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Jackie Smith is an 82-year-old right-handed Caucasian woman. She has been diagnosed with dementia and her eldest son has petitioned the court for guardianship in the past. At that time Mrs. Smith's eldest son and his family were living with her. A psychiatrist following her case at the request of her son diagnosed Mrs. Smith with dementia based on interviews with her eldest son, his wife, and an interview with the patient's 16-year-old granddaughter who suggested that the patient was forgetful to the point of being a danger to herself. This led the physician to conclude the patient suffers from a progressive dementia and that the patient needed assistance in her self-care. He also recommended that the patient not drive and informed the Secretary of State regarding his findings. However, the patient's primary care physician asked for a second opinion as Mrs. Smith's son and family had approached him previously and was apparently was attempting to gain control of the patient's property and assets. The patient's son and his wife are unemployed and moved in the patient's home one day while she was out with friends. The patient reported that this initially helped her feel less anxious and depressed, but then they took over control of the patient's affairs. The patient reports that they were stealing money from her and trying to make her crazy by hiding things from her. They would not let her pay her bills and would not let her take her own medications, which she had been doing successfully with a medication organizer and reminders prior to their moving in.
The patient's medical history is significant for CVA in 2004 (although from her description of the symptoms and duration it sounds more like a TIA), coronary artery disease, hypertension, arthritis, depression, and anxiety. With respect to her CVA, the patient reports that it occurred at a casino and that she became very confused for a short period...
Neuroimaging performed at St. Bingo's Hospital reportedly revealed some stroke related changes in her left cerebral hemisphere according to her son, but I was unable to read this report. The patient reports another brief period of confusion occurring in November of 2007 that was also transient. She has no seizure history. Her medications at the time of this report included Memantine, Etodolac, Fluoxetine, Simvastatin, Alprazolam, Buspirone, Tramadol, Plavix, Lisinopril, and Isosorbide. She does not smoke, drinks alcohol socially, and does not use illicit drugs.
Recently the patient suffered an episode of confusion and agitation and was hospitalized. She did not recognize her family members, thought that she was in France, and reported to hospital staff that she was having conversations with her deceased husband. Inspection of her laboratory values indicated that all results were within normal limits. The neuropsychologist at the hospital recommended that the patient discontinue the Seroquel that the psychiatrist who diagnosed her with dementia had prescribed and was being given to her by her son. Three days after the discontinuation of the medication her mental status stabilized and she was released, although the social worker at the hospital was suspicious of the patient's caregivers and made an appointment for Family Protective Services to follow the patient.
The patient became very aggressive towards her older son once she returned home and demanded that she be able to monitor her own medications. Her son refused and the patient contacted her younger son and family for assistance. She became more depressed and started drinking two or three drinks at night to help her sleep and her son claimed that her decision-making ability was poor and contacted his attorney. The…
The patient currently lives at home and receives assistance from her younger son and daughter-in-law. The patient has completed 12 years of formal education. She is retired having worked in a molding plant and as an office worker. She is widowed (13 years) and also recently lost her boyfriend in July of 2007, which most likely made her anxious about being alone. Physical examination revealed a well-nourished female. She is 62 inches tall and weighs 175 lbs. Blood pressure was 150/88. Skin condition: no open areas turgor good. Bowels move every one to two days. There is no history of UTI. She has some arthritis in her hips and uses a walker to ambulate. She has discussed the possibility of hip replacement surgery with her physician, but due to the dementia diagnosis the family wished to discuss this further with her. There were no other abnormal findings on physical examination. MMSE was 18. She was very pleasant and cooperative throughout the evaluation. The patient wears eyeglasses and she wore these during the evaluation. I did not observe any significant difficulties with vision or hearing that would interfere with the test administration or with her performance. Thought processes were logical and goal directed. There was no evidence of a disorder of thought process or content. Expressive language was fluent and within normal limits for volume and prosody. I did not observe significant word-finding difficulties in her conversational speech during this evaluation, but she did display word-finding difficulties on a measure of confrontation naming. The patient's mood was slightly depressed. She reported that she was very distressed over her eldest son's actions and that she had been "down in the dumps" lately over this. She has been drinking alcohol more frequently to relieve her anxiety. She did endorse any thoughts of harming herself.
The patient does report some occasional difficulties with her memory, but does not believe they are severe. She does occasionally miss things and misplace things but she also uses lists and reminders to assist her. The patient does have a history of depression anxiety and takes medication for this. The patient's son reported to me that he does not believe that his mother has severe memory difficulties. He added that she does not frequently get lost driving, does not forget to turn off the stove when cooking, and is capable of paying her bills and taking care of herself.
Current concerns are the patient's hypertension, depression, and dementia. She is scheduled for formal evaluations to document the extent of her cognitive and mood problems and those reports are pending. Given her history of possible CVA it is recommended that her medications be reevaluated and that she be placed on a healthy heart diet. The need to control her hypertension was discussed with her son and it was agreed that he would assist his mother in monitoring her diet and alcohol intake. A referral to mental health is suggested to help manage her depression. Nursing will follow.
life of a patient dealing with the chronic disease, rheumatoid arthritis. Rheumatoid arthritis is a type of arthritis that can cause redness, swelling, pain, tenderness, stiffness, and abnormality of numerous joints of the body. For patients that are dealing with this type illness, each day's activities can present a lot of trials. In this patient case, there were a lot of simple activities, which we people take for granted,
Arthritis is considered as one of the major health conditions affecting a significant portion of the United States population. Even though the condition currently affects approximately 50 million adults in the country, it is not primarily an adulthood health condition. There are numerous cases of children suffering from arthritis, which implies that this condition is not uncommon among children. As a result of the prevalence of arthritis among children and
On the other hand a diet that is high in fruit and vegetable intake has also been found to increase the absorption of antioxidants and vitamins that help to manage the symptoms of this disease. Pineapples have been found to be effective in the control of inflammation in arthritis, as they contain bromelain enzymes. ".... bromelain enzymes block the prostaglandins that play a part in swelling. These enzymes have
As well as several reports relating diseases and mood, mental status has also been reported to affect immuno-regulatory systems. Chronic depression or chronic stress conditions lead to immuno-suppressive status and imbalance in corticotrophin-releasing hormone, which induces cancer and hyperthyroidism. It has been reported that depressive states induce suppression of mitogenic reaction in lymphocytes, decreases the number and activity of natural killer cells and decreases the production of interferon." Sadamoto,
Rheumatoid Arthritis is a serious medical condition that affects "between 1 and 2% of the world's population." (Lee 21) Several theories on how to best treat the disease have been bantered about for years. Many, unsatisfied with the results of conventional treatment, [i.e. medication, surgery, joint protection] (Lee 127) have turned to a more holistic and proactive approach to treat their aliment -- yoga. Rheumatoid Arthritis manifests itself as an "abnormality
Rheumatoid Arthritis What is happening to the synovium in Arletha's knees and probably her hands as well? In all likelihood, the synovium is inflamed and is not doing its job. The synovium is meant to secret liquid that keeps the joint lubricated. If it's not present or is not doing its job at high efficiency any more, then the joints in the hands and knees will start to become damaged and broken