Question

you are the nurse working triage in the emergency department. this afternoon, a woman brings in her

father, K.B., who is 74 years old. the daughter reports that over the past year she has noticed her father has

progressively had problems with his mental capacity. these changes have developed gradually but seem

to be getting worse. at times he is alert and at other times he seems disoriented, depressed, and tearful.

He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and

sugar in the refrigerator. K.B. reports that he has been having memory problems for the past year and

at times has difficulty remembering the names of family members and friends. His neighbor found him

down the street 2 days ago, and K.B. did not know where he was. this morning he thought it was night-

time and wondered what his daughter was doing at his house. He could not pour his own coffee, and he

seems to be getting more agitated. a review of his past medical history is significant for hypercholester-

olemia and coronary artery disease. He had a myocardial infarction 5 years ago. K.B.'s vital signs today are

all within normal limits.

1. What are some cognitive changes seen in a number of elderly patients?

2. You know that physiologic age-related changes in the elderly can influence cognitive

functioning. Name and discuss one.

3. For each behavior listed, specify whether it is associated with delirium (DL) or dementia (DM).

______ a. Gradual and insidious onset

______ b. Hallucinations or delusions

______ c. A sudden, acute onset of symptoms

______ d. Progressive functional impairment

______ e. Inability to perform activities of daily living (ADLs)

______ f. Incoherent interactions with others

______ g. Possible wandering behavior

______ h. Behavioral disorders that often worsen at night

Based on the information provided by the daughter, do you think K.B. is showing signs of

delirium or dementia? Explain.

5. You know that there are several types of dementia that result in cognitive changes. List two of

these types of dementia.

6. How can the level or degree of the dementia impairment be determined?

7. A number of diagnostic tests have been ordered for K.B. From the tests listed, which would

be used to diagnose dementia?

______ Mental status examinations

______ Toxicology screen

______ Mini-Mental State Examination

______ Electrocardiogram

______ Electroencephalogram

______ Complete metabolic panel

______ Complete blood count with differential

______ Thyroid function tests

______ Colonoscopy

______ Rapid plasma reagin (RPR) test

______ Serum B12 level

______ Bleeding time

______ Human immunodeficiency virus screening

______ Liver function tests

______ Vision and hearing evaluation

______ Magnetic resonance imaging (MRI)

After review of K.B.'s history and diagnostic test results, K.B. is diagnosed with Alzheimer's dementia. The

physician calls a family conference to discuss the implications with K.B. and his daughter.

8. What neuroanatomic changes are seen in individuals with Alzheimer's disease?

9. List at least three interventions you would plan for K.B.

Case Study Progress

K.B. is discharged and sees his primary care physician 2 days later. K.B. receives a prescription for donepe-

zil (Aricept) 5mg PO per night. As you review the prescription with K.B.'s daughter, she tells you that she is

"excited" because she did not know there were medications that could cure Alzheimer's disease.

10. How do you respond?

Case Study Progress

Two weeks later, K.B.'s daughter calls the physician's office and states, "I realize that the Aricept will not

cure my dad, but there has been no improvement at all. Are we wasting our money?"

11. What is the best answer for her question?

12. K.B.'s daughter mentions that she has found him out in the front yard and once in the

neighbor's yard. What are some interventions that you can suggest to promote safety for K.B?

Answer 1

1. What are some cognitive changes seen in a number of elderly patients?

            A degree of cognitive degeneration in alleged humans, which will include the following:

• Loss of immediate memory and associated benign amnesia
• Worsenedpresentation on intricate learning tasks
• Decelerating of the thought processes

2. You know that physiologic age-related changes in the elderly can influence cognitive functioning. Name and discuss one.

            Physiological changes in the elderly influence cognitive functioning, for instance:

A reduced visual acuteness and accommodation can result in diminished capacity to process visual cues. Yellowing and flattening of the cornea can lead to difficulty distinguishing colors.

3. For each behavior listed, specify whether it is associates with delirium (DL) or dementia (DM).

            The following behaviors associate with Delirium:

• Hallucinations or delusions
• A sudden, acute onset of symptoms
• Incapacity to execute ADL
• Behavior disorders often degenerate at night
• Incoherent interaction with others

                The following behaviors associated with Dementia

• Slow and insidious onset
• Progressive functional impairment
• Patient may exhibit wandering behavior

Furthermore, fewer functional cochlear cells can lead to a diminished ability to process auditory input.

4. Based on the information provided by the daughter, do you think K.B. is showing signs of delirium or dementia? Explain.

    K.B. is showing signs of DEMENTIA. Delirium presents with acute and reversible symptoms.

5. You know there are four main types of dementia that result in cognitive changes. List two of these types of dementia.

                Two of the four types of Dementia are:

• Alzheimer’s disease
• Vascular dementia

6. How can one determine the level or degree of dementia impairment?

            Determination of the level or degree of the dementia impairment may include:

A psychologist may administer testing of neuropsychologic testing in the major domains of thinking and memory; verbal and expressive abilities; constructional skills and executive functions. The information helps determine whether the patient is capable of continued handling of his or her own finances, driving, or ADLs.

7. K.B. has a number of diagnostic tests on order. From the tests listed, which ones use determines a diagnosis of dementia?

            Tests used to diagnose Dementia:

• Mental status examinations
• Toxicology screen
• Mini-Mental State Examination
• CMP
• CBC with differential
• Thyroid function tests
• RPR
• Serum B12
• HIV screening
• CT
• MRI

NB: I am unable to answer rest of the questions due to time limit, but you can still ask it separately