Case Study
Ms. N is a 74 year-old female who is accompanied for admission to the nursing home by her daughter Doris. Ms. N appears distracted and confused repeatedly saying "I want to go home, why am I here?" Doris reports for over the past 3 weeks her mother, who has lived with her for over 10 years, has gone downhill quickly and she can no longer manage her falling and urinary incontinence (UI) at home. Doris has sought nursing home admission for respite for the next few weeks, but plans to admit her mother permanently due to her inability to care for herself.
During your focused interview you learn that Ms. N is actually paranoid, saying, "that lady over there, brought me here to get rid of me, I think she's trying to kill me." You quickly integrate questions from the Mini-Mental State Examination into your causal, but focused interview. Ms. N scores a 20/30. You conclude she is probably suffering from Dementia of the Alzheimer's type. A review of her medical records shows mild benign forgetfulness and recent confusion which was treated with Haldol 0.5 mg BID. Ms. N was independent in activities of daily living (ADL) up until 1 month ago. A typical day was spent driving herself to a part-time job at the local library.
A review of the medical record accompanying Ms. N reveals a recent CAT Scan of the head performed 1 week ago that was normal with no masses or atrophy. All other laboratory data is normal (CBC, B12, folate, and SMA-24). Missing are a routine urinalysis and thyroid function studies.Questions:
What would be a preliminary problem list for Ms. N?
What is the most important piece of information given in this scenario? Why?
Identify the atypical presentations and/or geriatric syndromes in this case study.
What other subjective data do you need to gather? Why?
What objective data do you need to gather about Ms. N? Why? Which screening tools would be helpful?
Finish this case study scenario to include the further subjective and objective data you might receive. What interventions would you propose? What would be some realistic and measureable projected outcomes?
2-3 pages not including reference and title page.