NRNP 6540 Week 2 Assignment: Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

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. NRNP 6540 Week 2 Assignment 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, NRNP 6540 Week 2 Assignment and treatment for these disorders and complete a SOAP (subjective, objective, assessment, and plan) note.

^{Reference:
Alzheimer’s Disease International. (2019). World Alzheimer report 2019: Attitudes to dementia. Author. https://www.alz.co.uk/research/NRNP 6540 Week 2 Assignment 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 NRNP 6540 Week 2 Assignment

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. NRNP 6540 Week 2 Assignment 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. NRNP 6540 Week 2 Assignment
• 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? NRNP 6540 Week 2 Assignment 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.
• Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results? NRNP 6540 Week 2 Assignment 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. NRNP 6540 Week 2 Assignment 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. NRNP 6540 Week 2 Assignment 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.

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By Day 7

• 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) (attach sent)

Rubric Detail Tutor needs to FOLLOW

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Name: NRNP_6540_Week2_Assignment_Rubric

Name: NRNP 6540 Week 2 Assignment_Rubric

Week 2: Psychosocial CASE SCENARIO

Week 2 Case 1: Dementia

HPI: Ms. Peters is a 70-year-old female who is brought to your office by her son with reports of acute confusion (more than usual) and some agitation and restlessness. She has a known history of dementia, managed with Aricept 10 mg. daily. Her son, Jared, reports that 2 days ago she began to become more confused than usual and very easily agitated. He reports that yesterday, she couldn’t remember where she was in her own home. She had a doctor’s appointment 3 days ago and her HCTZ (hydrochlorothiazide) was increased to 50 mg. due to increased bp’s.

Ms. Peter’s last Mini-Mental State Exam (MMSE) score was 18/30. The assessment was repeated, and the score remained unchanged. NRNP 6540 Week 2 Assignment

Ms. Peters and her son denies her having any falls or contributing traumas recently. She denies any changes in diet or routine regimens. No reported dysuria, no fever, nausea, or vomiting. NRNP 6540 Week 2 Assignment

Note: Be sure to review the MMSE and how to interpret results (Mental State Assessment Tests). Make sure you document the patient’s score in your SOAP note document. Also review the Geriatric Depression Assessment (Geriatric Depression Scale [GDS]).

Ms. Peters is a 70-year-old female who is alert but easily distracted, at times, during today’s clinical interview. Her eye contact is fair. Speech is clear and coherent but tangential at times. She makes no unusual motor movements and demonstrates no tics. NRNP 6540 Week 2 Assignment She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert but disoriented to place and time. She denies any falls, denies any pain. Her son does say she has had some “stumbling” and balance issues but no reported falls.

All other Review of System and Physical Exam findings are negative other than stated.

Vital Signs: 98.1 120/64 HR-72 20

PMH: Hypertension, Diabetes, Osteoporosis, Chronic Allergic Rhinitis

Allergies: Atorvastatin NRNP 6540 Week 2 Assignment

Medications:

• Multivitamin daily
• Losartan 50mg daily
• HCTZ 50mg daily
• Fish Oil 1 tablet daily
• Glyburide 5mg daily
• Metformin 500mg BID
• Donepezil 10mg daily
• Alendronate 70mg orally once a week

Social History: As stated in Case Study

ROS: As stated in Case study

Diagnostics/Assessments done:

1. CXR—no cardiopulmonary findings. WNL
2. CT head—diffuse Cerebral Atrophy
3. MMSE—Ms. Peters scored 18 out of 30 with primary deficits in orientation, registration, attention and calculation, and recall at a previous visit. At today’s visit, there is no change. The score suggests moderate dementia. NRNP 6540 Week 2 Assignment
4. Hemoglobin A1C7.2%
5. Basic Metabolic Panel as shown below