NURS6070: Integrated care and management plan - Medical Science Assignment Help

Assignment Task

Description

Using the evolving clinical scenario for Mrs B (provided in Canvas Assessment 3 folder) and complete the following points supported by high quality contemporary literature:

1. Discuss the potential evolving problems for Mrs B
2. Identify and describe the appropriate assessment tool/s to complete an appropriate comprehensive assessment for Mrs B
3. Discuss the physical and physiological factors that may affect the assessment
4. Identify and critically analyse four models of successful aging in relation to Mrs B
5. Discuss the potential psychiatric diagnoses for Mrs B
6. Discuss the most appropriate treatment & management plan for Mrs B

Case Study

Mrs. B, an 85-year-old woman, who lives in a assisted living facility presented to the Emergency Department with her son. She is experiencing an increase in paranoia, visual hallucinations, and agitation. Her son had taken her to her GP when facility staff reported concerns about these symptoms. Mrs B. angrily accused the GP of trying to euthanise her when the discussion progressed to treatments that may alleviate her current complaint. The GP, concerned, encouraged the son to take her to ED and he would fax a referral.

Mrs B had been living in an aged care facility for approximately 3 years. She initially was doing well in the facility until she was hospitalized 2 years ago with agitation. At that time, she was diagnosed with moderate degree of Alzheimer’s type dementia with delusions, depressed mood, and behavioural disturbance. She returned to the aged care facility and had been stable until a few months before her current hospitalization, which was precipitated by gradually worsening paranoid delusions, visual hallucinations, severe restlessness, and difficulty in being redirected.

According to her son, Mrs. B had had "strange thoughts" for as long as he could remember. For example, for a time, Mrs. B would eat only foods that were white. Still, in her adult life, she had actively participated in developing and running a successful family business with her husband and had raised two sons. When her husband died 5 years ago, Mrs. B developed a major depressive disorder, single episode, severe with psychotic features. This episode was treated through titration of DESVENLAFAXINE 200 mg PO MANE, MIRTAZAPINE 30 mg PO NOCTE and OLANZAPINE 2.5 mg PO NOCTE. A period of supplemental DIAZEPAM 2 mg PO PRN QID was employed to assist with "behaviour management" and was advised to be ceased after one month.

Mrs. B then moved to the assisted living facility and did well there until she was hospitalized two years later with agitation. At that time, she was diagnosed with late onset Alzheimer’s type dementia with delusions, depressed mood, and behavioural disturbance. She returned to the assisted living facility and was stable until a few months before her current presentation. The staff had noticed gradually worsening paranoid ideation, with concerns that they may be of delusional intensity, visual hallucinations, severe restlessness, and difficulty in being redirected.

The son reports that Mrs B had no significant medical history previously and was not taking any regular psychotropic medication. She has experienced some pain that has been managed through Paracetamol XR 665 mg PO TDS, breathlessness managed with Ventolin - PRN. Medications choices for symptom control of Alzheimer's were being explored with a specialist, however, not finalised before the deterioration in presentation. Mrs. B enjoys hydrotherapy at the "Water Winged Women of the West" pool. Mrs. B's son is now living locally and is supportive of his mother.

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