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AGGRESSIVE BEHAVIORS IN PATIENTS WITH DEMENTIA

You are rounding on the inpatient geriatric unit. Your first patient is Eva Harold, who was admitted late yesterday after being discharged from her nursing home because of assaultive behavior.

Intake Note
photo of Eva Eva Harold, a 78-year-old female, has been a resident of Carrot Patch Assisted Living for about two years. Her husband initially admitted her because of Alzheimer’s disease, associated memory decline, and progressive need for assistance with activities of daily living (ADLs) that could not be met by her family or community-based programs. She had a history of osteoarthritis but was otherwise healthy.

She had a Mini Mental State Exam (MMSE) =18 (moderate cognitive impairment) on admission last night. Meds on admission were galantamine 24 mg daily and celecoxib 200 mg daily. Nursing staff describe Eva as a sweet lady. However, recently she began having confrontations with staff and has become increasingly restless and agitated. She even started hitting staff. These behaviors are especially prominent during the evenings.

She also seems sad and has been expressing helplessness and hopelessness in comments to staff. She recently shouted for an aide to leave her room—for unclear reasons—while the two of them were looking at pictures in one of her photo albums. She was restless and tense that day and, as the sun began to set, another resident approached her in her room, voices were raised, and Eva struck the other resident. Eva is now being assessed for her new onset of behaviors.

Physical examination, blood work, and medication review are negative. The short form GDS=8 (above 5, positive screen for depression). She also appears sad and expresses helplessness and hopelessness. Her pain scale score is 0 out of 5 (zero being no pain).

Questions
From your perspective as Eva’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) in APA format. Include at least three peer-reviewed, evidence-based references.

What assessment and screening tools would you use with Eva?
What medications would you start? Please include the rationale for each medication you chose and starting dose, medication education, side effects, and any special considerations.
What are the steps to get her placed into a different nursing home? Please remember that she has a history of aggressive behavior and note that she has Medicare.
What resources and education would you give her family?

Sample Solution

When compared to other Africapitalist nations, Nigeria thrives and struggles in some areas. Nigeria has outgrown all African nations to claim the highest GDP at 521.8 billion USD. This has been made possible by the flourishing private sector and the involvement of public sectors such oil and gas sectors, agriculture and others. Nigeria’s has had a rapidly increasing human development index when compared to the likes of its West African competitors such as Cameroon and Togo. However, Nigeria is still very far behind when compared to other countries on the continent. Having a literate nation is a basic component to reaching economic development however, this is one area where Nigeria struggles. Literacy rates in Nigeria clock at 59.6% of the whole population which makes the nation inferior when compared to the likes of Botswana and Kenya who clock at roughly 87%. Unemployment is another huge problem that Nigeria suffers from, with roughly 13.3% of the working population being unemployed. The most popular type of unemployment that Nigeria suffers from is frictional unemployment as majority of the population are either in the working age group or are below it, meaning that many graduates are still waiting to get a job or have skills not applicable to available jobs otherwise known as structural unemployment. The adoption of Africapitalism has promoted import substitution not only in Nigeria but in other African nations such as Ghana and Kenya, for example, and this gives Africans motivation to continue being innovative as their countrymen are supporting local produce. We have since seen a number of countries in Africa seeking to uplift the lives of their population by emulating Tony’s concept. For example, South Africa came up with the Black Economic Empowerment (BEE) after attaining independence and abolishing the apartheid regime. This programme is aimed at the young aspiring entrepreneurs in South Africa. In my own country Botswana, the government established the Citizen Entrepreneurship Development Agency (CEDA), whose aim is to support the local entrepreneurs both financially and technically so as to create more jobs and alleviate poverty. Figure 5: Shows Nigeria’s unemployment rate Source: http://www.tradingeconomics.com/nigeria/unemployment-rate Hindrances to Africapitalism The economic philosophy of Africapitalism is of much benefit to countries within the African continent that have very transparent governments. However in Nigeria this unfortunately is not the case. The economic philosophy of Africapitalism fails to reach many of its goals due to internal problems in the country’s government such as corruption. Some of the challenges faced by the Government of Nigeria are discussed and elaborated below. Corruption Nigeria’s public sector is one of the key prospects for Nigeria to further develop its economy. In order for Africapitalism to thrive it is important that both the private and public sector work hand
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