(Name)
D.O.B:
Birth place:
Marital Status:
Living Situation:
Address:
Next Of Kin:
Address:
Phone:
Doctor:
Phone No:
Address:
POA Health and Welfare:
POA Finances:
Future provision:
(guidance in the event of an emergency i.e. carer pre-deceases client)
Contacts
** = primary contacts who know (name) ’s needs.
(name) ’s (number) Children:
Names
|
Phone No
|
Mobile No
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Address:
|
Other Contacts:
Name & Relationship
|
Phone No
|
Mobile No
|
Address:
|
** (name)
i.e. Grand-daughter-in-law
| |||
** (name) Alzheimers (name)
Community Support Coordinator
| |||
Alzheimers (name)
| |||
(name) Bus Service
| |||
(name)
(Agency) Co-ordinator for
Carer support workers..
| |||
(name)
NASC assessor
| |||
(name)
Occupational Therapist
| |||
(name)
(Physiotherapist)
|
(name) ’s Medications
Morning (when wakes):
(early morning)
| ||
Breakfast time Blister Pack Meds:
Lunch time:
Tea (Dinner) Time Blister Pack Meds:
Night time Meds:
Notes:
*INR / Blood test frequency:
Dispensing Pharmacist: (name) PH:
(Address)
Prescribing GP: Dr (name) PH:
(name) ’s Medical Issues
NHI: Weight: Height:
Past History:
Current Diagnoses:
-
- E.G. Early Dementia (most likely* Lewy Body Disease): *= diagnostic.
(Name)’s Symptoms E.g. :
1. *Has some Alzheimers symptoms (reason & memory) and Parkinsonian symptoms (movement) I.e. no reflexes when falls or movement too slow to counteract unbalances.
2. *Symptoms are unpredictable and fluctuate (come and go) from hours, days to weeks apart.
a. *Has vivid hallucinations (mostly night). (name) doesn’t disclose unless she feels understood;
‘visitors’ in her room are a common symptom. Always check security before discounting.
b. *Reduced attention and fluctuating cognition, day time sleepiness.
c. Time perception disorientation and short term memory loss.
d. Mistaken beliefs due to hallucinations or ‘c’ above.
e. Faulty reasoning and problem solving.
f. Fluctuating memory for family members, own identity, names.
g. Difficulty processing information (talk slower paced and check what she heard).
h. Balance problems, light headedness, “funny head”. HIGH FALL RISK!
i. No reflexes if she falls, and doesn’t stop until head hits the ground
j. Rarely feels hunger or thirst.
k. Has reduced warning messages for urine; urgency or Incontinence. Has continence products.
l. Occasional no control over bowels.
m. Legs give out occasionally.
n. Slow shuffling gait (intermittent). Trips easy (i.e. loose mats etc). NO REFLEXES IF FALLS!
o. Occasional dribbling (keeps it wiped). Keeps tissues with her at all times.
p. Not remembering common names for things I.e. tissues “those nose blowy things”.
q. Difficulty finding the words to express self. Often uses the wrong word / name.
r. Occasional and short lasting swallowing difficulties.
s. Doesn’t initiate (i.e. will sit in front of TV wondering why it is not going).
t. Anxiety.
LBD affects the processing of information received. There is nothing wrong with her intelligence. Is known to cause Severe Neuroleptic Sensitivity and Malignant Hyperthermia Syndrome if given Neuroleptics.
Neuroleptics are known to cause irreversible deterioration of symptoms in LBD. NOT to have any.
NURSING CARE INFORMATION
ALLERGIES
| |
Airway
| |
Breathing
| |
Circulation
| |
Cognition
| |
Eyesight
| |
Hearing
| |
Diet/Meals
| |
Hygiene
| |
Mobility
| |
Toileting
| |
Urine
| |
Bowels
| |
Exercise
| |
Sleep
| |
Social
|
(name) ’s usual Routine
Alzheimer’s Club Days:
(Name) Disability Bus Service:
Daily Routine:
Morning
Afternoon
Evening
Overnight:
11:30-1am I.e. A time between these hours, (name) will get up, needing to use toilet once.
3-4:30am As Above
NOTES: If you find (name) just sitting there, it is because she doesn’t remember or understand what to do next. Because symptoms fluctuate (come & Go) it is easy to expect (name) to do something she was capable of doing (e.g. an hour ago). She is not putting it on THIS IS A LEWY BODY SYMPTOM. (I.e. sometimes she doesn’t know what to do with her glasses when given to her).
Thank you for being involved with her care J
