Question

DIFFERENTIALS (how will you work these up): Give a list of Differentials and how each of these would be worked up or how you came to the conclusion it is not your primary diagnosis.

ASSESSMENT: Your primary diagnosis should indicate how you would come to this conclusion. You need to decide which further testing you would order and justify the reasoning for ordering these tests. Keep in mind efficacy, feasibility and cost of each further test you order. Please identify a thorough list of secondary diagnosis you would include.

PLAN: How do you plan to implement best practice for this patient? Please list pharmacologic and nonpharmacological options for treating this patient and rational for each option. Consider drug interactions, side effects and feasibility of all your interventions. Be sure to address any knowledge deficits and dietary modifications. Please keep in mind cost when formulating this plan. Include what your follow-up plans may be in this case.

Judy is an 81 year old female in your office for memory problems. She is with her daughter. Her daughter wanted her mother seen because she feels her mother is getting more forgetful. She forgot to pay the phone bill for two months. This is not a sudden change but has been coming on for some time. Judy did have cataract surgery 2 months ago and is doing well post-surgery. Labs for review in her chart from prior to her cataract surgery.

Answer 1

ASSESSMENT::primary diagnosis 1)memory loss related to post surgical cognitive impairment-------Due to visual field injuries during cataract surgery can cause dementia in some cases while,it can occur as anesthetic complications in other patients.secondary diagnosis 1)loss of memory related to aging----certain brain changes occur when it comes to aging.as we grow older we experience physiological changes that can cause glitches in brain functions.therfore,patient take longer to learn and recall information.

Dignostic test:::1)cognitive test to check thinking ability.2)blood test to know vita.B12 and thyroid level.3)MRI and CT scan to know about neurological functions.

BEST Practices:::1)to observe the patient carefully after surgery to find out signs of memory loss.2)tell the patient to write everything down to remember the things easily.3)give psychological suppi to cope with situations

Non pharmacological treatment::this assist to improve persons cognitive functions and enable the person to practice daily activities of living.some therapies for dementia are1)Reminiscences therapy::help to recall past events,activities through photos,movies or music.2)validation therapy:::it aid to avoid stress ,loneliness etc.3)cognitive stimulation therapy:::Through social settings in small groups involving cognitive based task or activities .

staff should give information about diet which can help to solve the problem.increase intake of vitamin especially vit.b 12 and minerals

Pharmacological treatment:::1)donepezil :::side effects--nausea,vomiting,diarrhea,insomnia,muscle problems 2)rivastigmine::::actetylcholnesterase inhibitors.side effects::nausea and vomiting