Reference no: EM133988803
Case Study
Mr. Edwards, an 85 year old male lives alone near a senior center facility that provides both medical and social services for senior citizens. His wife passed away, so he has been alone in his apartment for the last 8 years. His medical diagnosis includes hypertension, impaired vision, and rheumatoid arthritis which has progressed over the past two years, leaving him with severely limited dexterity in his prominent hand and problems with walking. His son Joseph lives nearby and visits weekly. His daughter lives about 8 hours away but keeps in touch by phone once or twice weekly and tries to visit every other month.
In the past he has been well organized and independent in most aspects of his daily living, but lately Joseph has become aware of his father's progressive cognitive decline including forgetting last night's newspaper, miscalculating checkbook balances, neglecting his hygiene needs, forgetting to eat his meals, and confusing his grandchildren's names. The home health nurse who assists Mr. Edwards with his ADL's, notes that Mr. Edwards is unable to recall his home address without prompting, unable to name the correct date, and unable to subtract serial 7s more than twice. Mr. Edwards also seems easily agitated, and reports long periods of wakefulness in the nighttime hours.
Joseph accompanies his father to the neurologist office for an evaluation and diagnostic testing to rule out possible disorders that may be causing his father's cognitive decline. Results of the diagnostic testing indicate that Mr. Edwards has dementia of the Alzheimer's type. Mr. Edwards and his son Joseph indicate to the neurologist that Mr. Edwards would like to stay in his apartment for as long as possible.
CASE STUDY 1- PATIENT CENTERED CARE Questions
1. What are your concerns for this client?
Relate your response(s) to the concepts of patient-centered care.
2. Identify/list the categories of cognitive disorders. Where would you place Mr. Edwards?
3. List/identify the diagnostic tests for cognitive impairment and how they related to Mr. Edwards diagnosis.
4. Identify at least four patient-centered-care interrelated concepts (using the Concept Related Diagram for Patient-Centered-Care) and discuss how they would interact with the cognitive disorders.
Part 2 with Mr. Edwards
Mr. Edwards cognitive impairment has continued to decline since his case was presented in Part 1 of the Case Study. Mr. Edwards is now exhibiting the following behaviors: Insulting friends and family, refusing to take his medications without encouragement, and hygiene issues have increased. He often refuses to bathe, perform oral hygiene, and wash his hair. He becomes upset if any mistakes are mentioned and states "Oh well, a senior moment is to be expected now and then." His son Joseph reports that his father often wanders from room to room and calls out for his deceased wife. Over the past three months Mr. Edwards' weight has declined by 10 pounds.
Joseph takes his father to the neurologist for another evaluation and reports the above behaviors and states "My father seems to make up things when he can't remember."
After a complete physical, neurological, and cognitive evaluation the neurologist advises the patient and his son that Mr. Edwards' disorder has progressed to Stage II of Alzheimer's Disease.
1. What are the characteristics of Alzheimer's Stage II? How do these relate to Mr. Edwards now?
Being forgetful of events or personal history.
Feeling moody or withdrawn, especially in socially or mentally challenging situations.
Demonstrating personality and behavioral changes.
Showing an increased tendency to wander.
2. Develop a plan for management of life affairs, such as power of attorney, advance directives, care arrangements, care giver role strain, and communication techniques for the individuals, care givers, and the community that are involved with Mr. Edwards. Include ethical and legal issues in your plan.