Case study marta

, 2017; Saftari & Kwon, 2018). Information on other neurological changes such as poor coordination when ambulating, a decline in attention, spatial awareness and psychomotor processing increase fall risk in patients(Liu, Chan, & Yan, 2014). Additional information on home-hazards such as loose rugs on the floor at home, clutter among others such hazards expose the patient to tripping and fall within their house or other environments where they live(Worapanwisit, Prabpai, & Rosenberg, 2018). Patient education is a key recommendation on the risk of falls such as; removal of home hazards, fitting of assistive devices such as rails that help in movement around the house, medication risk of falls due to medication side effects and effective management of hypertension(West, Bhat, Stevens, & Bergen, 2015). Another strategy is to ensure that Marta is moved to a care home where she has regular support and assistance in her day to day activities and assistance in ambulation.

The rationale for its continuity is that the American Heart Association (AHA), recommends for the continuation of statin therapy for all patients older than 75 years who are already on statin therapy (American Heart Association, 2018). Marta LDL levels are also above the normal range of 100mg/dl which increases her risk for heart disease hence a need to maintain her on statin therapy. She also has not had any adverse events related to drug or drug interactions. Metformin for the patient will also be sustained to manage her diabetes. Metformin has a low risk for hypoglycemia and had proven success rates in the management of hyperglycemia (Unnikrishnan, 2017). Aspirin and ibuprofen will be stopped as their long term use is contraindicated due to high risk for stomach ulcers according to the AGS Beers Criteria.

Alternative stroke preventive therapies such as the use of calcium channel blockers, diet and exercise regulation can be pursued. Alternative safer analgesics such as acetaminophen can be used for arthritis pain (Van de Laar, 2017). Docusate and Senna will be stopped, and the patient advised on dietary intake of high fiber foods that can aid in bowel movements (Van de Laar, 2017). This is essential to reduce the medication/pill burden for the patient which increases the risk for non-adherence and drug interactions. The monitoring of the patient’s lipid profiles is recommended for patients with high risk for cardiovascular complications with monitoring done every -8 weeks according to European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Guidelines for the management of dyslipidemias (Janský, Rosolová, & Vrablík, 2017).

Regular blood glucose and blood pressure monitoring will be done by the patient at home and recorded to aid in the evaluation of the blood pressure. Patient education is a critical aspect in ensuring safety in medication and positive patient experience of care and outcome. Patient education for Marta will aim to educate her to watch for any signs of medication side effects such as shakiness, sweating, dizziness, confusion or seizures which can be symptoms of hypoglycemia. This will be accompanied by education on the emergency response for hypoglycemia before seeking medical attention. When will you ask her to return to the clinic for a follow-up? The patient will be requested to return to the clinic for follow up care on her progress in care after four weeks.

A period of four weeks is essential to assess the progress in her management of the blood pressure and diabetes as well as to assess for any medication interactions and severe side effects and stroke risks. What is your differential? Explain. The differential diagnosis for the Marta on her second visit includes; vascular dementia is a condition that is characterized by impairment in memory, planning, and judgment due to stroke (Markus, Pereira, & Cloud, 2017). In Marta’s history, she has difficulties in judgement and memory as she forgets major events such as death of a loved one, gets lost in town, is confused and has difficulties concentrating (she is unable to concentrate during her game of the bridge), unsteady gait characterized by use of a cane to walk, agitation.

Neurological testing that would be important for this visit includes; assessment of any involuntary movements such as chorea, tremors, dystonia, and muscle fasciculations. Reflex assessment for primitive reflexes, assessment of the visual acuity, eye movements, pupillary responses, and visual fields. Cardiovascular assessment for Marta will be critical due to her previous diagnosis of aortic stenosis. The physical cardiovascular assessment will focus on assessing her blood pressure levels, assessment for complications related to aortic stenosis heart failure characterized by shortness of breath lower limb edema fatigue among others (Bull, 2015). Musculoskeletal assessment is essential to assess the range of motion for various joints and pain due to arthritis (Skorga & Young, 2015). Depression in dementia Cornell Scale for Depression in Dementia (CSDD) The tool is used to assess depression in patients with dementia and utilizes both caregiver information and patient observation to diagnose depression.

Delirium Serum maker for delirium- calcium-binding protein S-100 B The calcium-binding protein S-100 B is a serum marker that is only seen in high levels in patients with delirium compared to others without hence can be a key test for delirium (Khan et al. Marta scores 1 on the Mini-cog test. Discuss the meaning of this score The MMSE is a tool that is scored out of 30 depending on the extent of cognitive impairment. A score of 1 in the MMSE is indicative of severe cognitive impairment, it, however, is not confirmatory for the diagnosis of dementia in patients. Community resources in Peel Community resources are critical in the care and in ensuring continuity of care for patients with dementia as well as enhancing caregiver support and caregiver training.

The Alzheimer’s Society Peel works with patients with Alzheimer’s or other dementia through the First Link referral program to link the individuals, families to community resources such as learning and support. NPS can use the First link for referral of Marta for care and support within the community. Peel long-term care is another community resource that offers respite care for the caregivers for patients with dementia hence reducing the care burden for the patient. References American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.  International Journal of Older People Nursing, 6(2), 85-92. doi:10. 1111/j. x Edelman, M. , & Ficorelli, C. , Egstrup, K. , Ray, S. , Boman, K. , … Wachtell, K. Stroke in Patients With Aortic Stenosis. , & Mandl, K.

 D. Predicting Falls in People Aged 65 Years and Older from Insurance Claims.  The American Journal of Medicine, 130(6), 744. e17-744. 1016/j. crvasa. 007 Kato, Y. , Narumoto, Matsuoka, Okamura, Koumi, Kishikawa, … Fukui. Diagnostic performance of a combination of Mini-Mental State Examination and Clock Drawing Test in detecting Alzheimer’s disease. , Hui, S. , … Buckley, J. S100 calcium binding protein B as a biomarker of delirium duration in the intensive care unit – an exploratory analysis.  International Journal of General Medicine, 855. doi:10. , Van Campen, J.  P. , Beijnen, J.  H. , Hortobágyi, T. , Baraliakos, X. , Heldmann, F. , Mintrop, B. , Sarholz, M. , … Braun, J.  S. , & Yan, J.  H. Neuropsychological mechanisms of falls in older adults.  Frontiers in Aging Neuroscience, 6. , & Schindler, C. Clinically and pharmacologically relevant interactions of antidiabetic drugs.