Case Study: Dementia

Case Study: Dementia

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 hypercholesterolemia 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

4. 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. Several 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)

CASE STUDY PROGRESS
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 donepezil (Aricept) 5 mg 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 to 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 promoting safety for K.B.?