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Case study

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Compares and contrasts the pathophysiology between Alzheimer’s disease and frontotemporal dementia. (CO1)
Identifies the clinical findings from the case that supports a diagnosis of Alzheimer’s disease. (CO3)
Explain one hypothesis that explains the development of Alzheimer’s disease (CO3)
Discuss the patient’s likely stage of Alzheimer’s disease (CO4)
Due Date

Initial post is due on Wednesday by 11:59 p.m. MT. All posts are due by Sunday, 11:59 p.m. MT

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.

Total Points Possible: 100

Preparing the Assignment

Requirements

Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.
Case Scenario

A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.

His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.

Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression

Allergies: No known allergies

Medications: None

Family History

Father deceased at age 78 of decline related to Alzheimer’s disease
Mother deceased at age 80 of natural causes 
No siblings
Social History

Denies smoking
Denies alcohol or recreational drug use 
Retired lawyer
Hobby: Golf at least twice a week
Review of Systems

Constitutional: Denies fatigue or insomnia
HEENT: Denies nasal congestion, rhinorrhea or sore throat.  
Chest: Denies dyspnea or coughing
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
Musculoskeletal: denies falls or loss of balance; denies joint point or swelling
General Physical Exam  

Constitutional: Alert, angry but cooperative
Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
Wt. 178 lbs., Ht. 6’0″, BMI 24.1
HEENT

Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact
Neck/Lymph Nodes

No abnormalities noted  
Lungs 

Bilateral breath sounds clear throughout lung fields.
Heart 

S1 and S2 regular rate and rhythm, no rubs or murmurs. 
Integumentary System 

Warm, dry and intact. Nail beds pink without clubbing.  
Neurological

Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia
Diagnostics

Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
MRI: hippocampal atrophy
Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.
Discussion Questions

Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.  
Explain one hypothesis that explains the development of Alzheimer’s disease
Discuss the patient’s likely stage of Alzheimer’s disease.


 

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