Question

DIRECTION: Create an NCP in relation to the case scenario.

Case Scenario: This is a case of a patient referred to a specialty memory clinic at the age of 62 with a 2-year history of repetitiveness, memory loss, and executive function loss. Magnetic resonance imaging scan at age 58 revealed mild generalized cortical atrophy. He is white with 2 years of postsecondary education. Retirement at age 57 from employment as a manager in telecommunications company was because family finances allowed and not because of cognitive challenges with work. Progressive cognitive decline was evident by the report of deficits in instrumental activities of daily living performance over the past 9 months before his initial consultation in the memory clinic. Word finding and literacy skills were noted to have deteriorated in the preceding 6 months according to his spouse. Examples of functional losses were being slower in processing and carrying out instructions, not knowing how to turn off the stove, and becoming unable to assist in boat docking which was the couple’s pastime. He stopped driving a motor vehicle about 6 months before his memory clinic consultation. His past medical history was relevant for hypercholesterolemia and vitamin D deficiency. He had no surgical history. He had no history of smoking, alcohol, or other drug misuse. Laboratory screening was normal. There was no first-degree family history of presenile dementia. Neurocognitive assessment at the first clinic visit revealed a poor verbal fluency (patient was able to produce only 5 animal names and 1 F-word in 1 min) as well as poor visuospatial and executive skills. He had fluent speech without semantic deficits. His neurological examination was pertinent for normal muscle tone and power, mild ideomotor apraxia on performing commands for motor tasks with no suggestion of cerebellar dysfunction, normal gait, no frontal release signs. His speech was fluent with obvious word finding difficulties but with no phonemic or semantic paraphrasic errors. His general physical examination was unremarkable without evidence of presenile cataracts. He had normal hearing. There was no evidence of depression or psychotic symptoms.

Answer 1

1. Disturbed thought process related to changes in cognitive abilities

Goal: patient maintains appropriate mental and psychological function as long as possible

Interventions:

• Assess the level of confusion and disorientation
• Orient the patient with the environment using calendars, TV etc.
• Maintain a daily schedule for routine
• Provide freedom for doing activities
• Allow wandering in a limited space
• Provide positive reinforcement and feedback for positive behaviors
• Provide opportunities for social interaction

2. Chronic confusion related to disease condition

Goal: patient maintains stable, safe environment with routine scheduling of activities

Interventions:

• Assess patients ability to interpret the environment
• Maintain consistent daily routine schedule
• Avoid frustrating situations
• Provide time for reminiscing
• Limit sensory stimuli and independent decision making
• Instruct family to avoid arguing with patient

3. Impaired verbal communication related to disease condition

Goal: patient maintains effective speech and understanding communication

Interventions:

• Assess the patients ability to speak and interpret communication
• Assess for nonverbal communication
• While talking with the patient use eye contact
• Make effective pacing
• Provide calm,unhurried environment for communication
• Use simple, direct questions to the patient

4. Risk for injury related to disease condition

Goal: patient remains free from injury

Interventions:

• Assess patients surrounding for hazards
• Eliminate or minimize the source of hazards in the environment
• Maintain adequate lighting and clear pathways
• Do not leave the floor slippery
• Use protective guards
• Monitor patient carefully