NU 664B Discussion 1: Memory Loss

Sample Answer for NU 664B Discussion 1: Memory Loss Included After Question

QUESTION

1. When did you notice a change in her memory? Its been ongoing for about 6 months now
2. Does she have any memory issues at baseline? No she was a college professor and has always been on top of everything
3. Is the memory loss different throughout the day? I think its worse in the evening hours
4. Does she have times when her memory seems normal? yes she has good days and bad days
5. Does she have any rambling or irrelevant conversations? No I havnt noticed anything like that
6. Do her thoughts seem disorganized or does she switch often from subject to subject? Yes I have noticed her do that and I also notice her repeat herself a lot
7. Are there times when she seems less alert? In the evening hours I have noticed this
8. When was her last concussion? The last one was a couple of months ago when she fell
9. When was her last TIA? She had one a year ago
10. Does she take any medications for stroke prevention? She was placed on plavix 75 mg daily when she had her first TIA 2 years ago
11. Is she on blood thinners? just the plavix
12. What medications is she on for HTN? She takes amlodipine 5 mg daily and lisinopril 5 mg daily
13. Is her blood pressure typically well controlled? its usually 130/80
14. Do you take her blood sugars daily? yes fasting in the morning
15. What is her normal blood sugar range? fasting in the morning it is usually 110-120
16. What medications does she take for diabetes? she takes metformin 500 mg twice a day and glipizide 5 mg daily
17. What medications does she take for her high cholesterol? Lipitor 10 mg at bedtime
18. When she fell, did she lose consciousness? Yes for a few seconds both times
19. How does she move around the house? she uses a cane
20. Does she take anything for her osteoarthritis? she takes extra strength tylenol and oxycodone 5 mg daily as needed
21. Has she had any new medications recently? the oxycodone was added a few months ago because she was in so much pain.

A Sample Answer For the Assignment: NU 664B Discussion 1: Memory Loss

Title: NU 664B Discussion 1: Memory Loss

HPI: 70-year-old African American woman, Selah, who is accompanied by her daughter, Britt, to the appointment. The PMH of the patient includes HTN, DM, Hyperlipidemia, TIA × 2, and Osteoarthritis of both knees, with multiple falls resulting in two diagnosed concussions. The daughter is concerned because she feels as if her mother’s memory isn’t what it used to be. Britt states that her mother sometimes misplaces things and forgets events, as well as the names of people she has known for a long period of time.

Differential Diagnoses

1. Alzheimer’s Disease. AD has an insidious and progressive onset for symptoms (Dunphy et al., 2019). Common signs of the onset of disease are seen by family members who start noticing changes over time. Cognitive decline often seen in AD patients are an inability to learn new information or recall things they knew previously, aphasia, apraxia, agnosia, and weaknesses with executive function (Dunphy et al., 2019). This patient is displaying signs of learning and memory deficits. She is having issues with misplacing familiar items and forgets events, and names of people she knows well. These are all signs for further assessment of AD (Dunphy et al., 2019).

 
2. Depression. Symptoms of depression can mimic AD (Dunphy et al., 2019). Once older adults have multiple falls, they can be fearful of falling again (Kiel, 2022). Fears of falling are associated with depression as well as cognitive impairments (Kiel, 2022). Increased depression can be a sign of increasing dementia with AD (Dunphy et al., 2019).

3. Head Injury. Head injuries are a risk factor for Alzheimer’s disease (Dunphy et al., 2019). She takes two antihypertensive medications, an opioid for pain, and a blood thinner. Antihypertensive medications should be closely monitored in older adults due to the increased risk for falls (Kiel, 2022). I would want to check PT/PTT and platelets as well as a head CT to ensure she does not have any intracranial bleeding.

4. Drug-related dementia. Opioids can negatively affect cognitive function in older adults (Dunphy et al., 2019). However, this can be ruled out in this patient because she was prescribed pain meds a couple of months ago, and her daughter states her memory issues started 6 months ago. Another drug to be weary of is the Plavix. This is a blood thinner and she has two recent falls.

 
Final Diagnosis: Alzheimer’s Disease


Pharmacology

• Donepezil (Aricept) (Dunphy et al., 2019).
• Vitamin E (Dunphy et al., 2019)


Non-Pharmacology

• Keeping a Routine
• Memory training
• Daily exercise
• Good nutrition/hydration
• Keeping up with preventative care (Dunphy et al., 2019).

 
Labs/Diagnostics

• CBC, CMP, serum Ca, TSH, FT4, Vitamin B12, UA, non-contrast CT brain (to rule out any surgically treatable lesions or vascular disease), PET scan (detect amyloid deposits) (Dunphy et al., 2019).

Referrals

• Memory disorder center
• Neurology for PET scan and evaluation
• Social services (Dunphy et al., 2019).

Patient Education

• Use memory aids and modify the environment at home so that her independent functioning can be maximized. By this I mean, declutter the house, make sure she uses proper footwear to avoid falls, keep important things she uses all the time out in the open where it can easily be found, etc. (Dunphy et al., 2019).
• Stick to routine. The more familiar her day to day is, the longer her cognitive function will remain intact (Dunphy et al., 2019).
• You can practice memory training to help with recall (Dunphy et al., 2019).
• Exercise and enroll in recreation activities she would enjoy to help with socialization (Dunphy et al., 2019).
• Have discussions about legal and financial issues related to decisions she is able to make and ones that should be left to someone she trusts, this includes end-of-life decisions (Dunphy et al., 2019).
• Be sure to keep a closer eye on her; memory issues can be dangerous if she starts to wander and cannot remember where she is (Dunphy et al., 2019).
• Donepezil (Aricept) common side effects are nausea, diarrhea, anorexia, and weight loss. We will monitor her liver function on this medication (Dunphy et al., 2019).
• Donepezil does not prevent progression of AD, but can slow the rate of decline in cognitive function (Dunphy et al., 2019).
• Donepezil reaches its therapeutic level with consistent administration. This means that she should not start and stop this medication as it will not allow her to reach the level of function she had before stopping the medication (Dunphy et al., 2019).
• Make sure she is eating a well- balanced diet (Dunphy et al., 2019).

Follow-up

• Placed referral to memory disorder center. This will give you resources which are multidisciplinary, to include counseling and support groups. These can be beneficial for your mother and you as her caregiver (Dunphy et al., 2019).
• Follow-up with social services so that an evaluation can be done for yours and her needs at home (Dunphy et al., 2019).
• Follow-up by returning to the clinic or urgent care if you notice aggressive changes in her behavior, increased depression, or changes involving loss of functional daily living (incontinence) or anything that may require more assistance from services or medical providers (Dunphy et al., 2019).

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care: The Art and Science of Advanced Practice Nursing-An Interprofessional Approach. (5th ed.). F.A. Davis.


Kiel, D. P. (2022). Falls in older persons: Risk factors and patient evaluation. UpToDate. Retrieved from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/falls-in-older-persons-risk-factors-and-patient-evaluation?search=Falls%20on%20blood%20thinners&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3