Nee help on these medical discussion questions

Oct 12th, 2015
DreamIt
Category:
Biology
Price: $25 USD

Question description

. Your patient is a 77 year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well. While shopping for groceries with her daughter she became separated from daughter in the aisles. She became confused and angry when store employees and others tried to assist her. It is now 30 minutes later.

=Discussion questions part one:

-What is your differential diagnosis based on the information you now have?

-What other questions would you like to ask her now?  (Questions can be asked of patient first, and then of reliable historian separately.)

*Part Two

ADDITIONAL HISTORY:

The daughter has noticed increased anxiety and confusion in her mother on several occasions

No personal or family history of psychological illness

Problems with abstract thinking

Poor or decreased judgment

Disorientation to time and place

Changes in mood and behavior

Changes in personality

FURTHER HISTORY:

No history of trauma or recent infection

Family history; father and brother have died from stroke and heart disease; mother had Alzheimer disease

 Current medications:  aspirin, 325 mg. daily; hydrochlorthiazide, 25 mg. bid

 No other medical history

 No known allergies

Discussion questions part two-1:

Now what do you think about her history?

 PHYSICAL EXAMINATION
 

Alert, elderly woman in no acute distress

T = 37 C orally; P = 85 and regular, RR = 15 and unlabored; B/P 158/88 right arm (sitting)

HEENT, skin, and neck:

Pupils are small, equal, and react to light sluggishly

Ocular fundus is pale; vessels are narrow and attenuated

Dentures present, buccal and pharyngeal membranes are moist without lesions or exudates

Skin pale, dry with senile lentigines

Skin is transparent with decreased turgor

Minor multiple ecchymosis noted on both forearms, no other lesions or abrasions

Trachea is midline, and no lymphadenopathy or thyromegaly noted

Carotid pulses full and equal bilaterally without bruit

No jugular venous distension

Lungs:

Increased anterior/posterior diameter with mild kyphosis

No shortness of breath, lungs clear to auscultation bilaterally

Cardiac:

Apical pulse (PMI) at the 5th ICS, left mid-clavicular region

Normal S1, S2; no murmurs, clicks, or rubs

Abdomen, Extremities, Neurological:

Abdomen round, symmetric with no apparent masses, hernias, scars, or lesions

Bowel sounds present and normal; no bruits

Tympanic to percussion in all quadrants with no masses or organomegaly

Extremities symmetric with no swelling, atrophy, redness, cyanosis, or skin lesions, warm bilaterally and all pulses present and equal bilaterally

No lymphadenopathy noted

Orientation to time, person, and place are inconsistent—does not know the day or date

Pinprick, light touch, vibration sensation are intact, and able to identify a key

Motor:  no atrophy, weakness or tremor; rapid alternating movements smooth

DTR’s all 2 + with no Babinski noted


Musculoskeletal:

Gait slightly wide based and unable to tandem walk

No Romberg

Joints and muscles symmetric; no swelling, masses, deformities, or tenderness

Mild spinal kyphosis

Joints:  smooth range of motion; no crepitation or tenderness noted

Extremities:  able to maintain flexion and extension against resistance without tenderness

=Discussion questions part two-2:

-What studies would you initiate now while preparing for intervention?
-What therapies would you initiate immediately while awaiting lab work?

Part three


LABORATORY RESULTS:

Head CT scan showed one small capsular infarction, no mass lesions or edema, and no hydrocephalus

No significant abnormalities noted in chemistry, hematology, and metabolic screens

MMSE findings of impairment of memory and three other cognitive areas

Geriatric Depression scale (GDS) positive for memory difficulty, disrupted sleep-wake cycle, apathy, increased dependence (classic for Alzheimer disease)

=Discussion questions part three-1:
 
-What does Alzheimer dementia look like on a CT scan?


EMERGENCY ROOM COURSE: 

Patient is cooperative with no apparent distress and becomes less confused with repeated explanation of circumstances

No change in physical exam and no repeat lab studies completed

=Discussion questions part three-2:


-What do you think is happening?

-Now what should be done and what can the patient expect?


HOSPITAL COURSE: 

Responds to therapy; condition stable

Discharged home in the care of daughter after 24 hours

Referred to neurologist for further evaluation of cognitive deficits and treatment

=Discussion questions part three-3:

 -What instructions and medications should this patient go home with?

Identify the interprofessional team necessary to care for this patient.

Describe the roles of each team member.

Explain how you as the advanced practice nurse will work with each team member and the patient to provide current evidenced based care.
 
What steps can she take to prevent further problems?


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