Neurological Disorders/Case Studies, assignment help

Your response must include your own conceptualization of the case, whether you agree or disagree with your peer’s response and why. You must use a minimum of one peer-reviewed source to support your response.

Response: 1 Warren

Case Study #1
This case is an 80-year-old male who is on an inpatient rehabilitation unit and you are being asked to see the patient to evaluate him for dementia versus delirium. The patient is a retired professor who was living alone and independently prior to his injury. He fell on the ice while retrieving his mail and sustained a right hip fracture. He underwent surgery for repair of his hip fracture two days prior to your consult. The patient has been exhibiting the following symptoms: occasional visual hallucinations, confusion about where he is, inconsistent recall as to the reason he is in the hospital, and behavioral outbursts (e.g., yelling and swearing at the staff).

In this case, I believe the patient is suffering from Delirium and not Dementia. Depression, Delirium and age-related memory impairment can all be mistake for Dementia. If a person start to display signs of cognitive impairment it is important not to assume it is Dementia, as there are other conditions that have similar symptoms to those of Dementia. In Dementia, memory loss were symptoms of dementia, a slowly progressing, generally irreversible loss of intellectual function. It affects both recent and remote memory, but a clear state of consciousness and alertness are maintained.

Delirium can also be mistaken as dementia, Delirium can develop quickly and is usually reversible. People have hallucinations, delusions, problems thinking or severe confusion. Some of the causes include dehydration, pain, low blood sugar level or a chest/urinary infection. Delirium is defined as a mental disturbance characterized by confusion, disordered speech and hallucinations. Delirium which is characterized by disorganized thinking, a decreased attention span, lowered or fluctuating level of consciousness, disturbances in the sleep-wake cycle, and disorientation.
Depression is a common condition which can be triggered by lives events and can be caused by chemical imbalances in the brain.

I would test low blood levels and sugar levels and also check for any types of infections to diagnose if delirium was the case.
Since delirium is usually reversible I would not come up with a long term plan right away. The patient just had surgery for his hip and has been yelling and swearing at the staff, therefore allowing a little time to pass and allow the patient to heal from the surgery is currently the key factor. Once the patient has time to heal from his surgery then we could start diagnosing him and running test. It doesn’t appear out of the norm to go from living independently to falling on ice to having surgery in the hospital at 80 years old and waking up hallucinating, confused and behavioral outbursts.

References

Von Rueden, K. T. (2017). Delirium in Trauma Patients: Prevalence and Predictors. Critical Care Nurse, 37(1), 40-48. doi:10.4037/ccn2017373

Russell, B., Buswell, M., Norton, C., Malone, J. R., Harari, D., Harwood, R., & … Goodman, C. (2017). Supporting people living with dementia and faecal incontinence. British Journal Of Community Nursing, 22(3), 110-114.

Response: 2 RUNNALS

I thought long and hard about which case to review and analyze here and decided upon case three in the week five case studies. This is the case of a 48-year-old male who in this case was being evaluated for behavioral and mood changes that had presented themselves in the preceding year as noted by his wife. He was noted at work and at home as appearing to be uninterested in activities that used to interest him and no longer do. I chose this case to discuss because bipolar and depression runs in my family and I am interested in learning more about it and the best means to treat and assist those suffering from it.

In this case, I will be playing the role of the clinician and I will report my findings backed with evidence support and possible successful treatment options. Depressive symptoms often occur because of a change in one’s environment, genetics, personal stresses, even a relapse of a depressive case that had presented itself during young adulthood, or even the teenage years. The symptoms of the individual in my case, in case three include but are not limited to; withdrawal symptoms, feelings of isolation, lack of interest in previously enjoyed activities, no desire for socializing, decline in work ability, not motivated, no longer cares about work, lack of time management, lack of interest in keeping job of twenty years. It was also stated in the week five discussion case study that the individual in question had no previous history of medical, neurological, or psychiatric disorder or disease. It was also stated that the individual was college educated and works at what can be a stressful job as an engineer with time sensitive plans and can affect upon the individual’s self-confidence and view on their own abilities.

My diagnosis here would be that the individual male is suffering from a depressive episode that most likely came about due to a combination of probable familial history of depression that was unreported due to fear of shaming for suffering from a mental illness. Depression in middle adulthood is typically defined as being stable but can adjust or change given one’s environment, genetics, or depressive symptoms in previous years (Tomitaka, Kawaskai, & Furukawa, 2015).

Another probability being that the stress of his job meeting demanding time limits and important projects that if spent considerable time working on and received negative feedback could impact upon his self-confidence and induce depressive symptoms. “Low self-esteem functions as a predictor for the development of depressive symptoms whereas the scar model assumes that these symptoms leave scars in individuals resulting in lower self-esteem (Steiger, Fend, Allemend, 2015).” Some testing that I would suggest here would be to determine a life satisfaction test to determine why he appears to no longer be happy. I would suggest also that there be a complete background write up on his familial medical history as well as his own medical history to prove suggested and assumed depressive symptoms. I would recommend for the individual patient and his family to take time and be patient with him while he readjusts and determines why he feels the way that he does. I would recommend open communication and perhaps even going to talk to a therapist as a family and individually so that there is no fear of judgement or retaliation.

References

Steiger, A. E., Fend, H. A., & Allemand, M. (2015). Testing the vulnerability and scar models of self-esteem and depressive symptoms from adolescence to middle adulthood and across generations. Developmental Psychology, (2), 236.

Tomitaka, S., Kawasaki, Y., & Furukawa, T. (2015). Right Tail of the Distribution of Depressive Symptoms Is Stable and Follows an Exponential Curve during Middle Adulthood. Plos ONE, 10(1), 1-8. doi:10.1371/journal.pone.0114624.