Part 1
What are the possibilities for change in Mrs. Smith’s current mental status?
Her mental change was due to acute brain dysfunction caused by the underlying medical illnesses and her advanced age which yielded confusion and memory loss. She had medical history of long term illness of osteoarthritis, hypertension and diabetes which were potentially life threatening with adverse health effects on brain due to depression (Fong, Davis & Inouye, 2015). Her brain dysfunction was caused by death of brain cells and her nervous system which caused disorientation and altered behavior.
What is your top differential diagnosis? Give 3 reasons why you chose that diagnosis.
Mrs. Smith was suffering from delirium. First, her symptoms were similar to those of delirium which causes an acute change of mental of status. The change occurs within hours where one loses cognition and attention for quite some time or throughout the day (Voyer, Monette & Belzile, 2016). Second, the patient was experiencing delirium because she was restless, anxious, experienced disorganized thought and sleepless nights. Finally, altered level of consciousness and possible hallucinations is evident from the patient suffering from delirium.
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How can you differentiate depression, dementia and delirium?
Depression is a medical illness that influences a person’s mood leading to sadness and loss of interest in everything and which interferes with daily functioning of a person. It brings negative thinking, low self-esteem, poor concentration and lack of sleep. Social withdrawal, irritability and fatigue are also associated with depression (Voyer et al., 2016). Dementia is not a specific disease but a combination of several conditions or social symptoms which are associated with impairment of brain functions such as loss of memory and impaired judgment. The patient suffering from dementia is often forgetful, has poor communication, and has limited social skills. The conditions interfere with thinking behavior and ability to handle daily activities. Fong et al., (2015) asserted that delirium is an acute change or deterioration of mental reasoning which results from terminal illness in the body, brain, severe injury or drug intoxication. The patient suffers distress and poor outcomes which leads to long term care.
Explain to Mrs. Smith’s daughter what treatment is needed and what you think her prognosis is.
Treatment for delirium can be addressed by identifying the underlying causes of the disease like reducing or stopping a particular medication which causes mental disturbance. Other treatments include addressing metabolic imbalance, incorporating effective communication, orientation, and treating infections among others (Voyer et al., 2016). The diagnosis and treatment will improve her condition and make it stable over time in the recovery process.
Part 2
What would you ask him and his wife regarding the seizures, and why?
As a doctor, I would ask him whether he has any genetic abnormality or if he is using any drugs and substance abuse like alcohol which may be the contributing factors towards seizure (Pitkanen, Buckmaster &Moshe, 2017). The reason behind asking him about genetic problem is because seizures have a link with chromosomal abnormalities during mutation of cells. Abusing drugs and alcohol leads to intoxication, mental imbalance and impulsive behavior that can cause seizure when abused for long.
What would be the most important parts of a physical exam in this patient and why?
The diagnosis for the patient would be a complete neurological examination that includes laboratory and imaging tests to differentiate seizure and non-seizure event (Pitkanen et al., 2017). Laboratory tests like blood checks would be carried out to determine the level glucose in the blood and any other abnormality or infection in the blood cells (Bergey, Goldman & Barkley, 2015). Electroencephalogram is also used to test the brain’s electoral activity by recording the brain wave patterns and impulse to identify any irregular movements or communication of brain.
What lab or radiology tests would you want to do and why? He tells you he has no insurance so be sure to defend the importance of a particular test.
Magnetic Resonance Imaging (MRI) and Computer Tomography (CT) scans to detect any tumors or abnormality of the brain cells. Neuroimaging identifies neurologic deficits and malignant cells that could be affecting the brain functionality (Bergey et al., 2015). Finally, I would advise the patient to contact the insurance provider for subscription and approval of the scans.
References
Fong, T. G., Davis, D., Growdon, M. & Inouye, S. K. (2015). The interface between delirium and dementia in elderly adults. The Lancet Neurology , 14 (8), 823-832.
Voyer, P., Monette, J., Ciampi, A., & Belzile, E. (2016). Six ‐ month outcomes of co ‐ occurring delirium, depression, and dementia in long ‐ term care. Journal of the American Geriatrics Society , 62 (12), 2296-2302.
Pitkänen, A., Buckmaster, P., & Moshé, S. L. (Eds.). (2017). Models of seizures and epilepsy . Academic Press.
Bergey, G. K. Goldman, A., King-Stephens, D., Nair, & Barkley, G. (2015). Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology , 84 (8), 810-817.
