Patient Presentation of Dementia, Delirium, and Depression – GradSchoolPapers.com

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 the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and
follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Case Study 1:
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when
Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish
her correct address and they subsequently brought her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data: PE: VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.
General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.
Psych: A & 0 x 1 to person only. She has episodes of agitation and alternating withdrawaVsomnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer
questions, but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2:
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr.
White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing
it.
On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband
did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for
chronic lower back pain and occasional Benadryl to help her sleep at night. Objective data: Her physical examination is within normal limits. Case Study 3:
HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned
that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”

 
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