NRNP 6540 Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

NRNP 6540 Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

Situation

Don't use plagiarized sources. Get Your Custom Essay on
NRNP 6540 Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression
Just from $7/Page
Order Essay

I am presenting Ms. Clara Simmons, a 74-year-old female, who was evaluated after expressing persistent low mood, loss of interest in activities, and feelings of helplessness. She also endorsed fears that something bad may happen, a sense of worthlessness, and hopelessness. It looks like she might be depressed because she got an 8 out of 15 on the short form of the Geriatric Depression Scale. She says she does not have severe confusion, hallucinations, or changes in how alert she is, all of which make delirium less possible (Marx et al., 2023).

Background

Ms. Simmons is a 74-year-old widowed woman who has lived alone since her husband’s death three years ago. She has limited social support, as her adult children visit infrequently. She has osteoarthritis, high blood pressure, and high cholesterol in her medical history. She also had a hysterectomy when she was fifty. Lisinopril 10 mg once a day, atorvastatin 20 mg once a night, and acetaminophen as needed for joint pain are the medications the patient is taking. She has not been in a psychiatric hospital, but she says her depression has gotten worse over the past year, especially in the last few months. She does not smoke, drink, or use illegal drugs. On exam, she was alert, oriented, and hemodynamically stable. Cognitive screening was standard, with an MMSE score of 29/30 and a MoCA score of 26/30. Routine labs were unremarkable (Abdoli et al., 2021).

Assessment

According to my assessment, Ms. Simmons most certainly fits the criteria for major depressive disorder with a late onset and no psychotic symptoms. This conclusion is supported by her self-reported symptoms, which are consistent with clinically severe depression, and her GDS score of 8/15. Although dementia is one of the differential diagnoses taken into consideration, her cognitive scores and maintained memory contradict this. Additionally, Delirium is unlikely due to the chronic nature of her symptoms and absence of acute medical illness or fluctuating mental status. A grief reaction, Prolonged Grief Disorder (PGD), is also a consideration; however, since she lost a loved one several years ago and is still having symptoms that make it hard for her to function, depression is the more likely diagnosis (Resendes et al., 2022).

Recommendation

I recommend starting treatment with an SSRI, such as sertraline 25 mg daily, with gradual titration as tolerated, along with a referral for cognitive behavioral therapy (Lubsen et al., 2021). In order to lessen her sense of loneliness, I would also advise her to join a bereavement support group or a senior community activity. In terms of follow-up, I advise continuing to coordinate with her primary care physician for the management of her chronic diseases, and I intend to review her in four weeks to check treatment response and side effects. If her symptoms worsen or suicidal thoughts develop, I would seek urgent psychiatric consultation.

References

Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2021). The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 132, 1067–1073. https://doi.org/10.1016/j.neubiorev.2021.10.041

Lubsen, J., Landeck, J., & Stiles, M. (2021). Depression and grief in older women. In Springer eBooks (pp. 45–60). https://doi.org/10.1007/978-3-030-59058-1_4

Marx, W., Penninx, B. W. J. H., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M. (2023). Major depressive disorder. Nature Reviews Disease Primers, 9(1). https://doi.org/10.1038/s41572-023-00454-1

Resendes, N., Hammel, I., & Hogue, C. (2022). The 3 DS: Dementia, Delirium, and Depression in oral health. In Springer eBooks (pp. 161–175). https://doi.org/10.1007/978-3-030-85993-0_9

CLICK HERE TO ORDER A PLAGIARISM-FREE PAPER

Assessing, Diagnosing, and Treating Dementia, Delirium, and Depression

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as an advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care.

The Situation-Background-Assessment-Recommendation (SBAR) format is a widely recognized method of communication in healthcare settings and assists in organizing and presenting information in a way that is understandable and integrated into the diagnostic process. It can be used to present a case as a nurse to a provider, or provider to provider, during consultations. As a nurse practitioner student and future provider, being able to communicate effectively about a patient to ensure the best and most efficient outcomes, is a critical skill.

In this assignment, you will demonstrate your ability to present a clinical case to another healthcare provider using the SBAR format. Think of this as formal practice in the skill of presenting a case. The following from The Agency for Healthcare Research and Quality (2019) is an example resource for SBAR: https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/sbar.htmlLinks to an external site.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

 

Learning Resources

Required Readings

  • Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Psychosocial disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 502-541). F.A. Davis.
  • Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Appendix B: Laboratory values in the older adult. In Advanced practice nursing in the care of older adults (3rd ed., pp. 581-582). F.A. Davis.

Note: See the labs that are relevant to this week’s topics.

Required Media

Recommended Media

To prepare:

  • Review the case studies provided by your Instructor, select the case you are to use based on the first letter of your last name. 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.
  • Prepare a 3-minute video as though you were presenting the case to your preceptor in the clinical setting and post it to the discussion board.

By Day 3

Using the case assigned, imagine you are presenting this case to your clinical preceptor or another provider, physician or nurse practitioner. You will create a short, less than 3-minute video of you presenting this case using the SBAR format. Please dress as if you were in a professional, clinical setting. The idea is to get in the habit of professionally and briefly presenting clinical cases to your preceptor that includes only the information clinically relevant to the case. If possible, please select an established/known patient to present your case on.

Please present the following in your video. You are encouraged to review the peer response prompts for information on how your presentation will be evaluated.

Important: Ensure patient confidentiality by de-identifying any personal health information in your case presentation.

  1. Situation: Briefly describe the patient’s current condition and why you are presenting the case.
  2. Background: Provide relevant patient history, including past medical history, medications, and pertinent findings from physical examination and diagnostic tests. Keep this section brief and related to the patient’s current condition.
  3. Assessment: Summarize your assessment findings, including your differential diagnosis and any relevant diagnoses.
  4. Recommendation: Present your recommendations for further management, including potential interventions, medications, referrals, and follow-up plans, or ask for consultation/the provider’s expertise.

Please post your video presentation by Day 3 of the week assigned. Then, please thoughtfully respond using the prompts below to at least two peers over the course of two separate days, by Day 6, to earn full credit in discussion.

By Day 6

Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.

  • Evaluate the clarity and organization of the SBAR presentation. Did the presenter effectively communicate the key points of the case? Was there extraneous, unrelated, or distracting, information present?
  • Assess the accuracy and completeness of the assessment. Were the differential diagnosis and clinical reasoning well-supported? Review the evidence-based guidelines presented.
  • do the recommendations align with evidence-based practice guidelines and the patient’s individual needs? Are there any additional evidence-based recommendations you would add to this presentation? Please include references to support your recommendations.
  • Reflect on the overall effectiveness of the communication. How could the presenter improve their SBAR presentation for future cases?

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

NRNP_6540_Week2_Discussion_Rubric

NRNP_6540_Week2_Discussion_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeUsing the SBAR format, the Situation component is thoroughly reviewed. 10 to >6.0 ptsExcellentThorough coverage of condition and reason for presenting case.

6 to >3.0 ptsGoodAdequate coverage of condition and reason for presenting case.

3 to >1.0 ptsFairCondition not covered well, nor reason for presenting case.

1 to >0 ptsPoorCondition not covered and/or reason for presenting case no covered.

 10 pts
This criterion is linked to a Learning OutcomeUsing the SBAR format, the Background component is thoroughly reviewed. 10 to >6.0 ptsExcellentThorough coverage of background.

6 to >3.0 ptsGoodAdequate coverage of background.

3 to >1.0 ptsFairBackground not covered well.

1 to >0 ptsPoorBackground not covered.

 10 pts
This criterion is linked to a Learning OutcomeUsing the SBAR format, the Assessment component is thoroughly reviewed. 10 to >6.0 ptsExcellentThorough coverage of assessment.

6 to >3.0 ptsGoodAdequate coverage of assessment.

3 to >1.0 ptsFairAssessment not covered well.

1 to >0 ptsPoorAssessment not covered.

 10 pts
This criterion is linked to a Learning OutcomeUsing the SBAR format, the Recommendation plan is thorough. 20 to >16.0 ptsExcellentThorough coverage of recommendations.

16 to >10.0 ptsGoodAdequate coverage of recommendations.

10 to >4.0 ptsFairRecommendations not covered well.

4 to >0 ptsPoorRecommendations not covered.

 20 pts
This criterion is linked to a Learning OutcomeEvaluate the clarity and organization of classmate’s presentation. 10 to >6.0 ptsExcellentDiscussion of classmate’s video presentation is clear and organized.

6 to >3.0 ptsGoodDiscussion of classmate’s video presentation is mostly clear and organized.

3 to >1.0 ptsFairDiscussion of classmate’s video presentation is somewhat clear and organized.

1 to >0 ptsPoorDiscussion of classmate’s video presentation is lacking clarity and organization.

 10 pts
This criterion is linked to a Learning OutcomeDo discussion of classmate’s differential diagnosis and plan align with practice guidelines? 10 to >6.0 ptsExcellentThoroughly align with practice guidelines.

6 to >3.0 ptsGoodMostly align with practice guidelines.

3 to >1.0 ptsFairOccasionally align with practice guidelines.

1 to >0 ptsPoorLimited to no alignment with practice guidelines.

 10 pts
This criterion is linked to a Learning OutcomeReflection on classmate’s presentation. What went well, what can be improved. 20 to >16.0 ptsExcellentThorough review of classmate’s video.

16 to >10.0 ptsGoodAdequate review of classmate’s video.

10 to >4.0 ptsFairReview of classmate’s video missing key points.

4 to >0 ptsPoorLimited or no review of classmate’s video.

 20 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – correct APA format for reference list. Timely response to classmates presentations. 5 to >4.0 ptsExcellentUses correct APA format with no errors. Response to classmates on time.

4 to >3.0 ptsGoodContains a few (one or two) APA format errors. Response to classmates on time.

3 to >2.0 ptsFairContains several (three or four) APA format errors. Response to classmates late.

2 to >0 ptsPoorContains many (≥ five) APA format errors. No response to classmates.

 5 pts
This criterion is linked to a Learning OutcomeTime 5 ptsExcellentThe video does not exceed the 3-minute time limit.

0 ptsPoorThe video exceeds the 3-minute time limit. (Note: Information presented after the 3 minutes will not be evaluated for grade inclusion).

 5 pts

Total Points: 100

 

Good News ! We now help with PROCTORED EXAMS. Chat with a support agent for more information

CHAT US NOW
X