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Dementia is a progressive disease that has an extensive impact on the quality of life of the sufferer and a very deplorable effect on friends and family. There are several forms of dementia, Alzheimer’s disease is the most common, and vascular dementia the second most common type. The presentation of the condition is variable, although the term ‘dementia’ is widely used to describe a collection of symptoms ranging from memory impairment, a loss of communication skills and a gradual deterioration in the person’s ability to carry out daily tasks and activities of living (Perry, 2012, p. 25). “Vascular dementia or vascular neurocognitive disorder (NCD) associated with cerebrovascular disease in the form of multiple infarcts or strokes, a single larger infarct, or small vessel disease. The rate is higher in men than in women. It affects 10%-20% of people with dementia” (Hinkle & Cheever, 2014, p. 203). In what stage of Alzheimer’s disease is this client? What criteria did you use to determine this? The patient in this scenario is in Stage 4 of Alzheimer’s disease. This stage is defined as a mild to moderate cognitive decline and may be present as forgetting major events and having difficulty performing basic and instrumental activities of daily living (Townsend, M., & Morgan, K. , 2018). An individual in this stage may also have trouble with finances, understanding news, events, and deny that a problem exists (Townsend, M., & Morgan, K. , 2018) According to history, in the scenario, the patient has exhibited some personality changes, trouble understanding news events, and difficulty managing personal finances. What are the three priority RN assessments when home visits are made? This patient has a history of hypertension and atherosclerosis, which predisposed him to the disease. Due to the facts in the scenario, he was diagnosed with vascular dementia.Vascular dementia is related to an interruption of blood flow to the brain (Townsend, M., & Morgan, K. , 2018). Knowing this, the RN should take and monitor the patient’s blood pressure, assess the type, frequency, and severity of mood swings, personality/behavioral changes,and catastrophic emotional reactions.Cognitive changes such as problems with attention span, thinking process, problem-solving, and memory should be assessed. Medication reconciliation should be completed to ensure any changes and to make sure that they are correctly documented. A physical assessment should be completed to include signs of damage to the nervous system and signs of other organ diseases that may affect mental function (Townsend, M., & Morgan, K. , 2018). List and describe three inter-collaborative referrals that may be needed for this client within the next year or so. Referrals the patient may need include a neurologist that specializes in neurocognitive disorders, a psychiatrist whom would specialize in and treat emotional or mood disorders, and/or occupational or physical therapists who can assist the patient with activities of daily living. A referral to a social worker may also be very beneficial for the spouse. They can assist in helping the spouse and other family members locate resources in the community for legal,financial,and support group assistance. REFERENCES Hinkle, J.,& Cheever, K. (2014). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia,PA: Wolters Kluwer Health.Perry, M. (2012). A guide to vascular dementia. Practice Nurse, 42(14), 25-29.Townsend, M., & Morgan, K. . (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice . Philadelphia, PA:: A. Davis.

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