Loading Geriatric Case Study

Instructions

This case study consists of one hypothetical patient situation.

Select the Patient Information tab. Within this tab, you will be able to watch a video to gain more insight regarding the patient as well as view important patient details.

For this assignment, you will address a series of questions regarding the care of the patient. Your answers should include specific reference to relevant guidelines and other clinical information. The national guidelines should also be considered with treatment plans.

When you are done viewing the patient information, download the Case Study Assignment (Word) document from the assignment page in Moodle. Use this document to complete the assignment and then submit it to the assignment page.

Current Medications

Valsartan 80 mg daily. Citalopram 40 mg daily, Gabapentin 300 mg tabs 2 tabs three times daily. Tylenol 500 mg one to two four times daily prn. Brimonidine tartrate 0.15% ophth 1 drop OU twice daily 13. Cosopt 2%-0.5% 1 drop OU at hs. Latanoprost 0.005% 2 drops OU at hs. Trazodone 25 mg at hs. Calcium carbonate 500 mg 1-2 tabs three times daily.

Constitutional

Vitals: Head: ENMT: CV: Respiratory: GI: This is a thin, alert, older African American female in no apparent distress, pleasant and cooperative, but with a notably flat affect. Supine - 135/76, 69; Sitting - 112/75, 76; Standing - 116/76, 75. BMI 19. Normocephalic / atraumatic. Wearing glasses. Acuity 20/30 R, 20/70 L. Regular rate and rhythm normal S1/S2 without murmurs, rubs, or gallops. Clear to auscultation bilaterally. Normal bowel tones, soft, non-tender, non-distended. Musculoskeletal: Strength: UE strength 5/5 B biceps, triceps, deltoids; LE strength 4+/5 bilateral hip flexors and abductors; 4+/5 bilateral knee flexors/extensors; 5/5 bilateral AF/AE; 5/5 bilateral DF and PF. No knee joint laxity. Foot exam shows no calluses, ulcerations, or deformities. Neurology: Whisper test for hearing: Tone/abnormal movements: Psych: Cognitive screen: recalled 3/3 items. Intact. Tone is mildly increased in both legs, normal tone in both arms. Sensation is intact to light touch and pain throughout. Reflexes are normal and symmetric. PHQ-2 = 4/6. A mini-mental status exam was administered, and she scored 22/30, indicating mild cognitive impairment.

Medical Problems

  • Hypertension
  • Anxiety
  • Occasional incontinence
  • Hyperlipidemia
  • Gastroesophageal reflux disease
  • B12 deficiency
  • Allergic rhinitis
  • Glaucoma

Laboratory Results

  • Leukocytes: 5,700 cells/mcL
  • RBC: 3.02 million cells/mcL
  • Hgb: 8.1 g/dL
  • HCT: 25.2%
  • MCV: 83 fL
  • MCH: 26.5 Hgb/cell
  • MCHC: 32%
  • RDW-CV: 15.8%
  • Platelets: 150,000 cells/mcL
  • Glucose: 92 mg/dL
  • Blood urea nitrogen (BUN): 34 mg/dL
  • Creatinine: 1.4 mg/dL
  • GFR: 38 mL/minute/1.73 m2

Questions

  1. What important information is missing from the case study?
  2. Discuss normal developmental achievements and potential vulnerabilities.
  3. What precipitating factors could be contributing to the current symptoms?
  4. What is the differential diagnosis?
  5. Describe the etiology of the primary diagnosis.
  6. How should physiologic complications be monitored and assessed?
  7. What are the usual nonpharmacologic therapies that would help?
  8. What medications could help and why?
  9. Identify safety risks and how they should be dealt with in the treatment plan.
Activity is complete.