Case Studies for Case Studies for Delirium and DementiaDelirium and Dementia

From: GNRS 584: Mental Health NursingFrom: GNRS 584: Mental Health NursingAzusa Pacific University Azusa Pacific University 20112011

Meet the Brady’sMeet the Brady’s

Howie and S., 89 & 87, currently living at home Howie and S., 89 & 87, currently living at home with the following medical hx.with the following medical hx.H. has LH. has L6 6 fx. 6 months ago, prostate Ca for 3+ fx. 6 months ago, prostate Ca for 3+ yrs. (has declined tx) with hypertrophy, long yrs. (has declined tx) with hypertrophy, long standing hypothroidism, and skin disorder that standing hypothroidism, and skin disorder that standing hypothroidism, and skin disorder that standing hypothroidism, and skin disorder that leaves a chronic groin and scrotal Stage IIleaves a chronic groin and scrotal Stage II--III III wd., and has declining cognitive, social and wd., and has declining cognitive, social and physical functioning over last year. Old hearing physical functioning over last year. Old hearing impairment kept him out of armed forces.impairment kept him out of armed forces.S. developed wandering behaviors, delusional S. developed wandering behaviors, delusional thinking and agitation c nocturnal sleep disorder.thinking and agitation c nocturnal sleep disorder.

Meet the Fife’sMeet the Fife’s

D. and A., both 84, currently living at home with D. and A., both 84, currently living at home with the following medical hx.the following medical hx.D. lost sight in L eye 30 yrs ago due to D. lost sight in L eye 30 yrs ago due to glaucoma, NIDDM for ~ 20 yrs. with pain from glaucoma, NIDDM for ~ 20 yrs. with pain from neuropathy , cycles through depression espec. if neuropathy , cycles through depression espec. if stops meds, and has a virtual pharmacy in his stops meds, and has a virtual pharmacy in his neuropathy , cycles through depression espec. if neuropathy , cycles through depression espec. if stops meds, and has a virtual pharmacy in his stops meds, and has a virtual pharmacy in his home home –– rrxx & otc’s. Recent x2 TIA with blindness.& otc’s. Recent x2 TIA with blindness.A. has severe osteoarthritis of knees, takes a A. has severe osteoarthritis of knees, takes a cardiac beta blocker, recently sustained a fall cardiac beta blocker, recently sustained a fall with several bruised or fractured ribs.with several bruised or fractured ribs.Both = decreased energy, and increased Both = decreased energy, and increased forgetfulness, and interrupted sleep patterns.forgetfulness, and interrupted sleep patterns.

MedicationsMedications

H. takes Levothyroxine, Lexapro, Tylenol H. takes Levothyroxine, Lexapro, Tylenol arthritis, risperdal, mag colate, MVI, arthritis, risperdal, mag colate, MVI, Metamucil caps, Tetracycline,and Metamucil caps, Tetracycline,and RazadyneRazadyneRazadyneRazadyne

S. takes Exelon, Namenda, Lexapro, S. takes Exelon, Namenda, Lexapro, Vytorin, DSS, and Seroquel.Vytorin, DSS, and Seroquel.

MedicationsMedications

D. takes Metformin (Glucophage), Gabapentin D. takes Metformin (Glucophage), Gabapentin (Neurontin), HCTZ, Levothyroxine, Wellbutrin, (Neurontin), HCTZ, Levothyroxine, Wellbutrin, Tomazepam, terazosin, baby asa, plavix, & Tomazepam, terazosin, baby asa, plavix, & brimonidine, levobunilol, travatan eye drops, brimonidine, levobunilol, travatan eye drops, omaprazole & chloranthiaminine maleate prn.omaprazole & chloranthiaminine maleate prn.omaprazole & chloranthiaminine maleate prn.omaprazole & chloranthiaminine maleate prn.

A. takes pepcid & diazepam prn, lisinopril, A. takes pepcid & diazepam prn, lisinopril, atenolol, and triamterine HCTZ.atenolol, and triamterine HCTZ.

Positive Coping FactorsPositive Coping Factors

H. & S. H. & S. –– dtr and son close by and dtr and son close by and available in case of emergency, have available in case of emergency, have continuity of 24/7 in home private duty continuity of 24/7 in home private duty care givers with an Alzh. Specialist C.M., care givers with an Alzh. Specialist C.M., care givers with an Alzh. Specialist C.M., care givers with an Alzh. Specialist C.M., and House Call Doc.’sand House Call Doc.’sHave fenced in yard and patio with locks, Have fenced in yard and patio with locks, house doors are alarmed, well resourced house doors are alarmed, well resourced for whatever pt. needs.for whatever pt. needs.

Positive Coping FactorsPositive Coping Factors

D. does regular pool exercise, has a mini paper D. does regular pool exercise, has a mini paper route within retirement complex, does yoga once route within retirement complex, does yoga once or twice weekly, now has a computer and or twice weekly, now has a computer and collects jokes and funny stories, volunteers at collects jokes and funny stories, volunteers at the local hospice fundraisers, is involved in the local hospice fundraisers, is involved in the local hospice fundraisers, is involved in the local hospice fundraisers, is involved in U.U.church.U.U.church.A. belongs to a professional sorority, plays A. belongs to a professional sorority, plays bridge 1bridge 1--2 x’s monthly, gets her hair done 12 x’s monthly, gets her hair done 1--2 2 x’s a month, and does the domestic tasks, e.g. x’s a month, and does the domestic tasks, e.g. cooks their meals, shops, laundry, etc. cooks their meals, shops, laundry, etc.

True or falseTrue or false

Bereavment is risk factor for depression.Bereavment is risk factor for depression.10 10 –– 20%20%+ + of widows/widowers experience of widows/widowers experience depressive sdepressive sx x during the first yr of loss.during the first yr of loss.Crying, anxiety & agitation, insomnia and loss of Crying, anxiety & agitation, insomnia and loss of Crying, anxiety & agitation, insomnia and loss of Crying, anxiety & agitation, insomnia and loss of appetite for more than 1 month = major appetite for more than 1 month = major depressive disorder. depressive disorder. (p.655)(p.655)

Depression is the greatest risk factor for suicide.Depression is the greatest risk factor for suicide.Social support Social support to be meaningfulto be meaningful has to be has to be reciprocal.reciprocal.

True or falseTrue or false continuedcontinued

Suicide is the leading cause of death Suicide is the leading cause of death among > 65 yrs. among > 65 yrs. Risk factors include chronic illness, Risk factors include chronic illness, polypharmacy, care of pets (increased polypharmacy, care of pets (increased polypharmacy, care of pets (increased polypharmacy, care of pets (increased falls), grief and loss, and poverty.falls), grief and loss, and poverty.Spirituality and spiritual interests wanes Spirituality and spiritual interests wanes with age.with age.Never give pt.s c delirium pyschotrophic Never give pt.s c delirium pyschotrophic meds. meds. (p.677)(p.677)