What Should the Nurse Do?
Tahira, a sixty-eight-year-old female, arrives at the clinic with memory lapses and challenges in daily tasks. She forgets names and misplaces items, causing increased frustration. Her daughter notes a gradual decline in cognitive abilities over the past year. Medical history includes well-controlled hypertension and type 2 diabetes. Compliant with treatment, Tahira monitors blood pressure and glucose levels at home, maintaining an active lifestyle. No significant psychiatric history is reported. During the assessment, the nurse observes mild confusion and a struggle with recall. Culturally sensitive care is emphasized. Vital signs show stable blood pressure (120/80 mmHg), heart rate (78 bpm), respiratory rate (16 breaths/min), and normal temperature (98.6°F). While physiological parameters are within limits, a comprehensive evaluation is needed to address cognitive concerns.
1
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Considering Tahira’s case, what challenges might health-care professionals face in diagnosing mild neurocognitive disorders, and how can cultural factors influence the diagnostic process?
2
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As a nurse caring for Tahira, what nursing interventions could you implement to support her and her family in managing the cognitive decline associated with mild neurocognitive disorders?
Carlos, a seventy-eight-year-old male, is brought to the emergency department by his daughter due to sudden changes in behavior and cognition. Carlos’s daughter reports that over the past forty-eight hours, he has become increasingly disoriented, agitated, and has exhibited fluctuations in attention. She notes that he has had difficulty recognizing family members, and his speech has become more incoherent. Carlos has a history of hypertension and type 2 diabetes, both well-managed with medication. He has no known psychiatric history. During the initial assessment, the nurse observes Carlos’s vital signs, noting a blood pressure of 140/90 mmHg, a heart rate of 110 beats per minute, and a respiratory rate of 20 breaths per minute. His temperature is elevated at 101.2°F (38.4°C).
3
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What key features in Carlos’s case help distinguish delirium from dementia, and how might the sudden onset of symptoms influence the diagnostic process?
4
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What specific nursing interventions can be implemented to support Carlos’s overall well-being?
5
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Given Carlos’s medical history, which common causes of delirium might be relevant in his case, and how could these causes be further assessed or addressed in the emergency department?
Evgeniia, a seventy-five-year-old female, is brought to the clinic by her son due to concerns about her cognitive decline. Evgeniia has been experiencing increasing forgetfulness, confusion, and difficulty with daily activities, such as managing medications and meal preparation. Her son reports that she often repeats herself and has become socially withdrawn. Medical history reveals hypertension and osteoarthritis, both managed with medication. No significant psychiatric history is reported. During the initial assessment, the nurse observes Evgeniia exhibiting signs consistent with dementia, characterized by memory loss, impaired judgment, and changes in personality. Vital signs indicate a blood pressure of 130/85 mmHg, a heart rate of 76 beats per minute, a respiratory rate of 18 breaths per minute, and a normal temperature of 98.4°F (36.9°C).
6
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Considering Evgeniia’s symptoms, discuss which stage of neurocognitive disorder according to Reisberg’s stages she might be in and elaborate on how these stages help in understanding the progression of cognitive decline in dementia.
7
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Outline the approaches to treatment used for clients with dementia, focusing on how these approaches address the progressive and irreversible nature of the condition.
8
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Discuss specific nursing interventions outlined in the chapter that contribute to the care of clients with dementia, especially those related to creating a supportive environment and addressing cognitive decline.