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NURS 6670 The PMHNP is asked to evaluate the elderly father of one of her patients. The father is a 72-year-old male who is demonstrating some difficult personality changes.

NURS 6670 The PMHNP is asked to evaluate the elderly father of one of her patients. The father is a 72-year-old male who is demonstrating some difficult personality changes.

 

The PMHNP is asked to evaluate the elderly father of one of her patients. The father is a 72-year-old male who is demonstrating some difficult personality changes.

Answer:

The PMHNP is asked to evaluate an elderly man who may have dementia. The man displays some of the changes that are common in an older adult with dementia; memory loss and a decreased ability to perform ADLs. He also has some changes in behavior that are not normal for him, such as being very impulsive, making inappropriate sexual remarks to his daughter’s friends, and not understanding that it is wrong to behave this way. As she considers the various causes of dementia, she looks for additional symptoms that may indicate the cause.

The first steps in evaluating the father include a physical examination, lab work, and imaging. The PMHNP observes that the patient does not have any focal deficits on his exam. His labs are sent to the laboratory for routine testing, including a complete blood count, a chemistry panel, liver function test, thyroid stimulating hormone (TSH), a hemoglobin A1c and urinalysis. A brain MRI demonstrates mild cerebral atrophy and infarction in the centrum semiovale on the right side of his brain. After further review of symptoms and knowledge of risk factors presented in this case scenario, the PMHNP decides to also order an HIV test to evaluate for HIV-sensitive dementia.

The PMHNP evaluates for potential causes of dementia, for example, bvhd, traumatic brain injury (TBI), delirium and vascular dementia. In this case, the PMHNP finds that the grandfather does not have bvhd, TBI or any other condition. He is prescribed Apo-Phenylbutazone ER and neurostimulants to combat his symptoms of impulsivity and restlessness.

The PMHNP listens to the daughter’s concerns and asks questions to help clarify the matter in order to continue with a more complete assessment.

If we assess both the known and baseline cognitive status, as well as any new symptoms, the PMHNP can determine if there’s going to be any decline in mental status, and whether or not that patient should be referred for additional screening. It is appropriate to do this at least annually. Tracking decline can help with early intervention services when they are needed.

It’s not uncommon for patients with dementia to have changes in personality and behavior. Impulsiveness, sexual and aggressive behaviors may be caused by changes in the brain linked to dementia or may be unrelated to dementia. One way to tell if these symptoms are related to dementia is to examine the memory and problem-solving skills of a patient. Often, when problems with memory, executive functioning, or language exist, it is unlikely that these symptoms are due to dementia. This article discusses the difficulties caused by impulsive behavior in patients with Alzheimer’s disease.

The father exhibits some symptoms of dementia. He seems to have a decrease in cognitive abilities (a memory problem).  He doesn’t seem to be able to function socially very well either. He might need a mental status exam or a psychosocial evaluation

Please review the attachment regarding Mr. Smith’s medical history and diagnostic examination, this will give you all of the details. From a nursing perspective, there are a few things that I would like to discuss with you further including assessment, strengths, priorities and goals. I have also included relevant documentation from my consultation with Mr. Smith’s daughter and his primary care physician.

Female: White: 60 years, presenting with confusion and disorientation. She seems lethargic, apathetic, disoriented, and confused. Her hair is a light brown color and she has it in a long braid. She has dark blue eyes and is not wearing any make-up.

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Question:

The PMHNP is asked to evaluate the elderly father of one of her patients. The father is a 72-year-old male who is demonstrating some difficult personality changes. His memory and ability to function ADLs seem intact, but the daughter reports that he seems very impulsive, and he doesn’t seem to appreciate that some actions or behaviors are inappropriate. He has been making inappropriate sexual remarks to some of her daughter’s friends and doesn’t understand that it is a problem. When considering various causes of dementia, the PMHNP evaluates for additional symptoms including:

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