| Course | NRNP 6540 Advanced Practice Care of Older Adults |
|---|---|
| Week | Week 8 |
| Paper type | Dementia care plan |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6540 Week 8
Dementia Behavior Care Plan: Evening Pacing, Bath Refusal, and One Strike, Each Traced to Its Trigger
Student Name
College of Nursing, Walden University
NRNP 6540: Advanced Nurse Practice in Primary Care Adult Gerontology II
Instructor Name
Month Day, Year
Dementia Behavior Care Plan: Evening Pacing, Bath Refusal, and One Strike, Each Traced to Its Trigger
Behaviors, One at a Time
The patient is a composite: an 80-year-old woman with moderate Alzheimer-type dementia who lives with her daughter. The daughter kept notes for one week, and each behavior below comes from those notes, described by time, setting, trigger, and consequence.
Evening pacing: most evenings from about 5 to 8 p.m., she walks the hallway and tries the front door, saying she needs to "go home." The living room is dim once the sun sets; the television news is loud. Consequence: her daughter follows her, redirects her repeatedly, and misses her own dinner.
Bath refusal: on four of seven evenings she refused her bath, pulling away and crying when her daughter helped her undress. The bathroom is at the unheated end of the house; her daughter noted that she flinches as she enters. Consequence: baths have become a nightly struggle, and she has gone five days without one.
The single strike: on day five, during an evening bath attempt, she struck her daughter's arm as her daughter lifted her leg over the tub edge. She had been rubbing her left knee earlier that day. Consequence: a bruise on the daughter's arm, and the daughter's fear that it will happen again.
The three behaviors are not merged into one label, because each has a different time, setting, and trigger, and each points to a different response.
Investigation
Pain: she rubs her left knee, winces when rising, and has moderate osteoarthritis on examination; she has not been receiving any regular pain treatment because she cannot ask for it. Untreated pain is a common and treatable driver of distress in dementia (Kales et al., 2015). Constipation: last bowel movement three days ago. Infection: afebrile, no cough, urinalysis negative. Sleep: wakes twice nightly and naps in the late afternoon. Hearing aids: not worn for two weeks because they were lost behind the couch, so she cannot hear instructions clearly in a noisy room. Medications: an over-the-counter nighttime pain reliever containing diphenhydramine, an anticholinergic that can worsen confusion. The investigation finds untreated knee pain and a bathroom so cold she flinches entering it, as well as missing hearing aids and an anticholinergic drug.
Environmental and Care Changes
For evening pacing: brighter lighting in the living room from late afternoon, the television off during the evening, a short walk outside with her daughter before dinner, and her own music, big band records she has enjoyed for decades, played at five o'clock. Nonpharmacologic approaches tailored to the specific trigger are first-line for behavioral symptoms of dementia (Gitlin et al., 2012).
For bath refusal: move the bath to late morning, when she is least tired; heat the bathroom beforehand with a space heater; keep her covered with a towel while undressing; offer a sponge bath on alternating days; let her hold a washcloth.
For the strike: scheduled acetaminophen for knee pain, taken each morning and before bath time; a tub transfer bench so her leg is not lifted over the tub edge.
Across all three: hearing aids found and worn; diphenhydramine stopped; constipation treated; afternoon nap limited.
The Daughter's Capacity
Her daughter is 54, works part time from home, and is her mother's only caregiver. She sleeps about five hours a night and is exhausted. She says she loves her mother and is frightened of both the strike and her own frustration. The plan includes two days a week at an adult day center, covered by her mother's long-term care insurance, a caregiver education program at the local Alzheimer's organization, and respite care for one weekend a month. Her own sleep and health are part of the plan, not an afterthought.
Medication, Considered Last
The FDA's boxed warning on antipsychotics names higher mortality in elderly patients treated for psychosis tied to dementia, and they are among the drugs the American Geriatrics Society advises avoiding for behavioral symptoms of dementia unless other options have failed and the person is a danger to self or others (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023). No antipsychotic is started. The stated threshold for reconsidering: repeated physical aggression causing injury despite full implementation of the changes above for two weeks, or distressing psychosis that endangers her or her daughter. If that threshold is reached, any medication would be discussed with her daughter, started at the lowest dose, and reviewed for discontinuation within weeks.
Evaluation: the daughter will keep the same notes for two more weeks, and the plan will be reviewed at a visit in two weeks to see which behaviors changed.
References
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Gitlin, L. N., Kales, H. C., & Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. JAMA, 308(19), 2020-2029. https://doi.org/10.1001/jama.2012.36918
Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 350, h369. https://doi.org/10.1136/bmj.h369
The Walden NRNP 6540 Week 8 instructions
The eighth week of NRNP 6540 usually asks for a care plan for behavioral and psychological symptoms of dementia. You describe each behavior with its context, investigate medical and environmental causes, create nonpharmacological strategies, consider caregiver needs, and discuss medication only after those steps. Faculty grade sequence, so opening with an antipsychotic answers before asking. Cite the DICE approach or similar frameworks and antipsychotic safety evidence in APA 7. Caregiver strain should be assessed. Evaluation of the plan's effect is commonly required. Use respectful language about the person with dementia. NRNP 6540 faculty want each behavior described separately with its trigger and consequence, drawn from the daughter's notes. Name the medical causes checked and the results. Describe specific changes to the bath routine and evening environment. Assess the daughter's strain with a tool.
How the NRNP 6540 Week 8 example is put together
Each behavior is written up separately with its time, setting, trigger, and consequence, taken from a week of notes the daughter kept. Evening pacing, bath refusal, and the single strike are not merged into a general label. The investigation section checks for pain, constipation, infection, poor sleep, missing hearing aids, and a medication with anticholinergic effects, and finds untreated knee pain and a bathroom so cold she flinches entering it. Environmental changes follow: brighter evening lighting, a bath moved to late morning, a warmer room, her own music. The daughter's capacity is recorded plainly, including her sleep. Medication appears last, with the FDA boxed warning on antipsychotics in dementia named, and a stated threshold of danger that would justify reconsidering.
Reading the NRNP 6540 Week 8 rubric
Sequence carries this plan's grade. Opening with a medication for agitation answers before asking. This example describes and investigates before creating anything. Precise behavioral description earns credit on its own, because agitation as a single word cannot be targeted or evaluated. Investigation of unmet needs draws close attention, pain in particular, since an older adult with moderate dementia may be unable to report it. Credit also goes to caregiver feasibility, judged against what the daughter said she can manage. Points are withheld for antipsychotics proposed without their risks named, for one generic intervention like redirection applied to every behavior, and for plans with no measure of whether anything worked. The family in the example stands in for no real household.
NRNP 6540 Week 8 help from the desk
Behavior plans lose their grade at the start when a medication for agitation comes before any description or investigation. Describe and investigate first. Another common gap is treating all three behaviors with one strategy, though each has its own trigger. Match the strategy to the cause. Writers also forget pain, constipation and infection as causes of new behavior. Check them. Avoid ignoring the daughter's exhaustion. Assess her capacity and support. If medication is discussed, state the boxed warning and the plan to reassess. Close with how the plan will be evaluated. Writers also forget to record what happened after the strike, including safety for the daughter. Add a safety plan. Another frequent slip is a plan without an evaluation date. Set one.
Get a NRNP 6540 Week 8 example written to your instructions
Send the Week 8 prompt and rubric with the behaviors your case describes. The plan returned describes each one, investigates causes before proposing anything, and holds medication to the end with its risks named. Each behavior is written from the caregiver account in your scenario. Your first custom sample is free and reaches you within 24-48 hours.
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NRNP 6540 Week 8 questions, answered
What is the DICE approach?
A structured method for behavioral symptoms of dementia: describe the behavior and its context, investigate possible causes, create a plan that addresses them, and evaluate whether it worked. The example uses those four stages as its section headings. Other frameworks exist, and when your course teaches one, the finished sample is organized around it while keeping the same describe-before-treat logic.
Why is medication placed last?
Because the behaviors often have causes that medication does not treat, such as pain, a cold room, or a mistimed bath, and because antipsychotics carry an FDA boxed warning for older adults with dementia. The example names that warning and states what level of danger would justify reconsidering. Placing medication first is a common reason plans in this area lose credit.
How does the plan account for the daughter?
It records her sleep, her other commitments, and what she said she can manage, then sizes the interventions to fit. A plan built on unlimited caregiver capacity reads as unrealistic, and graders notice when a plan could not work in the household described. The daughter is as invented as her mother, and the feasibility section is written for their situation alone.
Where can I find a free NRNP 6540 Week 8 sample paper?
The dementia behavior plan is printed here with each behavior traced to its trigger, the investigation, the care changes, the daughter's capacity and medication last.
Which three behaviors does NRNP 6540 Week 8 address?
Evening pacing, refusal to bathe and one episode of striking out, each described by time, setting, trigger and consequence.