Case Study 1
A confused elderly male who resides in a nursing home is 6 feet tall and has a large frame. He has a primary diagnosis of dementia. The patient is sitting in the residents’ dining room eating lunch. He has become annoyed with the noisy verbal disturbance caused by another resident. He yells at the resident telling her to be quiet. He is not aware of a visitor approaching him from behind. A visitor to the nursing home places her hand over the patient’s mouth, attempting to stop him from yelling at the resident who is annoying him. He is startled by the visitor’s actions and responds by striking the visitor in the jaw. The visitor complains to the nurse. The nurse tells the visitor, “When the patient hits you, he was responding to the feelings of perceived powerlessness.”
Why did the patient react aggressively by striking out at the visitor’s action?
What patient behaviors and indicators or cues should the nurse assess in the patient who has displays of anger inappropriately?
Case Study 2
While walking home from school, 7-year-old Jimmy and his older brother, Michael, were attacked by three boys from Michael’s class. The three boys pushed Michael into a cement wall and hit him in the stomach, calling him “stupid.” When Michael reached up to straighten his glasses, one of the boys snatched the glasses from Michael, threw them to the ground, and stomped on them. When Jimmy began to cry, one of the boys spit on Jimmy as the three boys fled into the nearby park laughing and yelling, “stupid, stupid, stupid!”
What signs/symptoms might indicate that Jimmy is disturbed by the bullying and is having trouble coping?
Outline a plan of care to assist Jimmy with coping with the bullying.