NURS 102 Dementia William “Butch” Welka SKINNY Reasoning
Dementia SKINNY
Reasoning
, NURS 102 Dementia William “Butch” Welka SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
William “Butch” Welka is a 72-year-old male with a history of heart failure, COPD, hypertension, diabetes type II and
dementia who has been hospitalized for exacerbation of heart failure three times the past six months. He is now a
resident of Pineville Estates, a local long-term care facility the past four months because his dementia progressed and
his wife Rita was unable to care for him. When Rita visited Butch this morning, she reports to the nurse that he is more
confused and is concerned because Butch is easily angered. Butch insists that he sees his friend Roger, who served with
him in the
Navy, is in the room, but he died ten years ago. Rita approaches the nursing station with tears in her eyes and states,
“What is happening to my husband? This just isn’t like Butch to act like this! Please do something to help him!”
Personal/Social History:
Butch has been married to Rita for 51 years. They have three adult children who visit him weekly. Rita comes to visit
Butch every day after work. Butch was a salesman for 35 years before he retired seven years ago. Butch believes he is
at Pineville Estates for rehab, but his family is concerned that it is no longer safe at home if he were alone. Rita was just
awarded guardianship due to his declining mental status.
What data from the histories are RELEVANT and have clinical significance to the nurse? (Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• 72-year-old male with a history of COPD, Comorbidities could play a role in his worsening condition.
hypertension, diabetes type II, dementia, Assessment of cognitive function and ability for independent living. and was
recently hospitalized for heart R/o side effects or other disease processes that may cause the patient to failure three
times in the last 6 months. experience memory loss, agitation, aggression, and confusion. .
• Patient’s progression of dementia and Assess the patient’s family history.
moving to a long-term care facility. The patient’s wife’s concern of the patient’s current baseline compared
Patient’s increased confusion and easily to his previous baseline. angered. Determine whether the
patient has a strong support system.
• Patient’s hallucinations of his friend in the room.
• Patient’s wife reaction to the patient’s behavior shows that she is concerned about his worsening condition.
RELEVANT Data from Social History: Clinical Significance:
• Patent has been married to his wife for 51 Patient and his wife are happily married.
years. Strong support system between his kids visiting him weekly and his Patient’s kids visit him weekly.
wife visiting him daily.
• Patient’s wife Rita visit him daily, and was Patient’s wife is now considered his caretaker and is responsible for
awarded guardianship due to his declining any decision-making on behalf of the patient.
mental status. Patient is retired now, which presents a possibility for feeling isolated
• Patient worked for 35 years before retiring. and as though he has no purpose in life.
• Patient living in a care facility, but believes Provide the patient with comfort- relieve his symptoms of confusion he is
staying at a rehab. and agitation.
• The nurse’s goal for the patient would be to regain his independent function and return home, as long as it would be
safe for him to do so.
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