muscles at his legs, since it started to get small and stiff. He rarely has movements of his legs, always fixed.
Mr. Tan is presently in gastrostomy feeding. His family prepares his food composed of osteorized
feeding combined with tube feeding formula of ensure and sustagen. We created our own feeding for my
father; we followed the advice given by a dietitian to be sure he received a complete balanced diet in every
feeding. It has meat, carbohydrates, vegetables, fruits, plus other nutrients from the tube milk., Lourdes
added. We even gave him small amounts of juices, oatmeal by mouth in the morning to satisfy his taste
buds.
The family also knows the importance of touch and continuous communication with their patient.
Despite his incoherence, I used to talk to him and touch my father, even kiss and hug him, to let him know
that we are still here, caring for him. Maybe he can not accurately respond to us but I know he can still feel
how we love him, Lourdes said.
She further added, I even try to explain simple procedures done to him like why we are moving
him, why I am tapping his back and surpassingly I commonly gain more of his cooperation.... There have
been frequent instances wherein MBT, despite his incoherence, able to respond accurately, distinguish and
verbally identify his loved ones when being touch and talked with. And this gives much delight and
encouragement to his family.
The recent accident wherein MBT was able to pull his gastrostomy reflects the need for more attention on
the different safety precaution at bedside. Probably we became lax with the restrain of his hands, railings
and padded sides, restraints should be more monitored in order to avoid recurrence of accidents like this,
Lourdes reacted.
Presently. MBT is now discharged from his recent confinement last November 1998, with his newly
inserted gastrostomy tube and his starting Pneumonia cured. But his condition still requires full time care
and support from his family to prevent further development of complication and for him to restore his sense
of well being despite of being in a bedridden condition.

Based on the case presented:

1. Develop a comprehensive wellness nursing care plan using the format below. The focus of the
care plan can be for the patient or for the family.
A. CUES
- Identify Gordons Functional Health Pattern
B. WELLNESS NURSING DIAGNOSIS
C. ANALYSIS
D. GOALS
E. IDENTIFIED STRATEGIES
F. RATIONALE
G. NURSES ROLE
H. ROLE EXPLANATION
I. EVALUATION (Hypothetical)

TSA\Prov. 3:5-6