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Eleanor is a 77-year-old white female resident of a skilled nursing facility. Recently her daughter requested an evaluation from the staff psychologist because she noticed that her mother’s Alzheimer’s symptoms appeared to be getting worse. Eleanor was admitted to the facility six months ago with moderately severe cognitive and physical decline and had to be placed in a skilled facility since she could no longer manage herself at home. Her daughter is a single mother of four teens and works too many hours to care for her mother in her home. She had attempted to care for her until Eleanor left the stove on, resulting in a minor kitchen fire. Eleanor has no history of mental illness, but she began to show signs of cognitive decline in her late fifties. The symptoms became much more pronounced after her husband’s death five years ago.

Recently her daughter and other members of the nursing staff noticed that Eleanor has become rather restless and combative. When she gets confused over her surroundings, she wanders through the halls attempting to open fire doors. When nurses attempt to redirect her back to her room, she swears at them and even struck one of them in the face. Her PCP authorized the use of restraints one day after she managed to wander out the front door and was found standing in the middle of the street trying to take a dog away from a woman who was walking it. She yelled at the woman, telling her that she needed the dog to protect her from people who were stealing her clothing in the nursing home.

• Summarize the clinical case.
• Create a list of the patient’s problems and prioritize them.
• Which diagnosis should be considered
• What is your rationale for the diagnosis
• What differential diagnosis should be considered
• What test or screening tools should be considered to help identify the correct diagnosis
• What treatment would you prescribe and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
• What standard guidelines would you use to assess or treat this patient

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Submission Instructions

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 evidence-based sources.

some answer for students

Patient’s Problems and Prioritization

1. Cognitive Decline and Alzheimer’s Disease
2. Behavioral and Psychological Symptoms of Dementia (BPSD):
3. Grief and Loss

Diagnosis

1. Primary Diagnosis: Alzheimer’s Disease.
2. Secondary Diagnosis: The symptoms of dementia that are behavioral and psychological (BPSD). Her symptoms of restlessness, agitation, violence, and delusions are typical of dementia patients, especially in the advanced stages.
3. Rationale for Diagnosis: Eleanor’s age, her declining cognitive function, and the way her symptoms have developed gradually make Alzheimer’s disease the most likely diagnosis. Her history of memory problems and cognitive deterioration is consistent with Alzheimer’s (Porsteinsson et al., 2021). BPSD is frequently seen in dementia patients and is usually linked to a deterioration of cognitive decline.

Differential Diagnosis

1. Vascular Dementia:
2. Delirium: Test/Screening Tools

1. Mini-Mental State Examination (MMSE): This standardized test can assess cognitive functioning and help monitor changes over time.
2. Brain imaging (MRI or CT): To confirm the presence of brain atrophy and rule out other structural brain abnormalities.

Treatment and Rationale

1. Psychopharmacology: Medications like cholinesterase inhibitors (e.g., donepezil) can help manage cognitive symptoms in Alzheimer’s disease. Antipsychotic medications may be considered to address BPSD if non-pharmacological approaches are ineffective (Srivastava et al., 2021).
2. Diagnostic Tests: Regular monitoring of cognitive status using tools like MMSE to track disease progression.
3. Referrals: Eleanor should be referred to a neurologist for a comprehensive evaluation and ongoing management. A geriatric psychiatrist can address her behavioral symptoms.
4. Psychotherapy: Cognitive-behavioral therapy or counseling for both Eleanor and her daughter can help them cope with the emotional and psychological challenges associated with dementia and caregiving (Srivastava et al., 2021).
5. Psychoeducation: Providing Eleanor and her daughter with information about Alzheimer’s disease, its course, and coping strategies is essential.

Standard Guidelines

• Follow the clinical practice guidelines established by the American Academy of Neurology for the management of Alzheimer’s disease.
• Implement non-pharmacological interventions, such as structured routines, environmental modifications, and sensory stimulation for BPSD, following recommendations from organizations like the Alzheimer’s Association.