Nursing Scenario of Cognitive and Physical Decline Discussion Response

Reply for the discussion of another student:

Eleanor is a 77-year-old White female.She is currently living in a skilled nursing home due to moderately severe cognitive and physical decline.This decline is specifically related to Alzheimer’s disease. Her condition has deteriorated over the past six months. Eleanor’s daughter, who is a single mother of four, noticed worsening symptoms of her mother. Eleanor’s cognitive decline became apparent after her husband’s death five years ago.Recently she has become more agitated, aggressive, and often exhibits wandering behavior. She had a tendency to be aggressive towards the nursing staff, attempt to leave the facility, and engage in irrational behavior, such as trying to take a stranger’s dog. Restrictions were authorized to ensure his safety

Patient problems 

Moderate Alzheimer’s disease is characterized by significant cognitive decline, memory loss, and behavioral disturbances

Aggressive and aggressive behavior resulting in risk of harm to self or others

This also includes verbal and physical violence against healthcare workers

Agitation and wandering behavior, such as attempts to leave the premises, pose a significant safety risk

Grief and bereavement may have contributed to the worsening of her symptoms following her husband’s death

Primary Diagnosis

Alzheimer’s Disease with behavioural disturbances ;The main clinical sign of AD is difficulty remembering recent events.As the disease progresses, symptoms progress to restlessness, agitation, aggression and confusion, as demonstrated by Eleanor. As Eleanor’s functional symptoms subside, her physical and mental functions may accelerate the progression toward losing the ability to respond appropriately to the people around her and her actions can be inappropriate and dysfunctional in any situation

Differential Diagnosis

Dementia with Lewy bodies (DLB) is commonly diagnosed in late AD and in healthy older adults based on gender, cognitive score, and dementia stage, as well as in otherwise healthy older adults good cognition related to their amyloid cerebrospinal fluid.

There are a number of factors to consider as the aging process continues as part of the assessment process or whether it is a normal part of the aging process.

More importantly, changes in mental status can be acute, as in delirium, subacute, as in depression, or chronic, as in degenerative dementia and Parkinson’s disease.

Screening Tools

Cognitive Assessment: Administer a comprehensive cognitive assessment, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), to assess her cognitive function.

Brain Imaging: Perform neuroimaging, like MRI or CT scans, to rule out other causes and confirm Alzheimer’s disease.

Neuropsychological Testing: This may help in assessing specific cognitive deficits and planning appropriate interventions.

Treatment

Acetylcholinesterase inhibitors such as donepezil, rivastigmine, and galantamine are the primary neurotransmitters of the parasympathetic nervous system that have a constant benefit across all stages of AD. Consumer reports and ratings about other dietary supplements like vitamin E and over-the-counter memory boosters can be helpful to focus and improve memory with fewer adverse effects, at a lower cost, and safe to use. On the other hand, Memantine has an advantage in cognition to improve memory loss in moderate to severe stages, and the combination of a cholinesterase inhibitor and memantine may have additional efficacy. Standard measures to analyze the change in mental status include computerized tomography to rule out tumors and masses and basic blood work to rule out any cancerous diseases. The goal for restorative interventions for AD focuses on pharmacological and lifestyle modification and intervention-based programs. Despite the acceptable evidence for psychotherapy in depression, evidence for such therapeutic strategies to enhance cognitive, emotional, and physical well-being thereby reducing psychological risk factors of AD. Referral for psychotherapy is the mainstream behavioral health services and support program to lessen the depression and anxiety of AD.

Standard Guidelines 

Evidence-based practice showed that early screening with mental status exam to evaluate the patient’s alertness to name, age, date of birth, date today, and asking who the current president are the standard evaluation of mental status. Also, the Mini-Cog screening tool is the most efficient way to save time to measure AD. The standard guideline in assessing AD is cognitive impairment with functional decline and the recommended treatment for AD as previously reported is Acetylcholinesterase inhibitors which reverse the neurodegenerative disorders and adjunct with psychotherapy are the suggested therapeutic and approved treatment to delay the mental and physical decline.