Psychiatric Disorders



Psychiatric Disorders



Case Study 126


Name______________________________Class/Group__________________Date___________


Group Members_____________________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.




Scenario


You are the nurse working triage in the emergency department. This afternoon, a woman brings in her father, K.B., who is 72 years old. The daughter reports that, over the past year, she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. This morning, he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his own coffee, and he seems to be getting more agitated. K.B. reports that he has been having memory problems for the past year and, at times, has difficulty remembering the names of family members and friends. His neighbor found him down the street 2 days ago, and K.B. did not know where he was.


A review of his past medical history is significant for hypercholesterolemia and coronary artery disease. He had a myocardial infarction 5 years ago. K.B.’s vital signs today are all within normal limits.



1. What are some cognitive changes seen in a number of elderly patients?


2. You know that physiologic age-related changes in the elderly can influence cognitive functioning. Name and discuss one.


3. For each behavior listed, specify whether it is associated with delirium (DL) or dementia (DM).



4. Based upon the information provided by the daughter, do you think K.B. is showing signs of delirium or dementia? Explain.


5. You know that there are four main types of dementia that result in cognitive changes. List two of these types of dementia.


6. How can the level or degree of the dementia impairment be determined?


7. A number of diagnostic tests have been ordered for K.B. From the tests listed, which would be used to diagnose dementia?






Case Study Progress


Two weeks later, K.B.’s daughter calls the physician’s office and states, “I realize that the Aricept will not cure my dad, but there has been no improvement at all. Are we wasting our money?”




Case Study 127


Name______________________________Class/Group__________________Date___________


Group Members_____________________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.



Scenario


You are working the day shift on a medicine inpatient unit. You are discussing discharge instructions with J.B., an 86-year-old man who was admitted for mitral valve repair. His serum blood glucose had been averaging 250 mg/dL or higher for the past several months. During this admission, his dosage of insulin was adjusted, and he was given additional education in managing his diet. While you are giving these instructions, J.B. tells you his wife died 9 months ago. He becomes tearful when telling you about that loss and the loneliness he has been feeling. He tells you he just doesn’t feel good lately, feels sad much of the time, and hasn’t been involved in his normal activities. He has few friends left in the community because most of them have passed away. He has a daughter in town, but she is busy with her work and grandchildren. He also tells you that he has been feeling so down the past few months that he has had thoughts about suicide.






Case Study Progress


The psychiatrist on call comes in to evaluate J.B. After meeting with J.B., the psychiatrist writes an order for escitalopram (Lexapro) 10 mg daily at bedtime. J.B. is scheduled to see the psychiatrist the day after he is discharged from the hospital.




Case Study Progress


J.B.’s daughter visits him in the hospital, and they have a long talk. She is shocked when she realizes that her father is lonely to the point of considering suicide and tells you that she will do all she can to help him when he goes home.





Case Study 128


Name______________________________Class/Group__________________Date___________


Group Members_____________________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.



Scenario


You are the RN case manager in an outpatient mental health clinic. S.T. is here today for her outpatient mental health appointment. She has a diagnosis of bipolar disorder and has been stable for the past 3 years. Her last episode was one of mania that required hospitalization. She is 29 years old, married, with two children ages 2 and 4. She reports that her mood is better than it has been in a long time and she has lots of energy. When asked whether she thinks this is a recurrence of mania, she says no, she thinks that things are just finally getting better.




Case Study Progress


Lithium (Eskalith) is commonly used to treat bipolar disorder. S.T. has been taking lithium for several years.


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Jan 16, 2017 | Posted by in NURSING | Comments Off on Psychiatric Disorders

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