AGGRESSIVE BEHAVIORS IN PATIENTS WITH DEMENTIA

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QUESTION
 
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?

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