NU 665 C Week 10 Geriatric Case Study

Important missing information from the case study

For Midge, a comprehensive evaluation and treatment plan are only possible if some vital information is known. To start with, we do not know what specific medications Midge is taking now, nor do we have the dosages. This is important, particularly in light of her statement that her blood pressure readings are erratic, and chances are she may not be adhering to her prescribed hypertension medicine (as directed). In order to identify any drug interactions or side effects that may be causing symptoms of this kind, it would help to know the entire pharmacological treatment.

Drawing from the case study, it is evident that the outcomes of recent medical examinations or cognitive evaluations are absent. These assessments would provide significant information on Midge’s general health and mental abilities. Regular medical examinations might uncover latent health conditions that may impact her behavior, while cognitive evaluations would assist in assessing the degree of any cognitive deterioration.

Most often, families come from a common genealogical background, live in similar areas, and act in much the same manner. All together, these features may be indicative of inherited diseases within a family (Lobbia et al., 2019). This is so because doctors can tell if someone or their relatives are more prone to getting certain diseases by looking at recurring maladies among their close kin. It must be remembered that the case involving Midge does not reveal any familial history of dementia or mental illness for the subject. Such information could affect the identification of Midge’s risk factors and help with diagnostic decision-making. Such data is beneficial since knowing about hereditary basis plays a big role in many neurological and behavioral disorders (American Psychiatric Association, 2022).

 

Lastly, there is insufficient information on Midge’s eating preferences, nutritional condition, and sleep routines. In older adults, cognitive performance and general health may be adversely impacted by inadequate diet and disrupted sleep. Gaining insight into these aspects of Midge’s life would be beneficial in formulating a holistic care strategy.

Average developmental achievements and potential vulnerabilities  

Midge is now 72 years old and in the late adulthood stage. Her stage in life comes with its spectrum of normative development and potential vulnerabilities. The bulk of the normative developments that would likely be on the ground at this level typically involve knowledge and experience accumulation. The majority of older adults like Midge have acquired a good deal of knowledge and expertise in life, and this may give them quite an advantage in making prudent decisions and problem-solving. Knowledge that could be an asset to this group as individuals and to the generations following them.

Grandparenthood and family bonds are often established throughout the latter stages of life. For several individuals, this phase of life comes with the pleasure of being a grandmother or, in Midge’s situation, a great-grandparent. Intergenerational interactions may provide individuals with a feeling of purpose and satisfaction. Nevertheless, Midge finds herself burdened by taking care of her great-grandchildren rather than finding it fulfilling.

Retirement is a milestone in the later years of life, particularly for older adults—a time when life offers extensive free time and the opportunity to pursue one’s interests. Midge has retired from working for Kroger, which could free up more leisure time for her. However, her current caregiving responsibilities appear to limit her ability to enjoy that aspect of later life.

While there are plenty of potential benefits to making it to late adulthood, there are also numerous perils to keep in mind as well. Physical and mobility concerns are at the top of most people’s lists. Weak muscles, difficulty in balancing, and long-standing health complications become common among older adults. If she were physically having problems, Midge would have more incredible difficulty handling activities in small children’s care.

Social isolation, therefore, is a risk that Midge is more likely to face when she reaches late adulthood. Reduced physical mobility, the loss of friends, and a social environment with few opportunities can create loneliness and feelings of isolation with detrimental effects on mental health.

Precipitating factors contributing to current symptoms

A lot of factors could contribute to the development of Midge’s symptoms. Taking care of young children at her advanced age is very likely to be among the most determinative factors. Looking after children aged 4 to 9 is a very demanding task from the point of view of energy and patience, as well as cognitively. An obligation of such nature could be too much for a 72-year-old woman and could add negative value to preexisting problems related to cognition or physical health.

Midge may be suffering from a grief response or residual trauma. The case study indicates that Midge’s husband died over ten years ago, and it speaks of a difficult childhood, where she had to stop schooling to be able to help out with her siblings’ needs when her father died. She has been a parent her whole life. Poor events in the past may have had lingering emotional impacts, now surfacing because of the stress of today’s realities.

Caregiving responsibilities can also lead to sleep disturbances, which might be another stressor. Good sleep plays an essential part in keeping the brain functioning normally and maintaining psychological stability. Lack of sleep because of late hours taking care of children could have a significant impact on Midge’s psychological well-being and ability to perform daily tasks or even cause hallucinations.

Differential diagnosis

One must consider alternative diagnoses with regard to Midge’s presentation. Alternative symptoms are consistent with dementia due to Alzheimer’s disease or other causes such as vascular dementia. Many of the potential dementias could be used to explain Midge’s symptoms, including what appears to be cognitive decline, difficulty with activities of daily living, and hallucinations. Due to her longstanding history of hypertension, it is essential to consider a specific workup for vascular dementia.

Another essential consideration is delirium. Unlike dementia, the development of delirium is typically acute and can be related to underlying systemic disease, drug side effects, or environmental factors. Midge’s confusion, hallucinations, and fluctuating changes in mental status could raise suspicions of delirium. Delirium has to be ruled out because it can often be reversed if the underlying etiology is identified and treated.

It is also essential to examine the possibility of a substance-induced psychotic condition, especially about probable interactions or adverse effects of medicine. Although there is no evidence indicating drug addiction, the combination of Midge’s blood pressure medicine and other medications she may be taking might result in cognitive changes or hallucinations.

Etiology of primary diagnosis

If we assume that the primary diagnosis is dementia, various things might contribute to its cause. Age-related changes in the brain primarily characterize dementia. As individuals age, the brain naturally experiences changes, such as shrinkage (atrophy), decreased blood supply, and inflammation. These alterations might potentially lead to a decrease in cognitive function and raise the likelihood of suffering from dementia.

Given Midge’s history of hypertension, vascular problems are most certainly a significant factor in her condition. Damage to brain blood arteries from chronic hypertension may limit blood flow and even cause cell death. A major cause of vascular dementia, this vascular injury may exacerbate cognitive impairment. The state of the blood vessels is essential in how symptoms develop in all types of dementia, including Alzheimer’s disease.

Midge may be genetically predisposed to dementia. Though there is no information regarding family history, it is pretty common that many types of dementia have genetic heredity. In Alzheimer’s disease, specific genetic mutations increase the risk for this type of dementia.

The effects of chronic stress on brain health also need to be considered. Early family obligations, her husband’s death, and her present caregiver responsibilities are just a few of the many stresses Midge has had to overcome throughout her life. An increase in cortisol levels caused by chronic stress may eventually cause damage to the hippocampus, an area of the brain that is essential for learning and memory.

Monitoring and assessing physiologic complications 

Regular physical checkups may detect additional health concerns causing Midge’s symptoms. Many health issues might affect cognitive performance in older adults; thus, systems should be thoroughly reviewed.  In Midge’s case, regular cognitive tests are needed. MMSE and MoCA are standardized cognitive function tests. These tests may follow cognitive changes and guide therapy.

Vitamin shortages and thyroid issues may be ruled out with blood testing. Thyroid problems and vitamin deficiencies (especially B12 and D) might manifest as mental fogginess. To further understand Midge’s health, doing a metabolic panel, complete blood count, and vitamin level testing would be helpful.

There is a dire need to monitor Midge’s everyday life skills. Regular health provider evaluations or family reports may help achieve this. Midge’s health deterioration may be tracked by changes in her capacity to care for herself or the children.

Useful nonpharmacologic therapies

Midge may benefit from a variety of nonpharmacologic treatments. People with mild to moderate dementia or Alzheimer’s disease may benefit from cognitive stimulation treatment (CST), a brief intervention program that is based on research. It can be done either individually or in groups. Dementia patients may maintain their cognitive abilities and social engagement with the help of CST, which consists of a sequence of themed activities. A therapist may help Midge by introducing activities that stimulate the mind and encourage social interaction, such as memory games and puzzles.

Midge could surely benefit from reminiscence therapy. Reminiscence therapy is a form of psychotherapy that involves thinking or talking about past experiences. By focusing on those past events, individuals experience satisfaction. Often, its applied among older adults, meaning it could serve an individual with overall well-being. Since Midge is attached to such traditional hymns, this can really be comforting and interesting therapy for her.

It is worth considering music therapy, mainly if it includes Midge’s favorite hymns. Music therapists employ music components such as tone, rhythm, and harmony to achieve stress reduction or enhance quality of life (Bakar et al., 2021). For Midge, listening to music she knows and loves might be a source of solace and inspiration.

Helpful medications and reasons

While nonpharmacologic treatments are essential, several drugs may ease Midge’s symptoms. Alzheimer’s disease and other dementias are treated with cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine (Redulla, 2019). These drugs boost acetylcholine, a neurotransmitter important in memory and thinking. In early to middle dementia, they may enhance cognitive performance.

Antidepressants may be helpful in cases when depression is present. It is believed that antidepressants alleviate depression by elevating levels of certain neurotransmitters. Certain brain chemicals may enhance mood and emotion. Due to their comparatively benign side effect profile, older individuals generally choose SSRIs like sertraline or escitalopram (Bakar et al., 2021). Improving cognitive performance and quality of life may be possible by treating depression if it is present.

It is essential to ensure the effective control of Midge’s hypertension. Individuals who have high blood pressure are advised to adopt healthy lifestyle modifications. The recommendation of medication is contingent upon an individual’s blood pressure measurement. Adequate blood pressure control is crucial for mitigating the risk of further cognitive deterioration in Midge, mainly if vascular factors influence her symptoms.

Safety risks and treatment plan

There are some safety concerns going on that the team will have to address with Midge. Wandering is one safety concern that needs to be addressed immediately. During the assessment, she walked with the children down the unpaved road. Not only is this type of behavior a risk to Midge herself but also to the children for whom she is responsible. The treatment plan for Midge could include adding door alarms and a GPS locator to address this specific potential safety concern. This function would be able to alert Midge’s daughter or other carers if Midge left the house and forgot to tell them.

Falls are common health issues among the aging population. Falls among older individuals with hypertension may compromise their general health and well-being (Rhoads, 2021). For that matter, fall risks should be reduced, especially at night when Midge checks the woodpile. A treatment plan should also allow for a thorough review of home safety conditions; these can include better lighting, removal of items that may cause stumbling, and handrails where necessary. It would be advisable for Midge to use walking aids where appropriate, as these may reduce the risk of falling.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, Text Revision (5th ed.). (DSM-5-TR) American Psychiatric Publishing, Inc. ISBN 978-0-89042-576-3

Bakar, A. a. A., Kadir, A. A., Idris, N. S., & Nawi, S. N. M. (2021). Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health, 18(16), 8257. https://doi.org/10.3390/ijerph18168257

Lobbia, A., Carbone, E., Faggian, S., Gardini, S., Piras, F., Spector, A., & Borella, E. (2019). The efficacy of Cognitive stimulation therapy (CST) for people with Mild-to-Moderate Dementia. European Psychologist, 24(3), 257–277. https://doi.org/10.1027/1016-9040/a000342

Redulla, R. (2019). Reminiscence Therapy for dementia. Issues in Mental Health Nursing, 41(3), 265–266. https://doi.org/10.1080/01612840.2019.1654572

Rhoads, J. (Ed.). (2021). Clinical consult to psychiatric mental health management for nurse practitioners. Springer Publishing Company.

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NU 665 C Week 10 Geriatric Case Study

Value: 100 points

Grading Category: Case Studies

Instructions

In this assignment, you will review the Geriatric Case Study and analyze the data to determine the health status of the patient. You will need a minimum of two scholarly references to support your work.

• Use the NU665C Geriatric Case Study Questions (Word) document to complete the case study assignment.
• Follow the requirements posted in the rubric.
• Interactive case studies should be five to seven pages, depending on the complexity of the case. This is excluding title and references pages.

All papers must conform to the most recent APA standards.

Please refer to the Grading Rubric for details on how this activity will be grade

Week 10: Learning Materials

Readings

Required

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, Text Revision (5th ed.). (DSM-5-TR) American Psychiatric Publishing, Inc. ISBN 978-0-89042-576-3
  • Review and utilize throughout the course as needed.
  • Neurocognitive disorders
• Boland, R., Verduin, M., & Ruiz, P. (2021). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Wolters Kluwer.
  • Chapter 3: Neurocognitive disorders
  • Chapter 25.2: Geriatric Psychiatry
• Fitzpatrick, J. J. (2022). Advanced practice psychiatric nursing (3rd ed.). Springer Publishing LLC.
  • Chapter 14: Integrative Management of Disordered Cognition
• Wheeler, K. (2021). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
  • Chapter 22: Psychotherapy with older adults
• MSN to DNP Informational Letter (Word)

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Recommended

• Rhoads, J. (Ed .) (2021). Clinical consult to psychiatric mental health. Springer Publishing.
  • Chapter 19: Neurodevelopmental Disorders

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Screening Tools

• PsychU
  • If you haven’t already done so, please register for access to this resource and search for applicable screening tools relevant to the assignments this week.

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Videos

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Use the following log in information to access the Symptom Media Library videos: Username: RegisNursing; Password: Regis0908.

• Brief Psychotic Disorder Video (5:29 Minutes)
  • A transcript for Brief Psychotic Disorder is available on the website, if needed
• Bi-Polar Disorder Current Episode Manic with Psychotic Features Video (3:00 Minutes)
  • A transcript for Bi-Polar Disorder Current Episode Manic with Psychotic Features is available on the website, if needed
• Schizophrenia Video (4:03 Minutes)
  • A transcript for Schizophrenia is available on the website, if needed