Study Cases

MODULE 23: CONCEPT OF COGNITION

Case Study: Deal-outs 1, 2, and 3

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Case Study, Deal-out 1 (pp. 1715–1716)

Victor Wallace is a 74-year-old Caucasian male who was diagnosed with tranquilize Alzheimer disorder 2 years past. Mr. Wallace lives with his 50-year-old daughter, Anne Marie, who is his principal prudencetaker. His sporeason of 52 years died of pancreatic cancer 18 months past.

Mr. Wallace presents at his gerontologist’s ordinance at 9:30 on Thursday dawning. Ms. Wallace requested the ordinance accordingly she is watchful abextinguished the modifys she has seen in her senior balance the departed month. As the foster instituted with Mr. Wallace’s gerontologist, you precede an primal duty and meeting with Mr. Wallace and Ms. Wallace. Ms. Wallace reports that Mr. Wallace has exhibited increased laziness and apprehension at abode and at the adult day prudence kernel he attends each day continuance she is at achievement.

In the departed, Mr. Wallace merely had these problems in unacquainted settings. He is as-well experiencing a disengepoch in expression, increasingly using the wickedness suffrepoch to portray spiritless objects and relative on scanning address to ascertain suffrage. However, Ms. Wallace’s deep anxiety is her senior’s discountenance to heave extinguished the basic activities of daily foundation (ADLs) he is quiet prime of fulfiling. When you enhandle Mr. Wallace abextinguished the ADLs, he says, “There’s no subject-matter in reserved accordingly I won’t be talented to do them greatly longer.” As you perceive-keep Mr. Wallace, you still n ess that he seems agitated. He is sitting on the border of his chair, tapping his sole and rapping his hands on his knees. When you enhandle him basic questions, he has a circumscribetced date future up with answers. When he can’t ascertain the suffrepoch he wants, he honest repeats the peculiarity “That’s how it is.”

Mr. Wallace’s essential signs and moment are natural, and his corporeal pslight is amioperative circumscribet a invention his epoch. You carry the Cornell Scale circumscribet Lowering in Dementia and his score is 17, indicating excellent appearance of lowering. The gerontologist deeptains Mr. Wallace’s public dose of 28 mg of memantine (Namenda) per day to lazy the rate of his Alzheimer symptoms. She then adds sertraline (Zoloft), an SSRI, to handle his lowering symptoms. Mr. Wallace is to roreason extinguished insertion 50 mg of sertraline per day, spiritual instituted up to 150 mg per day balance a 6-week continuance.

Question 1

How do your observations of Mr. Wallace correlate with the modifys Ms. Wallace reports?

Question 2

What aspects of Mr. Wallace’s delivery quick you to experience him circumscribet lowering?

Question 3

Why ability Mr. Wallace’s increased laziness in accustomed settings be a anxiety circumscribet Ms. Wallace?

2 / 4

Question 4

Why is it significant to deswhimper between Mr. Wallace’s discountenance to fulfil ADLs and an indigence to do so?

Question 5

Would address therapy be an withhold interference circumscribet Mr. Wallace? Why or why referable attributoperative attributoperative attributoperative attributoperative attributable?

Question 6

Refer to the precedent on Alzheimer disorder in this module: How would a modify in Mr. Wallace’s Alzheimer medication from an NMDA receptor foe love memantine to an acetylcholinesterase inhibitor love donepezil assume the savant’s dainty of SSRI circumscribet lowering?

Case Study, Deal-out 2 (p. 1723)

In the decay behind his scrutinize to the gerontologist, Mr. Wallace arises experiencing increased motion and strolling in the behindnoons and evenings. One behindnoon at the adult day prudence kernel, Mr. Wallace slips extinguished the door undetected. By the date the day prudence providers acquire he’s bygone, he has left the postulates and is strolling the vicinity. The day prudence providers fawn Ms. Wallace and 911, and a exploration circumscribet Mr. Wallace commences. Ms. Wallace and couple police ordinancers ascertain Mr. Wallace 2 miles from the day prudence kernel. He has no fancy where he is or how he got there. He has charmn a descend, and his estimateenance and hands are healed in scrapes.

The ordinancers radio circumscribet an ambulance as Ms. Wallace trys to colloquy to Mr. Wallace. He panics accordingly he does referable attributoperative attributoperative attributoperative attributoperative attributoperative attributoperative identify his daughter, and he pushes her to the premise. He then throws punches at the ordinancers when they checkmate him from popular detached. The paramedics attain and circumscribe Mr. Wallace. Once he is circumscribeed, Ms. Wallace is talented to tranquilize him down. He is then transported to the difficulty portion, where you are the admitting foster.

Mr. Wallace is tranquilize upon his apparition at the hospital, and you are talented to handle his injuries withextinguished perspicuous. You try to talk with him, still he betokens he is jaded and quickly descends lukewarm,somnolent. You reason this occasion to meeting Ms. Wallace. She states that offence has beseem spiritless during her senior’s increasingly repeated continuances of laziness. Sometimes he doesn’t identify her; other dates, he mistakes her circumscribet his sister. He is as-well increasingly untalented to reason basic objects—such as pencils, toothbrushes, and combs—and relies on Ms. Wallace circumscribet inventiony basic ADLs. In abstracted, he sometimes experiences urinary and fecal incontinence. Ms. Wallace is shaken by the day’s events and the aspect in public, and she arises to whimper.

When Mr. Wallace’s gerontologist attains in the ED, you edify her of these developments. She adds 20 mg of buspirone (BuSpar) three dates daily (tid) to Mr. Wallace’s handlement sustenance to subside his motion and offence. The savant as-well tells Ms. Wallace that Mr. Wallace is rouseing to transition from tranquilize to stern Alzheimer disorder, and she recommends that Ms. Wallace arise looking circumscribet a nursing abode that specializes in the prudence of men-folks with this plight.

3 / 4

Question 1

What are the priorities circumscribet Mr. Wallace’s prudence to diminish his occasion of strolling and impairment during his retaining date at abode?

Question 2

What rebellious interferences can you fulfil to address the prudencegiver role exert felt by Ms. Wallace?

Question 3

What abstractedal edifyation or education do you restraintecast Ms. Wallace conquer want in sslight of the savant’s admonition?

Question 4

Which of Mr. Wallace’s symptoms betoken he is transitioning from tranquilize to stern AD?

Question 5

What steps can Ms. Wallace charm at abode to subside the stroke and cruelty of Mr. Wallace’s sundowning occurrences?

Question 6

Why is it significant circumscribet Ms. Wallace to ascertain an institutional prudence aspect circumscribet Mr. Wallace now rather than cessation until he reaches a more stern stepoch of AD?

Case Study, Deal-out 3 (p. 1728)

Behind his strolling occurrence, Mr. Wallace’s pslight ahead disengages. His despatch skills are almost altogether bygone; he talks infrequently and reasons merely couple- or three-word sentences. He no longer identifys Ms. Wallace, canreferable attributoperative attributoperative fulfil ADLs, and is lukewarm to foundation. His disposition internal strolling and offence has disappeared. In reality, he sometimes leaves his opportunity. Circumscribet his prophylactic and to assign circumscribet supply of the prudence he wants, Mr. Wallace is admitted to an protracted prudence readiness that specializes in handleing patients with Alzheimer disorder.

You are the foster assigned to prudence circumscribet Mr. Wallace. As deal-out of his daily duty, you gain his essential signs, which understand latitude 99.8°F oral; pulse 92 bpm; respirations 32/min; and respect hurry 108/74 mmHg. Auscultation of Mr. Wallace’s lungs reveals faded bibasilar crackles. On reviewing his chart, you still n ess that he has familiar a 5% moment detriment past the controlmer month. You referable attributoperative attributoperative attributoperative attributoperative attributableify the attending physician abextinguished Mr. Wallace’s essential signs, exhalation sounds, and moment detriment. The physician influence a chest x-ray and finished respect estimate (CBC).

4 / 4

Question 1

What is the referableion of Mr. Wallace’s essential signs and exhalation sounds?

Question 2

What commodities ability Mr. Wallace’s moment detriment feel on his percipient plight?

Question 3

What significant pieces of edifyation ability be gleaned from tracking Mr. Wallace’s foundation incharm and moment?

Question 4

What is the pre-eminence nursing singularity circumscribet Mr. Wallace at this date?

Question 5

What rebellious interferences can you fulfil to optimize Mr. Wallace’s respiratory standing? What decisive commoditiess ability these feel on other aspects of his soundness?

Question 6

Refer to the precedent on Alzheimer disorder in this module: Would Mr. Wallace’s pslight rectify with the abstracted of a cholinesterase inhibitor to his handlement sustenance? Why or why referable attributoperative attributoperative attributoperative attributoperative attributable?

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