Clinical Case Study: A 74 year old woman was admitted to a long-term care facili
ID: 128020 • Letter: C
Question
Clinical Case Study:
A 74 year old woman was admitted to a long-term care facility. Her son reported that, over the past year he has noticed his mother progressively having problems with her mental capacity. The changes have developed gradually but have gotten worse. He reports that at times she is alert and other times she has been disoriented, depressed, and tearful. She has been forgetting thins and doing things out of the ordinary. His neighbor found her down the street looking for his father who passed 2 years ago. Because her behavior has gotten worse and she has become more agitated she is no longer able to live alone. She has medical diagnoses of dementia, a history of transient ischemic attacks, congestive heart failure, status post–myocardial infarction, hypercholesterolemia, and a history of urinary tract infections (UTIs), and urinary incontinence. Two weeks after her admission, she is observed by the nursing staff to be more confused and agitated over the past few days. She falls asleep during meals, and upon awakening, she is disoriented to place and time, thinking she is only visiting at the nursing home. She frequently calls out for her son and becomes combative and is always trying to leave the nursing home. These are new behaviors for this patient. The night staff report she is confused, and they have overheard her talking to her son during the night. Before this week, she was slightly confused, extremely courteous older women. The CNA reports the resident’s urine is foul smelling and dark in color.
1.What are some cognitive changes seen in a number of elderly?
2.Based on the information provided by the nursing staff do you believe the patient is experiencing delirium or dementia?
3.What type of test would be used to diagnose dementia?
4.What do you suspect has caused the most recent increase in the resident’s confusion, disorientation, and behavioral outbursts?
5.What medications would you suspect that she would be taking for her diagnosis of dementia?
Explanation / Answer
1.COGNITIVE CHANGES IN ELDERLY
As people age,they change in both biological and psychological.This mainly concerns the norm string brain,the neuroanatomical and neurophysiological changes that occur.The complexity of both the neural and cognitive functions ,however makes exact mapping between brain and behaviour extraordinary difficult,and so these relations remain largely speculative, although ultimately testable.
Age hinders attention, particularly when it is necessary to multitask.when switching from one task to another ,the elderly have more difficulty paying attention to multiple lanes of traffic, example noticing of someone bis about to step off a curb at a busy intersction.while memory declines for many people over time ,the exact nature of the decline depends on the particular type of memory.l language skills develop rapidly throughout childhood,with one exception:Recalling familiar
person's name.T his problem is particularly frustrating because mustering effort to force recollection of the word is likely not to help.
COGNITIVE OPTIMISM
Language and vocabulary are well retained throughout the life span.In fact ,vocabulary continues to improve in middle age.Rrcall of general knowledge acquired at young age and well practiced skill like arithmetic also peak in middle age and are resistant to age related decline.For example ,if asked why many foods need to be cooked ,most adults will have no trouble answering based on a lifetime experience .In addition older adults have a better overview of a situation.
2.As per the Information the patient is experiencing dementia
Since the patient as the symptoms of dementia which include:
1.subtle short term memory changes.
2.Difficulty in finding the right words
3.change in mood
4.Apathy
5.Difficulty in completing normal tasks.
6.confusion
7.Difficulty in following story lines.
8.A failing sense of direction
9.Being repetitive
10.struggling to adapt to changes.
3.Type of test used to dioagnose dementia
Mental ability test
This is used to check the mental abilities like memory and thinking These test are done by GP (General Practitioner). The name of test is GPCOG - General Practitioner Assessment Of Cognition.This include
Language and communication skills.
Blood tests to check OTHER condition:
Liver function
Kidney function
Thyroid function
Hemoglobin A1c
Vitamin B12 and folate levels
5.Medications for dementia
A. Tocorrect dementia thyroid replacement for hypothyroidism , vitamins for lack of vitamin B12 or antibiotics for infection.
B.cholinesterase inhibitors such as Donezepil ,galantamine and rivastigmine.
side effects include nausea ,vomiting,diarrhea and weight loss
Memantine .This is used to treat moderate vascular dedementia
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