Neurological Disorders Essay Paper

Neurological Disorders Essay Paper

Subjective Data

Chief Complaint: confusion, restlessness, and agitation

History Of Presenting Illness: Ms. Peters is a 72 years old female accompanied by her son. His son reports that the mother has had acute episodes of confusion, restlessness, and agitation. The confusion has been so severe that she cannot find her way home. She is restless and agitated because she is frequently doing tasks, walking up and down, and moving objects at odd hours. These symptoms are associated with excessive daytime drowsiness, disorganized speech, forgetfulness, fatigue, and visual disturbance. She denies hallucinations, delusions, suicidal ideation, and hopelessness. Neurological Disorders Essay Paper

Psychiatric History: the patient has dementia and is on treatment. She denies anxiety disorder, depressive mood, post-traumatic stress disorder, and psychosis. She denies the use of hard drugs and substance abuse.

Past Medical History: the patient has dementia, diabetes mellitus, osteoporosis, hypertension, and chronic allergic rhinitis.

Current Medication: the patient takes Multivitamin daily for reduced appetite, Losartan 50mg daily for hypertension, HCTZ 50mg daily for hypertension, Fish Oil 1 tablet daily for supplementation, Glyburide 5mg daily for diabetes mellitus, Metformin 500mg BID for diabetes mellitus, Donepezil 10mg daily for dementia, and Alendronate 70mg orally once a week for dementia.

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Allergies: the patient develops a rash after taking atorvastatin

Immunization: her immunization schedule is up to date. Her last tetanus vaccine was three months ago and she is due for the pneumococcal vaccine in three weeks.

Family History: the patient is the first born in a family of three. Her parents passed on due to chronic diseases. Her father had coronary heart disease, osteoarthritis, and Alzheimer’s disease. Her mother passed on due to myocardial infarction secondary to malignant hypertension and obesity. Her sister, 67 years old, has mild dementia and diabetes. Her brother is 65years old and has coronary heart disease.

Social History: Ms. Peters is married and lives with her husband. She has three sons. She is a retired lecturer and is currently doing small-scale farming. She enjoys reading books and traveling. Her interests have been reducing continuously over time due to loss of concentration and memory loss. She smokes cigarettes with her husband. She denies taking alcohol. She enjoys taking deep-fried food and coffee.

Review Of Systems

General: the patient denies weight loss, fever, chills, and night sweats.

Vitals: temperature is at 98.1F, blood pressure is 120/64 mmHg, HR-72 20 Weight 150kgs, height 1.8meters, and BMI 30.86kg/m².

HEENT: The patient denies headache, eye ache, redness of the eyes, loss of hearing, throat pain, and running nose.

Neurological System: the patient has had progressive visual disturbance, memory loss, lack of coordination, weakness of the muscles, and tingling sensation in the palms and feet. She denies convulsions and altered levels of consciousness.

Respiratory System: the patient denies chest pain, coughing, running nose, wheezing, and sputum production:

Cardiovascular System: the patient denies palpitations, tachycardia, lower limb edema, syncope, orthopnea, and paroxysmal nocturnal dyspnea.

Gastrointestinal System: the patient denies abdominal pain, nausea, vomiting, reflux, heartburn, diarrhea, and constipation.

Genitourinary System: the patient denies dysuria, hematuria, polyuria, urgency, and incontinence.

Musculoskeletal System: the patient denies joint pain, stiffness, and muscle spasms. Neurological Disorders Essay Paper

Endocrine System: the patient denies unexplained weight loss, heat intolerance, night sweats, and mood swings.

Lymphatic System: the patient denies easy bruising, recurring infections, swelling of extremities, and fibrosis.

Skin: the patient denies itchiness, rash, acne, and peeling.

Objective Data

General: the patient is alert, restless, and healthy. She has no pallor, edema, cyanosis, dehydration, lymphadenopathy, or jaundice.

Neurological System: the patient has mild resting tremors. He has an unstable gait

Musculoskeletal System: the patient has no fractures, congenital deformities, and edema. The lower limbs have a reduced muscle bulk, tone, and power 3/5. The upper limb has resting tremors with reduced bulk, reflexes, tone, and power 4/5.

Cardiovascular System: the heart is palpable at 5^th ICS. The heart sounds S1 and S2 are present. There are no bruits, murmur, fluid thrill, or jugular vein distension. The peripheral pulses are present with a regular rate and rhythm,

Respiratory System: the chest has a symmetrical expansion on breathing. There is a resonant percussion note, and vesicular breath sounds. There are no rhonchi, stridor, or crackles.

Abdominal Examination: the abdomen is distended with flank fullness. The bowel sounds are present in all four quadrants. There is a tympanic percussion note. There is no fluid thrill and shifting dullness. There is no organ enlargement. The liver span is 1cm below the coastal region.

Diagnostic Investigations

1. Hemoglobin A1C 7.2%
2. GLUCOSE 90 65–99
3. SODIUM 130 135–146
4. POTASSIUM 3.4 3.5–5.3
5. CHLORIDE 104 98–110
6. CARBON DIOXIDE 29 19–30
7. CALCIUM 9.0 8.6–10.3
8. BUN 20 7–25
9. CREATININE 1.00 0.70–1.25
10. GLOMERULAR FILTRATION RATE (egfr) 77 >or=60 ml/min/1.73m2
11. CXR—no cardiopulmonary findings. WNL
12. CT head—diffuse Cerebral Atrophy

Mental State Examination

The patient is alert but easily distracted. Her eye contact is fair, has a clear and coherent speech, and is tangential at times. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert but disoriented to place and time. She scores MMSE 18 out of 30 with primary deficits in orientation, registration, attention, calculation, and recall at a previous visit.

Assessment

The patient presents with confusion, restlessness, agitation, daytime drowsiness, disorganized speech, forgetfulness, fatigue, and visual disturbance. On examination, she has resting tremors, visual loss, unstable gait, and muscle weakness. She has lifestyle diseases; dementia, diabetes mellitus, osteoporosis, hypertension, and chronic allergic rhinitis. She has diffuse cerebral atrophy and scores MMSE 18 out of 30 with primary deficits in orientation, registration, attention, calculation, and recall at a previous visit. The patient’s symptoms and past medical history suggest metabolic syndrome. A metabolic syndrome is a group of diseases that increases the risk for heart disease and stroke. Metabolic syndrome is characterized by hypertension, hyperglycemia, obesity, and hyperlipidemia (Hirode, G., & Wong, R. J. 2020). Complications associated with it are kidney injury, osteoporosis, and coronary heart disease. Hypertension, diabetes mellitus, and hyperlipidemia are risk factors for dementia, Alzheimer’s disease, and depressive mood. The differential diagnoses are dementia, Alzheimer’s disease, and depressive mood.

Dementia is an acquired loss of cognitive function affecting social and occupational aspects. There is a progressive degeneration of the cognitive functions due to neuropathology and cerebrovascular pathology (Arvanitakis, et al, 2019). Patients with dementia present with impaired memory, language, and attention because of disruption of the bidirectional information from the striatum to the neocortex in the frontal lobe. Other classical symptoms of dementia are visual hallucinations, misidentification, and delusions. Visual hallucinations are a result of hypoperfusion of the parietal and occipital associations cortices. Misidentifications are due to hypoperfusion of the limbic-paralimbic structures. Delusions are due to hyperperfusion of frontal cortices (Kalaria, R. N. 2018). Risk factors for dementia are old age above of 65years, apolipoprotein, female gender, hypertension, and diabetes mellitus. This is the patient’s actual diagnosis because she presents with progressive deterioration of cognitive functions, has diffuse cerebral atrophy, has moderate dementia in the MMSE score, has a family history of dementia, is over 65years, smokes a cigarette, has diabetes mellitus, and has hypertension.

Alzheimer’s disease is a neural disease presenting with progressive impairment of cognitive and behavioral functions. It is a result of the accumulation of plagues in the hippocampus thus, inhibiting its function of memory, learning, attention, reasoning, and judgment. Alzheimer’s disease symptoms are memory loss, misplacing things, decreased judgment, changes in moods and behavior, and disorientation to time place, and person. Other symptoms are lack of bladder and bowel control, groaning, seizure, difficulties in swallowing, and weight loss (Weller, J., & Budson, A. 2018). Risk factors are advancing age, obesity, insulin resistance, hypertension, dyslipidemia, smoking, and genetic predisposition. However, this is not the patient’s diagnosis because the patient denies a lack of bladder and bowel control, seizures, and weight loss. Neurological Disorders Essay Paper

According to Gold, et al, (2020), the depressive mood is a mental illness that affects cognitive functions and interpersonal relationships. The American psychiatric association states that depressive mood presents with sadness, depressive mood, loss of interest, worthlessness, sleep disturbance, eating disturbance, restlessness or agitation, and recurrent suicidal ideation (Rohani, et al, 2018). However, this is not the patient’s diagnosis because the patient does not present with mood changes.

Plan

Treatment for this patient involves both pharmacologic and non-pharmacology. I will change the current medication for glycemic control because the blood glucose levels are not well controlled. Additionally, metformin is a biguanide that needs a cautious prescription in patients with renal injury. The patient is on HCTZ 50mg, which causes potassium depletion and hyperglycemia. It is not recommendable in a patient with renal disease and diabetes mellitus. I would change the current medication to prevent interactions and adverse effects. Donepezil is an anticholinesterase inhibitor that treats the effects of behavioral and cognitive effects of dementia.

Pharmacological Treatment Plan

1. Sitagliptin 50mg for diabetes mellitus
2. Losartan 50mg for hypertension
3. Amlodipine 5mg for hypertension
4. Alendronate 70mg for osteoporosis
5. Donepezil 10mg for dementia

Non-pharmacological treatment methods are physical activities mild to moderate to enhance cognitive stimulation that helps in boosting memory and the quality of life. The patient needs a multidisciplinary follow-up that involves the physician, psychiatrist, psychotherapist, nutritionist, and physical exercise specialist to monitor the vitals and prevent complications.

Subjective Data

Chief Complaint: confusion, restlessness, and agitation

History Of Presenting Illness: Ms. Peters is a 72 years old female accompanied by her son. His son reports that the mother has had acute episodes of confusion, restlessness, and agitation. The confusion has been so severe that she cannot find her way home. She is restless and agitated because she is frequently doing tasks, walking up and down, and moving objects at odd hours. These symptoms are associated with excessive daytime drowsiness, disorganized speech, forgetfulness, fatigue, and visual disturbance. She denies hallucinations, delusions, suicidal ideation, and hopelessness.

Psychiatric History: the patient has dementia and is on treatment. She denies anxiety disorder, depressive mood, post-traumatic stress disorder, and psychosis. She denies the use of hard drugs and substance abuse. Neurological Disorders Essay Paper

Past Medical History: the patient has dementia, diabetes mellitus, osteoporosis, hypertension, and chronic allergic rhinitis.

Current Medication: the patient takes Multivitamin daily for reduced appetite, Losartan 50mg daily for hypertension, HCTZ 50mg daily for hypertension, Fish Oil 1 tablet daily for supplementation, Glyburide 5mg daily for diabetes mellitus, Metformin 500mg BID for diabetes mellitus, Donepezil 10mg daily for dementia, and Alendronate 70mg orally once a week for dementia.

Allergies: the patient develops a rash after taking atorvastatin

Immunization: her immunization schedule is up to date. Her last tetanus vaccine was three months ago and she is due for the pneumococcal vaccine in three weeks.

Family History: the patient is the first born in a family of three. Her parents passed on due to chronic diseases. Her father had coronary heart disease, osteoarthritis, and Alzheimer’s disease. Her mother passed on due to myocardial infarction secondary to malignant hypertension and obesity. Her sister, 67 years old, has mild dementia and diabetes. Her brother is 65years old and has coronary heart disease.

Social History: Ms. Peters is married and lives with her husband. She has three sons. She is a retired lecturer and is currently doing small-scale farming. She enjoys reading books and traveling. Her interests have been reducing continuously over time due to loss of concentration and memory loss. She smokes cigarettes with her husband. She denies taking alcohol. She enjoys taking deep-fried food and coffee.

Review Of Systems

General: the patient denies weight loss, fever, chills, and night sweats.

Vitals: temperature is at 98.1F, blood pressure is 120/64 mmHg, HR-72 20 Weight 150kgs, height 1.8meters, and BMI 30.86kg/m².

HEENT: The patient denies headache, eye ache, redness of the eyes, loss of hearing, throat pain, and running nose.

Neurological System: the patient has had progressive visual disturbance, memory loss, lack of coordination, weakness of the muscles, and tingling sensation in the palms and feet. She denies convulsions and altered levels of consciousness.

Respiratory System: the patient denies chest pain, coughing, running nose, wheezing, and sputum production:

Cardiovascular System: the patient denies palpitations, tachycardia, lower limb edema, syncope, orthopnea, and paroxysmal nocturnal dyspnea.

Gastrointestinal System: the patient denies abdominal pain, nausea, vomiting, reflux, heartburn, diarrhea, and constipation.

Genitourinary System: the patient denies dysuria, hematuria, polyuria, urgency, and incontinence.

Musculoskeletal System: the patient denies joint pain, stiffness, and muscle spasms.

Endocrine System: the patient denies unexplained weight loss, heat intolerance, night sweats, and mood swings.

Lymphatic System: the patient denies easy bruising, recurring infections, swelling of extremities, and fibrosis.

Skin: the patient denies itchiness, rash, acne, and peeling.

Objective Data

General: the patient is alert, restless, and healthy. She has no pallor, edema, cyanosis, dehydration, lymphadenopathy, or jaundice.

Neurological System: the patient has mild resting tremors. He has an unstable gait

Musculoskeletal System: the patient has no fractures, congenital deformities, and edema. The lower limbs have a reduced muscle bulk, tone, and power 3/5. The upper limb has resting tremors with reduced bulk, reflexes, tone, and power 4/5.

Cardiovascular System: the heart is palpable at 5^th ICS. The heart sounds S1 and S2 are present. There are no bruits, murmur, fluid thrill, or jugular vein distension. The peripheral pulses are present with a regular rate and rhythm,

Respiratory System: the chest has a symmetrical expansion on breathing. There is a resonant percussion note, and vesicular breath sounds. There are no rhonchi, stridor, or crackles.

Abdominal Examination: the abdomen is distended with flank fullness. The bowel sounds are present in all four quadrants. There is a tympanic percussion note. There is no fluid thrill and shifting dullness. There is no organ enlargement. The liver span is 1cm below the coastal region.

Diagnostic Investigations

1. Hemoglobin A1C 7.2%
2. GLUCOSE 90 65–99
3. SODIUM 130 135–146
4. POTASSIUM 3.4 3.5–5.3
5. CHLORIDE 104 98–110
6. CARBON DIOXIDE 29 19–30
7. CALCIUM 9.0 8.6–10.3
8. BUN 20 7–25
9. CREATININE 1.00 0.70–1.25
10. GLOMERULAR FILTRATION RATE (egfr) 77 >or=60 ml/min/1.73m2
11. CXR—no cardiopulmonary findings. WNL
12. CT head—diffuse Cerebral Atrophy

Mental State Examination

The patient is alert but easily distracted. Her eye contact is fair, the speech is clear and coherent but tangential at times. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She is alert but disoriented to place and time. She scores MMSE 18 out of 30 with primary deficits in orientation, registration, attention, calculation, and recall at a previous visit.

Assessment

The patient presents with confusion, restlessness, agitation, daytime drowsiness, disorganized speech, forgetfulness, fatigue, and visual disturbance. On examination, she has resting tremors, visual loss, unstable gait, and muscle weakness. She has lifestyle diseases; dementia, diabetes mellitus, osteoporosis, hypertension, and chronic allergic rhinitis. She has diffuse cerebral atrophy and scores MMSE 18 out of 30 with primary deficits in orientation, registration, attention, calculation, and recall at a previous visit. The patient’s symptoms and past medical history suggest metabolic syndrome. A metabolic syndrome is a group of diseases that increases the risk for heart disease and stroke. Metabolic syndrome is characterized by hypertension, hyperglycemia, obesity, and hyperlipidemia (Hirode, G., & Wong, R. J. 2020). Complications associated with it are kidney injury, osteoporosis, and coronary heart disease. Hypertension, diabetes mellitus, and hyperlipidemia are risk factors for dementia, Alzheimer’s disease, and depressive mood. The differential diagnoses are dementia, Alzheimer’s disease, and depressive mood.

Dementia is an acquired loss of cognitive function affecting social and occupational aspects. There is a progressive degeneration of the cognitive functions due to neuropathology and cerebrovascular pathology (Arvanitakis, et al, 2019). Patients with dementia present with impaired memory, language, and attention because of disruption of the bidirectional information from the striatum to the neocortex in the frontal lobe. Other classical symptoms of dementia are visual hallucinations, misidentification, and delusions. Visual hallucinations are a result of hypoperfusion of the parietal and occipital associations cortices. Misidentifications are due to hypoperfusion of the limbic-paralimbic structures. Delusions are due to hyperperfusion of frontal cortices (Kalaria, R. N. 2018). Risk factors for dementia are old age above of 65years, apolipoprotein, female gender, hypertension, and diabetes mellitus. This is the patient’s actual diagnosis because she presents with progressive deterioration of cognitive functions, has diffuse cerebral atrophy, has moderate dementia in the MMSE score, has a family history of dementia, is over 65years, has diabetes mellitus, and has hypertension.

Alzheimer’s disease is a neural disease presenting with progressive impairment of cognitive and behavioral functions. It is a result of the accumulation of plagues in the hippocampus thus inhibiting its function of memory, learning, attention, reasoning, and judgment. Alzheimer’s disease presents with memory loss, misplacing things, decreased judgment, changes in moods and behavior, and disorientation to time place, and person. Other symptoms are lack of bladder and bowel control, groaning, seizure, difficulties in swallowing, and weight loss (Weller, J., & Budson, A. 2018). Risk factors are advancing age, obesity, insulin resistance, hypertension, dyslipidemia, smoking, and genetic predisposition. However, this is not the patient’s diagnosis because the patient denies a lack of bladder and bowel control, seizures, and weight loss. Neurological Disorders Essay Paper

According to Gold, et al, (2020), depressive mood is a mental illness that affects cognitive functions and interpersonal relationships. The American psychiatric association states that depressive mood presents with sadness, depressive mood, loss of interest, worthlessness, sleep disturbance, eating disturbance, restlessness or agitation, and recurrent suicidal ideation (Rohani, et al, 2018). However, this is not the patient’s diagnosis because the patient does not present with mood changes.

Chief Complaint: Acute confusion (more than usual) and some agitation and restlessness

History Of Presenting Illness: Ms. Peters is a 70-year-old female brought in by her son with reports of acute confusion (more than usual), agitation, and restlessness. She states that she has increased drowsiness during the day despite sleeping a night, trouble thinking, concentration, loss of interest, anger outbursts, loss of interest, lack of energy, and increased craving for food. She denies feeling worthlessness, hallucinations, delirium, and nightmares.

Current Medications:

1. Multivitamin daily for reduced appetite
2. Losartan 50mg daily for hypertension
3. HCTZ 50mg daily for hypertension
4. Fish Oil 1 tablet daily for supplementation
5. Glyburide 5mg daily for diabetes mellitus
6. Metformin 500mg BID for diabetes mellitus
7. Donepezil 10mg daily for dementia
8. Alendronate 70mg orally once a week for dementia

Allergies: she is allergic to atorvastatin and develops a rash

Past Medical History:

1. Hypertension
2. Diabetes mellitus
3. Osteoporosis
4. Chronic Allergic Rhinitis
5. Dementia

Psychiatric History

The patient has had dementia. she has had progressive confusion and memory loss. she denies depression, anxiety, post-traumatic stress disorder, and psychosis. She denies drugs and substance abuse.

Family History: the patient is the first born in a family of three. Her father had coronary heart disease, osteoarthritis, and Alzheimer’s disease. Her mother passed on to myocardia infarction secondary to malignant hypertension and obesity. Her sister, 67 years old, has mild dementia and diabetes. Her brother is 65years old and has coronary heart disease.

Social History: Ms. Peters is married and lives with her husband. She has three sons. She is a retired lecturer and is currently doing small-scale farming. She enjoys reading books and traveling. Her interests have been reducing continuously due to loss of concentration and memory loss. She smokes cigarettes with her husband but denies taking alcohol. She enjoys taking deep-fried food and coffee.

Review Of Systems

General: the patient reports generalized body malaise. She denies chills and rigors, night sweats, and weight loss.

Cardiovascular System: the patient reports dyspnea on exertion. However, she denies chest pain, coughing, orthopnea, paroxysmal nocturnal dyspnea, lower limb swelling, and syncope.

Respiratory System: the patient denies coughing, running nose, chest pain, wheezing, and difficulties in breathing.

Gastrointestinal System: the patient reports abdominal bloating and reflux. However, she denies abdominal pain, nausea, vomiting, and diarrhea.

Genitourinary system: the patient denies dysuria, polyuria, hematuria, incontinence, and urgency.

Musculoskeletal System: the patient complained of joint pain, muscle stiffness, and muscle spasms. However, she denies muscle weakness and joint swelling.

Neurological: she denies dizziness, light-headedness, tingling, loss of coordination, seizures, or a sense of disequilibrium.

Skin/hair/nails: she reports improved acne due to oral contraceptives. The skin on the neck stopped darkening and facial and body hair has improved. She reports a few moles but no other hair or nail changes.

Objective Data

General Examination: the patient is alert and restless. She is well-built with no pallor, jaundice, cyanosis, edema, dehydration, or lymphadenopathy.

Vitals: temperature is at 98.1F, blood pressure is 120/64 mmHg, HR-72 20 Weight 150kgs, height 1.8meters, and BMI 30.86kg/m².

Neurological: there is no reduced sensation to monofilament in bilateral plantar surfaces patient assumes an upright posture, has resting tremors, stumbling gait, and cannot walk in a straight line.

HEENT: Head is nomocephalic. There is a moist nasal and oral mucosa with uvula rising midline on phonation and the gag reflex is intact. There are no thyroid nodules, goiter Frontal, and maxillary sinuses non-tender to palpation.

Respiratory examination: there is asymmetrical chest expansion with vocal fremitus equal bilaterally. There are clear lung sounds in all areas and resonant on percussion. The chest is symmetric with respiration and clear to auscultation.

Cardiovascular system: the heart sounds S1 and S2 are present. The Carotid is 2+ and the pulse is present in all areas with a regular rhythm. There are bruits in the aorta or other arteries. The capillary refill is less than 2seconds.

Abdomen: the bowel sounds are present and normal in all quadrants.  There is no mass or scars. There is a soft abdomen with no organ enlargement. The Liver span is 1 cm below the right costal margin. The spleen and kidneys are not palpable. There is no CVA tenderness. There is a tympanic percussion note. There are no fluid thrills and shifting dullness.

Musculoskeletal: she has pain with movement the limb Strength is 5/5 bilaterally on the upper limb and 5/5 lower limbs bilatrally. They are without masses, deformity, or swelling, and are of the full range of motion in all joints.

Skin: there are no abnormalities in nails, acne on the face, and facial hair on the upper lip. There is a normal scalp with a visible old scar on the left shin.

Diagnostic tests

1. Hemoglobin A1C 7.2%
2. GLUCOSE 90 65–99
3. SODIUM 130 135–146
4. POTASSIUM 3.4 3.5–5.3
5. CHLORIDE 104 98–110
6. CARBON DIOXIDE 29 19–30
7. CALCIUM 9.0 8.6–10.3
8. BUN 20 7–25
9. CREATININE 1.00 0.70–1.25
10. GLOMERULAR FILTRATION RATE (eGFR) 77 >or=60 mL/min/1.73m2
11. CXR—no cardiopulmonary findings. WNL
12. CT head—diffuse Cerebral Atrophy

Mental State Examination

The patient 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. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. Her son does say she has had some “stumbling” and balance issues but no reported falls.

Assessment

The patient presents with acute agitation, confusion, restlessness, drowsiness during the day despite sleeping a night, trouble thinking, concentration, loss of interest, anger outbursts, loss of interest, lack of energy, and increased craving for food. She has dementia, hypertension, diabetes mellitus, osteoporosis, and chronic allergic rhinitis. Her laboratory results are within the normal limits. Head CT scan shows diffuse cerebral atrophy. She scores 18 out of 30 in the mini-mental state examination, showing mild cognitive impairment. Therefore, my differential diagnoses are dementia, Alzheimer’s disease, and depression. Neurological Disorders Essay Paper

Dementia is a progressive neurological disease characterized by deterioration of behavioral and cognitive functions. It interferes with a patient’s memory, and mood changes increase vulnerability to infections, difficulties in communication, aggressive behavior, and functional activities of everyday life (Arvanitakis, et al, 2019). Dementia presents with varying levels of alertness, attention, drowsiness, confusion, memory loss, resting tremors, mild gait impairment, orthostatic hypotension, and visual hallucinations. Risk factors for dementia are advanced age above 65 years, hypercholesterolemia, hypertension, smoking, family history, and diabetes mellitus. The patient is of advanced age above 65 years, has hypertension, has a family history of dementia, and smokes cigarettes.

Alzheimer’s disease is a neurogenerative disease characterized by significant impairment of cognitive, behavioral, occupational, and sociological functions of an individual (Weller, J., & Budson, A. 2018). Alzheimer’s disease is incurable though its non-cognitive symptoms are treated by the use of antidepressants and benzodiazepines. Alzheimer’s disease can be mild, moderate, and severe based on the presenting symptoms. Signs and symptoms are confusion, memory loss, loss of concentration, hallucinations, restlessness, agitation, inability to cope in new situations, weight loss, and lack of bowel and bladder control. However, this is not the patient’s diagnosis because she denies hallucinations, changes in bladder and bowel control, and weight loss.

Depressive mood disorder is a mental illness that disrupts interpersonal relationships, substance abuse, work, and the patient’s medical outcome. Depression has significant potential for mortality due to the increase in associated suicide cases. Causes of depression are bereavement, loneliness, impaired social support, negative life events, aging, genetic predisposition, and environmental factors. The American psychiatric association DSM-5 criteria for depression includes sleep disturbance, eating disorders, suicidal ideation, hopelessness, loss of concentration, fatigue, loss of interest, and psychomotor agitation or retardation (Rohani, et al, 2018). However, this is not the patient’s diagnosis because the patient denies suicidal ideation and hopelessness.

You will choose ONE of the case studies below to develop your SOAP note: Week 2 Case 1 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 could not 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. 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. 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. 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 Weight: BMI: (formulate these from your past experiences). Note whether the BMI falls within normal, overweight, obese, etc. There is an easy app to use you can google to plug in the Wt and Ht and it will calculate the BMI for you. PMH: Hypertension, Diabetes, Osteoporosis, Chronic Allergic Rhinitis Allergies: Atorvastatin, rash 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: CXR—no cardiopulmonary findings. WNL CT head—diffuse Cerebral Atrophy 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. Hemoglobin A1C 7.2% Basic Metabolic Panel as shown below TEST RESULT REFERENCE RANGE GLUCOSE 90 65–99 SODIUM 130 135–146 POTASSIUM 3.4 3.5–5.3 CHLORIDE 104 98–110 CARBON DIOXIDE 29 19–30 CALCIUM 9.0 8.6–10.3 BUN 20 7–25 CREATININE 1.00 0.70–1.25 GLOMERULAR FILTRATION RATE (eGFR) 77 >or=60 mL/min/1.73m2 Upon reviewing her labs – what is your diagnosis for Mrs. Peters? Look carefully at the labs, her PMH, and current symptoms. What is your treatment plan? Remember that she is already being treated for dementia. Part of making a correct diagnosis is being a detective – do not miss the simple diagnosis, nor the common symptoms. Your primary diagnosis should be one of the differential diagnoses. Include a rationale of why you ruled in – or ruled out the ddx and chose the primary diagnosis. (The standard is at least 3 ddx, with one of these being your primary dx).

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NRNP 6540 WEEK TWO

I read each and every one of your SOAP notes – so here are some PEARLS as we begin our journey this semester:

*Review the proper format of the SOAP note before you document your note. Remember: this is not a nursing note – this is a medical note.

Review the examples in doc sharing.
If you include neuro: include the CNs checked, gait, Romberg if done, if you include muscles – do not put “weak” or “strong” – grade them starting with 5/5 for UE and LE.
Do not leave any areas blank with “not done” – points will be taken off for this.
It is acceptable to state “deferred” for a rectal exam or genitourinary exam if not pertinent to the CC. Do not use this for any other PE.
You must put the BMI
You must put the Vital Signs – always. Do NOT skip this. (2 pts off)
ALLERGIES – should include drugs, food, and environmental in ONE PLACE with the reactions.
2 points off if Allergy reactions are missing.
ORIENTATION: is usually placed in the general survey at the beginning of the PE. This should be “alert and oriented to place, time, situation, etc” DO NOT USE A&OX3 OR 4.
POINTS ARE TAKEN OFF FOR THIS.

DO NOT REPEAT ORIENTATION IN NEURO. Neuro is for the CN, gait, etc. (see example in doc sharing)
For the elderly: always state if weight loss is intentional or unintentional. This is very important in the elderly as unintentional weight loss can indicated a serious cause such as cancer. Always include the BMI.
Cardiac: should always be in your PE. Always note the S1S2. This is standard. If you note a murmur – grade it. Please review the grading of murmurs as needed.
Note: All assessments, including the ROS – must be proximal to distal!

Please use the standard abbreviations for the PE: PERRLA, EOMI, review the abdominal signs such as murphy’s sign, etc.
ROS: this is often a confusing area for nurses becoming NPs. If you have access to Bates’s book, or an app for ROS I highly recommend it. DO NOT PUT PE IN THE ROS.
An example of this I see commonly is “no nodes” I will take points off for this. This is a PE finding. Rarely does a patient check themselves for enlarged nodes, so best to keep this out of the ROS. Put it in the PE where it makes sense.

When writing your ROS the best way to indicate you are INTERVIEWING THE PATIENT IS TO WRITE: Denies, no complaints of, no history of, endorses, etc. If you have a solid symptom like rash you can put “no rash” but it can be a slippery slope if you keep using it. You must indicate that the finding is what the patient is telling you. Neurological Disorders Essay Paper

PE: the PE is simple and is only what you see and examine on the patient. This is not the place for symptoms. There are many good resources and examples for how to write the PE in a SOAP note. (See how to Ace the Soap note).
DIAGNOSTICS: should be placed in a separate area titled “Diagnostics” at the end of the PE. Keep in mind other providers will read your note. It is always difficult to try to find lab results or diagnostics if they are interspersed within the note.
This is a Virtual Soap Note: so you will be adding information from past patients (without identifying information) such as SH, PMH, etc. Many students have written great notes from past patient notes. Think of this as a practice note. The key is to become familiar with the writing of the CC, HPI, ROS, and PE, the Assessment (remember that you should have at least two or three differential diagnosis (ddx) and a primary dx. Your primary dx should be one of the ddx! – not an extra one! Neurological Disorders Essay Paper
Lastly: as NPs – you should not be putting “call the physician” as you would as a nurse. There is a paradigm shift whereby you will evaluate and treat – including prescribe for your patient commiserate with your knowledge and training. As with all providers, when a patient needs specialty care – you will refer to another provider, such as a PMHNP, psychiatry, OT, PT, oncology, etc.
Prescribing: as NP students on your SOAP notes – you should be prescribing medications, treatments, diagnostics, and referrals.
PEARL: You must ALWAYS put a return date on your note. You should never see a patient without a follow update. In the case of a simple PC visit, perhaps a bug bite, the follow up can be “return to office if the bite does not clear up in one week.” Otherwise, “return to office in 2-3 weeks” is standard.

NRNP 6540 WEEK TWO SOAP NOTE ASSIGNMENT

Please note that this is a SOAP note assignment and not a Discussion Board!

Week 2: Psychosocial Disorders

To prepare:

Review the case study you chose. 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.
REMEMBER SOAP NOTES ARE VIRTUAL NOTES. YOU WILL NOT HAVE ALL THE INFORMATION PROVIDED FOR YOU – YOU FILL IN THE BLANKS FROM PREVIOUS PATIENTS YOU HAVE SEEN, OR WHAT YOU THINK WOULD BE APPROPRIATE. DO NOT WRITE “ INFORMATION NOT PROVIDED” – YOU WILL NEED TO REDO THE NOTE.
Access the Focused SOAP Note Template in this week’s Resources
Remember to use the soap note resources, geriatric assessments forms, and other resources in doc sharing. Review the format of the soap note, the MMSE, heart murmurs, neuro/ musculoskeletal exam, CV exam etc. This is expected of you as an NP.

In Blackboard (BB) read the required and recommended readings.
Complete the Engage IL modules to receive your certificate (you can save and use this for CEs for your license in addition to credit in this course.) Be sure to open an account in Engage IL so you can view all the modules and receive credit – this is free as it was created by grant money – so it is completely free to you. You should find it in your BB required readings for each week.

REMEMBER TO REVIEW THE GRADING RUBRIC FOR EACH ASSIGNMENT FOR EACH WEEK. THIS IS IMPORTANT!

Hello, the overall paper has 77% match in safe draft, some of which is understandable but please review. Also review the paragraphs that start with “Alzheimer’s disease and “The American psychiatric association” are 100% match with another paper. The references are too small, I asked for 6 recent references. thank you
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No treatment plan for patient’s diagnosis. It confusing what the primary diagnosis is and the differential diagnosis. This paper is due tomorrow and am still working on it since Monday
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No treatment plan for patient’s diagnosis. It confusing what the primary diagnosis is and the differential diagnosis. This paper is due tomorrow and am still working on it since Monday
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No treatment plan for patient’s diagnosis. It confusing what the primary diagnosis is and the differential diagnosis. This paper is due tomorrow and am still working on it since Monday SOAP note. Neurological Disorders Essay Paper