NRNP 6540—Week 2 Case Study Assignment

NRNP 6540—Week 2 Case Study

Mr. Y is a 78-year-old man who was born in Korea and moved to the U.S with his wife 50 years ago. Together, the couple opened a floral shop and ran the business for 40 years. Mrs. Y enjoyed watching her husband’s talent and love of nature come out in his flower arrangements.

When Mr. Y was in his late 60’s, he starting having difficulty making his favorite flower arrangements. Their son also noticed Mr. Y misplacing tools, losing paper orders, and forgetting important pick-up times. At home, Mrs. Y noticed her husband having problems remembering recent events, and waking up at odd hours in the night thinking it was time to open the shop. Mr. Y was becoming irritable at home and at the shop. NRNP 6540—Week 2 Case Study Assignment

When Mr. Y was 70 years old, the family decided to sell the business. Their health-care providers confirmed that Mr. Y was presenting with early stage Alzheimer’s disease. The family then decided that Mrs. Y would be appointed as her husband’s Power of Attorney for personal care and property. She continued to care for her husband at home.

When Mr. Y turned 75 years old, he was having increased difficulty remembering where things were in the house. He often woke his wife at odd hours of the night thinking it was time to get up and ready. When Mrs. Y reoriented her husband that it was still night-time, he would get confused and easily upset. Mr. Y was also becoming more physically weak, but did not perceive his limitations. He was having frequent falls at home. A few times, Mr. Y had become lost outside of their home, forgetting where he had to go and which house was his.

Their son recognized that his mother was not as happy as she used to be. She was constantly worrying about her husband’s increasing care needs, and could not enjoy activities she used to do. She was stressed and was not sleeping properly. With support from their health-care providers, the family decided that a long-term care setting would benefit Mr. Y and Mrs. Y’s well-being.

Admission to long-term care

At the admission conference, the long-term care home’s social worker and charge nurse met Mr. Y and his family, and learned more about his history and preferences. His medical diagnosis includes moderate Alzheimer’s disease and osteoarthritis, with a history of urinary tract infections. Mr. Y hears well, uses reading glasses, and wears upper and lower dentures. Mr. Y also requires reminders to use his walker properly. Mrs. Y always prompted her husband for toileting, as well as when to eat and take medications. Mr. Y requires limited assistance from his wife during activities of daily living, such as dressing or transfers. As for his preferences, Mr. Y loves homemade Korean food, pastries, and warm drinks. He had always enjoyed baths in the evenings.

At the end of the second week in LTC, Mr. Y was no longer pacing the halls. He was often found napping in his room during the days. One afternoon, a nurse went into Mr. Y’s room and found him sleeping. She tried to gently wake Mr. Y, but he was not easy to arouse. She tried a second time and asked very loudly, “Mr. Y, it’s lunch time, are you ready to go?” Mr. Y slowly opened his eyes. The nurse repeated her question, and Mr. Y replied slowly, “Oh, I ate last week.” The nurse then asked, “I know you had breakfast this morning, now it’s lunch time. NRNP 6540—Week 2 Case Study Assignment

Are you hungry?” Mr. Y paused and closed his eyes. The nurse gently woke him again by rubbing his arm and repeated her question. Mr. Y slowly replied, “Yes, my wife is cooking, I will eat”. Together, they walked slowly to the dining room.

In the dining room, Mr. Y stared out the window and did not answer the CNAs when they asked him for his lunch preference. When approached a third time, Mr. Y rambled slowly in English and in Korean to the CNAs. He continued to speak Korean to the CNAs as they tried to assist him with his lunch, but he was unfocused and inattentive. He was unable to finish his meal because of his behavior. The staff were worried that he was not eating or drinking enough since admission.

When there were group activities, the therapists found it harder to encourage Mr. Y to attend and participate like he had been doing before. It took a lot of encouragement and assistance to have him attend. During the activity, he did not participate or sometimes fell asleep in the middle of the exercise or social program.

A few nights in a row, he was found wandering outside his bedroom without his walker. One time, he told the nurse, “Someone is looking for me.” The nurse reassured him that he is safe, and tried to direct him back to his room. But Mr. Y walked past the nurse and said, “I have to go to the bus stop.” After a few attempts, the nurse was able to direct Mr. Y to his room to sleep, and reoriented him to the use of the call bell. This behavior continued with increasing disorientation. The sleep disturbances resulted in Mr. Y being too drowsy in the mornings, and not able to eat any breakfast.

Although Mrs. Y was kept informed of her husband’s condition since admission to long-term care, it was not until her first visit during Mr. Y’s third week in long-term care when she realized how much her husband had changed. She was alarmed and asked the staff, “What is happening? What will be done for him? How can I help?”

Week 2: Psychosocial Disorders

In so many countries, to be old is shameful; to be mentally ill as well as old is doubly shameful. In so many countries, people with elderly relatives who are also mentally ill are ashamed and try to hide what they see as a disgrace on the family.

—Dr. Nori Graham, Psychiatrist and Honorary Vice President of Alzheimer’s Disease International

In this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia, delirium, or depression. Among caregivers, 36% report having tried to hide the dementia diagnosis of their family member (Alzheimer’s Disease International, 2019). As an advanced practice nurse providing care to patients presenting with dementia, delirium, and depression, it is critically important to consider the impact of these disorders on patients, caregivers, and their families. A thorough understanding of the health implications of these disorders, as well as each patient’s personal concerns, will aid you in making effective treatment and management decisions.

This week, you explore geriatric patient presentations of dementia, delirium, and depression. You also examine assessment, diagnosis, and treatment for these disorders and complete a SOAP (subjective, objective, assessment, and plan) note. NRNP 6540—Week 2 Case Study Assignment

Reference:
Alzheimer’s Disease International. (2019). World Alzheimer report 2019: Attitudes to dementia. Author. https://www.alz.co.uk/research/world-report-2019

Learning Objectives
Students will:

Evaluate patients presenting with symptoms of dementia, delirium, or depression
Develop differential diagnoses for patients with psychosocial disorders
Develop appropriate treatment plans, including diagnostics and laboratory orders, for patients with psychosocial disorders
Learning Resources
Required Readings (click to expand/reduce)

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Psychosocial disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 428–469). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Appendix B: Laboratory values in the older adult. In Advanced practice nursing in the care of older adults (2nd ed., pp. 505–506). F. A. Davis.

Note: See the labs that are relevant to this week’s topics.

Laske, R. A., & Stephens, B. A. (2018). Confusion states: Sorting out delirium, dementia, and depression. Nursing Made Incredibly Easy!, 16(6), 13–16. https://doi.org/10.1097/01.NME.0000546254.38666.1f

NIH National Institute on Aging. (2017). Basics of Alzheimer’s disease and dementia: What is Alzheimer’s disease? [Multimedia file]. https://www.nia.nih.gov/health/what-alzheimers-disease

Document: Focused SOAP Note Template (Word Document)

Required Media (click to expand/reduce)

Hartford Institute for Geriatric Nursing. (2013, September 24). Elder mistreatment assessment [Video]. YouTube. https://youtu.be/L8jzycu0eTo

Note: The approximate length of this media piece is 39 minutes.

Recommended Media (click to expand/reduce)

Engage-IL (Producer). (2017f). Dementia: Patient-centered dementia care—understanding patient and caregiver expectations [Video]. https://engageil.com/modules/patient-centered-dementia-care-understanding-patient-and-caregiver-experiences/

Note: View the Dementia: Patient-centered Dementia Care—Understanding Patient and Caregiver Experiences video module available in this free course.

Engage-IL (Producer). (2017g). Depression and delirium of the older adult [Video]. https://engageil.com/modules/depression-and-delirium-of-the-older-adult/

Note: View the Depression and Delirium of the Older Adult video module available in this free course.

Engage-IL (Producer). (2017k). Elder abuse and self-neglect [Video]. https://engageil.com/health-professional-ce/psychosocial-needs/elder-abuse/

Note: View the Elder Abuse and Self-Neglect video module available in this free course.

Engage-IL (Producer). (2017z). Sleep quality of the older adult [Video]. https://engageil.com/modules/sleep-quality-of-the-older-adult/

Note: View the Sleep Quality of the Older Adult video module available in this free course.

Assignment: Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

Photo Credit: Getty Images

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as an advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care.

To prepare:

Review the case study provided by your Instructor. Reflect on the way the patient presented in the case, including whether the patient might be presenting with dementia, delirium, or depression.
Reflect on the patient’s symptoms and aspects of disorders that may be present. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
Access the Focused SOAP Note Template in this week’s Resources.
The Assignment:

Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:

Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems. NRNP 6540—Week 2 Case Study Assignment

Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results? How would you interpret and address the results of the Mini-Mental State Examination (MMSE)?
Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other healthcare providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.

Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7
Submit your Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NRNP_6540_Week2_Assignment_Rubric
Grid View
List View
Excellent Good Fair Poor
Create documentation in the Focused SOAP Note Template about the patient in the case study to which you were assigned.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Current medications, checked against Beers Criteria
• Allergies
• Patient medical history (PMHx)
• Review of systems
9 (9%) – 10 (10%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.
8 (8%) – 8 (8%)
The response accurately describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.
7 (7%) – 7 (7%) NRNP 6540—Week 2 Case Study Assignment
The response describes the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.
0 (0%) – 6 (6%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, current medications, allergies, medical history, and review of all systems that would inform a differential diagnosis. A cross-check of medications against the Beers Criteria has not been completed. Or, subjective documentation is missing.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses
9 (9%) – 10 (10%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
8 (8%) – 8 (8%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
7 (7%) – 7 (7%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
0 (0%) – 6 (6%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide:
• At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
23 (23%) – 25 (25%)
The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.
20 (20%) – 22 (22%)
The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.
18 (18%) – 19 (19%)
The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.
0 (0%) – 17 (17%)
The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
In the Plan section, provide:
• A detailed treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits.
• A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. NRNP 6540—Week 2 Case Study Assignment
• Reflections on the case describing insights or lessons learned.
27 (27%) – 30 (30%)
The response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies neeed, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate strong critical thinking and synthesis of ideas.
24 (24%) – 26 (26%)
The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided. Reflections on the case demonstrate critical thinking.
21 (21%) – 23 (23%)
The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains innaccuracies. Reflections on the case demonstrate adequate understanding of course topics.
0 (0%) – 20 (20%)
The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, innaccurate, or missing. Reflections on the case are vague or missing.
Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care.
9 (9%) – 10 (10%)
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.
8 (8%) – 8 (8%)
The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.
7 (7%) – 7 (7%)
Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.
0 (0%) – 6 (6%)
Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.
3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.
0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors.
3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors.
0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (one or two) APA format errors.
3 (3%) – 3 (3%)
Contains several (three or four) APA format errors.
0 (0%) – 2 (2%)
Contains many (≥ five) APA format errors.
Total Points: 100
Name: NRNP_6540_Week2_Assignment_Rubric NRNP 6540—Week 2 Case Study Assignment