CASE 2 Jack Richards Katarina Mayer Makenzie Nelson

CASE #2 Jack Richards Katarina Mayer Makenzie Nelson

Patient #2 A 78 -year-old man comes to your office with his daughter. The daughter reports that her father, Mark, has been confusing the name of relatives and is having trouble controlling his emotions. Her father was once a respected mathematician, but he is now having trouble completing simple calculations. He even claims that he does not know how to play the card game they have been playing since she was a little girl. She tried to get him to shower and put on clean clothes for the doctor’s visit, but he is adamant about the fact that he is clean. Most recently, he has had trouble recognizing people he has known for years. For quite some time, he has had trouble finding items such as his glasses or keys and his daughter attributed this to the natural aging process. Now she is not so sure.

Symptoms Confusion � Instability of emotions � Trouble doing math � Forgetfulness/Memory Loss � Stubbornness � Inability to find items �

Possible Diagnoses � Dementia �Confusion �Instability of emotions �Forgetfulness/ Memory Loss �Stubbornness �Inability to find items � Hypothyroidism � Forgetfulness/ Memory loss � Stubbornness � Fatigue � Muscle Weakness � Depression

Tests for Diagnosis � Blood Test �Test for hypothyroidism �Detects the hormone levels in the blood stream and can the function of the thyroid can be determined � Physical Exam �Asks about diet and alcohol use �Reviews all medications �Check blood pressure, temperature, and pulse �Listen to the heart and lungs �Perform other procedures to assess overall health

Tests for Diagnosis � Mini-Mental State Exam (MMSE) � Tests for Alzheimer’s and dementia � Maximum of 30 points 20 -24 points suggests mild dementia 13 -20 points suggests moderate dementia Less than 12 points suggests severe dementia With Alzheimer’s, the points decline two to four points per year � Mini-Cog � Tests for Alzheimer’s and dementia � Patient is asked to perform two tasks Remember and in a few minutes repeat the names of three objects Draw a face of a clock and draw the time instructed by the professional there

Actual Diagnosis- Alzheimer’s � � � Blood test was negative for hypothyroidism Alzheimer’s shared the most symptoms with the patient Brain scans, such as a MRI and a CT scan, exhibited multiple signs of a brain with Alzheimer’s

MRI

CT

Effects of Alzheimer’s � � In a brain with Alzheimer's, the brain shrivels up, the hippocampus shrinks, and ventricles become larger. Cell death and tissue loss in a brain with Alzheimer's contain plaques and dead/dying nerve cells that have tangles (twisted strands of proteins). � Plaques are made up of beta-amyloid, a protein, when they clump together. � The tangles and plaques block the synapse from cell-to-cell, thus disrupting the charges that was being transmitted. Plaques and tangles spread through the cortex. � More about Alzheimer’s

Prognosis � Alzheimer’s will affect the patient’s life in the ways of � Memory loss � Language deterioration � Impaired perception and spatial relationships � Poor judgement � To make the patient feel long term ease, the thought of a home health nurse, a family member monitoring the patient, or the admittance to a nursing home may be few options the family may consider

Medical Professionals: Neurologist � � � Perform mental status exams that may include a 20 -30 question test, asking standard questions about daily life or current events, drawing/counting items, and monitor ability to perform and complete routine activities Other exams may test motor reactions, senses, reflexes, coordination, and the cranial nerves Visits occur every six months or with any decline in memory or any other skills

Medical Professional: Home Health Nurse � � � � Help clients in their daily personal tasks, such as bathing or dressing Provide basic health-related services according to a client’s needs, such as checking vital signs or administering prescribed medication at scheduled times Do light housekeeping, such as laundry, washing dishes, and vacuuming in a client’s home Organize a client’s schedule and plan appointments Arrange transportation to doctors’ offices or for other kinds of outings Shop for groceries and prepare meals to a client’s dietary specifications Provide companionship

Treatment � There are no known cures, but there are options that may help symptoms �To help memory loss cholinesterase inhibitors or memantine can be prescribed �To aid behavioral abnormalities antidepressants, anxiolytics, or antipsychotic medications could be taken

Sources Cited � � � � Medical College of Wisconsin. (nd. ). Alzheimer’s Disease Treatment and Prognosis. [accessed 9 October 2015]. Retrieved from: http: //healthlink. mcw. edu/article/921383587. html. Alzheimer’s Association. (nd. ). Treatments for Alzheimer’s disease. [accessed 13 October 2015]. Retrieved from: http: //www. alz. org/alzheimers_disease_treatments. asp Alzheimer’s Association. (nd. ). Treatments for Behavior. [accessed 13 October 2015]. Retrieved from: http: //www. alz. org/alzheimers_disease_treatments_for_behavior. asp Everyday Health. (nd. ). Assembling Your Alzheimer’s Care Team. [accessed 13 October 2015]. Retrieved from: http: //www. everydayhealth. com/alzheimers-care-team. aspx Alzheimer’s Association. (nd. ) Tests for Alzheimer’s Disease and Dementia. [accessed 13 October 2015]. Retrieved from: http: //www. alz. org/alzheimers_disease_steps_to_diagnosis. asp Mayo Clinic. (Dec 1, 2012). Hypothyroidism (underactive thyroid). [accessed 13 October 2015]. Retrieved from: http: //www. mayoclinic. org/diseases-conditions/hypothyroidism/basics/symptoms/con 20021179 Medscape. (Jul 27, 2014). Alzheimer’s Disease Imaging. [accessed 13 October 2015]. Retrieved from: http: //emedicine. medscape. com/article/336281 -overview National Institute on Aging. (June 2015). Alzheimer’s Disease Medications Fact Sheet. [accessed 13 October 2015]. Retrieved from: https: //www. nia. nih. gov/alzheimers/publication/alzheimers-diseasemedications-fact-shee