Study Cases


Case Study: Distributes 1, 2, and 3

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Case Study, Distribute 1 (pp. 1715–1716)

Victor Wallace is a 74-year-old Caucasian male who was diagnosed with sparing Alzheimer disorder 2 years late. Mr. Wallace lives with his 50-year-old daughter, Anne Marie, who is his first preservationtaker. His consort of 52 years died of pancreatic cancer 18 months late.

Mr. Wallace presents at his gerontologist’s service at 9:30 on Thursday dawning. Ms. Wallace requested the enactment consequently she is uneasy environing the veers she has seen in her father aggravate the late month. As the protect afloat with Mr. Wallace’s gerontologist, you pass an judicious impost and confabulation with Mr. Wallace and Ms. Wallace. Ms. Wallace reports that Mr. Wallace has exhibited increased laziness and disquiet at residence and at the adult day preservation life he attends each day spaceliness she is at result.

In the late, Mr. Wallace solely had these problems in inconversant settings. He is to-boot experiencing a discard in turnology, increasingly using the evil-doing vote to narrate vile objects and trusting on scanning discourse to discbalance vote. However, Ms. Wallace’s main solicitude is her father’s disfavor to heave quenched the basic activities of daily help (ADLs) he is tranquil preferserviceeffectual of accomplishing. When you crave Mr. Wallace environing the ADLs, he says, “There’s no top in involved consequently I won’t be serviceserviceeffectual to do them fur longer.” As you heed Mr. Wallace, you music that he seems frolicsome. He is sitting on the verge of his chair, tapping his pavement and rapping his hands on his knees. When you crave him basic questions, he has a difficult space hence up with answers. When he can’t discbalance the vote he wants, he right repeats the turn “That’s how it is.”

Mr. Wallace’s life-containing signs and hurry are acknowledged, and his substantial aspect is amieffectual hindert a invention his date. You guide the Cornell Scale hindert Hollow in Dementia and his jaw is 17, indicating noble chance of hollow. The gerontologist maintains Mr. Wallace’s ordinary dose of 28 mg of memantine (Namenda) per day to lingering the series of his Alzheimer symptoms. She then adds sertraline (Zoloft), an SSRI, to discuss his hollow symptoms. Mr. Wallace is to romanifestation quenched portico 50 mg of sertraline per day, spiritual afloat up to 150 mg per day aggravate a 6-week end.

Question 1

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

Question 2

What aspects of Mr. Wallace’s endowment alert you to experience him hindert hollow?

Question 3

Why potentiality Mr. Wallace’s increased laziness in affeffectual settings be a solicitude hindert Ms. Wallace?

2 / 4

Question 4

Why is it influential to discern betwixt Mr. Wallace’s disfavor to accomplish ADLs and an weakness to do so?

Question 5

Would discourse therapy be an misspend insinuation hindert Mr. Wallace? Why or why referable?

Question 6

Refer to the archetype on Alzheimer disorder in this module: How would a veer in Mr. Wallace’s Alzheimer medication from an NMDA receptor foe enjoy memantine to an acetylcholinesterase inhibitor enjoy donepezil feign the savant’s rare of SSRI hindert hollow?

Case Study, Distribute 2 (p. 1723)

In the winter behind his investigate to the gerontologist, Mr. Wallace arises experiencing increased disturbance and vagrant in the behindnoons and evenings. One behindnoon at the adult day preservation life, Mr. Wallace slips quenched the door undetected. By the space the day preservation providers verify he’s bygone, he has left the accounts and is vagrant the neighborhood. The day preservation providers allure Ms. Wallace and 911, and a quest hindert Mr. Wallace commences. Ms. Wallace and brace police servicers discbalance Mr. Wallace 2 miles from the day preservation life. He has no fancy where he is or how he got there. He has enthralled a lapse, and his calculateenance and hands are practised in scrapes.

The servicers radio hindert an ambulance as Ms. Wallace strives to dialogue to Mr. Wallace. He panics consequently he does refereffectual acknowledge his daughter, and he pushes her to the account. He then throws punches at the servicers when they obviate him from ordinary afar. The paramedics enter and hinder Mr. Wallace. Once he is hindered, Ms. Wallace is serviceserviceeffectual to appease him down. He is then transported to the difficulty line, where you are the admitting protect.

Mr. Wallace is appease upon his likelihood at the hospital, and you are serviceserviceeffectual to discuss his injuries withquenched bright. You strive to say with him, still he betrays he is worn-out and alertly lapses heedless. You manifestation this occasion to confabulation Ms. Wallace. She states that invasion has grace vile during her father’s increasingly common ends of laziness. Sometimes he doesn’t acknowledge her; other spaces, he mistakes her hindert his sister. He is to-boot increasingly unserviceeffectual to manifestation basic objects—such as pencils, toothbrushes, and combs—and relies on Ms. Wallace hindert inventiony basic ADLs. In analysis, he casually experiences urinary and fecal self-indulgence. Ms. Wallace is shaken by the day’s events and the aspect in open, and she arises to grumble.

When Mr. Wallace’s gerontologist enters in the ED, you tell her of these developments. She adds 20 mg of buspirone (BuSpar) three spaces daily (tid) to Mr. Wallace’s discussment viands to diminish his disturbance and invasion. The savant to-boot tells Ms. Wallace that Mr. Wallace is rouseing to transition from sparing to violent Alzheimer disorder, and she recommends that Ms. Wallace arise looking hindert a nursing residence that specializes in the preservation of beings with this aspect.

3 / 4

Question 1

What are the priorities hindert Mr. Wallace’s preservation to curtail his expose of vagrant and damnification during his fostering space at residence?

Question 2

What dogged insinuations can you accomplish to oration the preservationgiver role clarify felt by Ms. Wallace?

Question 3

What analysisal tellation or command do you prejudge Ms. Wallace succeed need in easy of the savant’s admonition?

Question 4

Which of Mr. Wallace’s symptoms betray he is transitioning from sparing to violent AD?

Question 5

What steps can Ms. Wallace charm at residence to diminish the impact and cruelty of Mr. Wallace’s sundowning issues?

Question 6

Why is it influential hindert Ms. Wallace to discbalance an institutional preservation aspect hindert Mr. Wallace now rather than solicitude until he reaches a more violent stdate of AD?

Case Study, Distribute 3 (p. 1728)

Behind his vagrant issue, Mr. Wallace’s aspect fast discards. His message skills are closely fully bygone; he says hardly-ever and manifestations solely brace- or three-word sentences. He no longer acknowledges Ms. Wallace, canrefereffectual accomplish ADLs, and is lukewarm to patronage. His bias inland vagrant and invasion has disappeared. In deed, he casually leaves his capability. Hindert his protection and to sanction hindert anticipation of the preservation he needs, Mr. Wallace is admitted to an exhaustive preservation quickness that specializes in discussing patients with Alzheimer disorder.

You are the protect assigned to preservation hindert Mr. Wallace. As distribute of his daily impost, you gain his life-containing signs, which involve sky 99.8°F oral; pulse 92 bpm; respirations 32/min; and dignity hurry 108/74 mmHg. Auscultation of Mr. Wallace’s lungs reveals faded bibasilar crackles. On reviewing his chart, you music that he has conversant a 5% hurry detriment past the anterior month. You referableify the attending physician environing Mr. Wallace’s life-containing signs, inspiration sounds, and hurry detriment. The physician subserviency a chest x-ray and exhaustive dignity calculate (CBC).

4 / 4

Question 1

What is the perception of Mr. Wallace’s life-containing signs and inspiration sounds?

Question 2

What result potentiality Mr. Wallace’s hurry detriment enjoy on his sensitive aspect?

Question 3

What influential pieces of tellation potentiality be gleaned from tracking Mr. Wallace’s patronage incharm and hurry?

Question 4

What is the initiative nursing peculiarity hindert Mr. Wallace at this space?

Question 5

What dogged insinuations can you accomplish to optimize Mr. Wallace’s respiratory status? What dogmatic results potentiality these enjoy on other aspects of his heartiness?

Question 6

Refer to the archetype on Alzheimer disorder in this module: Would Mr. Wallace’s aspect reform with the analysis of a cholinesterase inhibitor to his discussment viands? Why or why referable?

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