Week 6 discussion
Patient Presentation of Dementia, Delirium, and Depression
With the prevalence of dementia, delirium, and depression in
the growing geriatric population, you will likely care for elderly patients
with these disorders. While many symptoms of dementia, delirium, and depression
are similar, it is important that you are able to identify those that are
different and properly diagnose patients. A diagnosis of one of these disorders
is often difficult for patients and their families. In your role as the
advanced practice nurse, you must help patients and their families manage the
disorder by facilitating necessary treatments, assessments, and follow-up care.
Consider the patient presentations in the following case studies. What distinct
symptoms or factors would lead you to a diagnosis of dementia, delirium, or
Case Study 1:
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to
the emergency room by the police at 11 p.m. She was found wandering and
confused in a local neighborhood. The police were called when Mrs. Mayfield
tried to use her key on a neighborâ€™s door. When confronted by the police she
became abusive, confused, and frightened and looked very pale and agitated. The
police could not establish her correct address and they subsequently brought
her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature
General: She appears clean and well nourished, with no signs
of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only
intermittently cooperative. Her mental status fluctuates and a full
neurological evaluation is not possible at this time.
Psych: A & O x 1 to person only. She has episodes of agitation and alternating
withdrawal/somnolence. During the examination, it takes several attempts to
gain Mrs. Mayfieldâ€™s attention to answer questions, but once focused, she
rambles on in a disorganized and incoherent way.
Case Study 2:
CC: â€œirritable and forgetfulâ€
HPI: Mrs. White, a 78-year-old married woman, is brought to
the office of her primary care provider by her husband because of increasing
forgetfulness and irritability over the past 3 months. Mr. White claims that
his wife has had problems for several years now, but has just gotten â€œworse in
her memoryâ€ in the past few months. She recently misplaced her purse and accused
her son of stealing it.
On three occasions, she left the stove on and boiled a pot
dry, nearly causing a fire. She recently put a container of ice cream into the
washing machine instead of into the freezer and her husband did not discover it
for more than a week. Mrs. White claims her family wants to take her money and
leave her with nothing. â€œNo matter what they say, there is nothing wrong with
me,â€ she states.
Past Medical History (PMH) includes: hypothyroidism, treated
with Synthroid, and successful treatment of breast cancer approximately 15
years prior. She also takes over-the-counter ibuprofen for chronic lower back
pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal
Case Study 3:
HPI: Mr. George is a 72-year-old male who has lived alone
since his wife died approximately 1 year ago. He has lived in the same house
for 45 years. He is brought in by his son who is concerned that his father has
lost more than 35 pounds over the past year. Mr. George admits to not eating
well because â€œI donâ€™t know how to cook for myself.â€
PMH: He has been in good health with the exception of
hypertension, which is well controlled.
Social history: He spends most of his time watching sports
on television. He occasionally drinks one or two cans of beer when he is
watching TV. He does go to his sonâ€™s house to visit with his grandchildren about
once a week, and he says he enjoys that. He does not receive any social
services, he still drives but only in the daytime, and he does not participate
in any other leisure activities.
Objective data: His physical examination is normal. He
responds correctly to questions, although he appears to have a flat affect.
Review Chapters 6â€“8 of the Holroyd-Leduc and Reddy text.
Select one of the three case studies. Reflect on the way the
patient presented in the case study you selected, including whether the patient
might be presenting with dementia, delirium, or depression.
Think about how you would further evaluate the patient based
on medical history, current drug treatments, and the patientâ€™s presentation.
Consider whether you would modify drug treatments, use additional assessment
tools, and/or refer the patient to a specialist.
Post on or before Day 3 an explanation of whether you
suspect the patient in the case study you selected is presenting with dementia,
delirium, or depression and why. Then, explain how you would further evaluate
the patient in the case study based on medical history, current drug
treatments, and the way the patient presented. Include whether you would modify
drug treatments, use additional assessment tools, and/or refer the patient to a
Read a selection of your colleaguesâ€™ responses.
Respond on or before Day 6 to at least two of your colleagues
on two different days in one or more of the ways listed below. Respond to
colleagues who selected a different case study than you did.
Suggest additional tools for assessing the patients in the
case studies your colleaguesâ€™ selected.
Offer and support an alternative perspective based on your
own experience and additional research.
Validate an idea with your own experience and additional
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