ACE.D triptych

Judy and Karen Jones


Judy Jones is an 85-year-old widow. Joseph, her husband of 50 years, died seven years ago. Three years ago Judy was diagnosed with mild dementia, and her oldest daughter, Karen, moved back into the family home to provide support for her mother. Judy also has two sons who live about an hour away. Karen works as a teacher in the local public school, and Judy has been able to stay home alone during the day while Karen is at work. 


As Judy is being admitted to the hospital with an upper respiratory tract infection, her daughter Karen describes her mother's recent increasing forgetfulness and need for more assistance with activities of daily living. Karen is feeling very guilty about not realizing how sick her mother was, and is showing signs of caregiver strain. She states that she thought her Mom only had a cold and was annoyed because she was unable to sleep well because her Mom was coughing so much during the night.

Scenario 1 Scenario 2 Scenario 3

This scenario takes place 24 hours after Judy was admitted to a medical/surgical unit. An x-ray confirms a diagnosis of pneumonia. Judy has been getting out of bed and crawling on the floor trying to get the small children that are crying out from under her bed. The nurse will be expected to conduct a respiratory assessment and implement appropriate respiratory care interventions. The nurse will also assess Judy's orientation using the Mini-Cog and CAM tools and will review her medications using the Beers Criteria.

Another 24 hours has passed. Judy has been wandering the halls, eating food taken from the employee refrigerator, and she has pulled out her IV line. The nurse calls the resident and he increases her dose of Lorazepam. One objective of the simulation is for the nurse to administer Judy's medications, including her IV antibiotic. Shortly thereafter, Judy becomes angry, confused, agitated, and starts screaming repetitively, "Why am I here?" The nurse will be expected to attend to Judy's safety needs using non-pharmacological interventions and reassess Judy using the Mini-Cog, and Beers Criteria tools to determine if Judy's behavior is related to her dementia and delirium or if it was precipitated by the increase in her dose of Lorazepam.

Judy's pneumonia has resolved, but during her hospital stay she was diagnosed with atrial fibrillation and started on a new medical regimen. Judy is doing well physically and her delirium is somewhat improved, but she is having insomnia. She will be discharged to a sub-acute facility soon. This scenario takes place while Judy's daughter Karen is visiting. Karen expresses concern about taking her mother back home after she is discharged from the rehabilitation center because she feels her dementia has gotten much worse. Karen believes she only has two choices: to resign from her teaching job and become a full time caretaker or put her mother in a nursing home. The nurse will be expected to use the caregiver strain index and explain to Karen the difference between delirium and dementia. The objectives also focus on selecting appropriate screening tools to reassess Judy's cognition and to review the new medication ordered for her atrial fibrillation using the Beers Criteria.

Finish the Story Assignment

Learners have now seen Judy at three snapshots in time. What do they think his life will be like three months from now?

Author Information

Jean Byrd, MSN, RN, CNE
Community College of Philadelphia
Philadelphia, PA


The Jenny and Karen Jones unfolding case content was reviewed in 2019.