SECTION 1. A summary of the case
The case study is about Ronald Reagan, who is a former American President. He served as president between 1981 to 1989. Three years after leaving office, he was diagnosed with Alzheimer's disease. The disease had a significant impact on his health and the psychological well-being of his family. Initially, he was able to carry out his routine activities such as dressing himself, playing gold, exercising, and making public appearances once in a while. However, with time, his condition continued to deteriorate. It is reported that after a few years after diagnosis, Reagan had a lot of memory challenges. He struggled with remembering people's names, although he retained his wife's name most of the time. His condition continued to deteriorate, and in 2001, he suffered a fall sustaining a fracture of the hip, and although it was repaired, he became home-bound due to the worsening of his condition. His family members suffered a lot of psychological torture as they witnessed how his condition deteriorated.
SECTION 2. The Actual Assessment. The assessment will be broken down into seven INDIVIDUAL sections:
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Demographic Information
Name-Ronald Reagan
Sex-Male
Age-83 years
Occupation-Retired American President
Presenting Problem
Ronald Reagan is the United States' 40th president and is suffering from a disease known as Alzheimer's. One of the president’s most notable accomplishments was the proclamation of November as Alzheimer's disease Awareness Month . He is diagnosed with early Alzheimer's disease after his doctor ran routine memory tests on him. The president acknowledged to be suffering from the disease via a letter that he said is also meant to create awareness of the disease among the Americans.
Relevant History
The disease is a neurologic type that causes the death of brain cells and shrinkage of the whole brain. It is the most frequent form of dementia. Dementia is a progressive loss of behavioral, cognitive, and social capabilities that hinders an individual's ability to perform tasks individually. It is estimated that 5.8 Americans are suffering from the disease. Those suffering from the disease have an age bracket of 65 and above (Lahiri & Maloney, 2004). Globally, it is also estimated that 70% of patients with dementia pose a high risk of also suffering from Alzheimer's disease (Lahiri & Maloney, 2004).The disease is a severe one with long history, with a clear example of the former president as patient.
Alzheimer's disease is a degenerative brain illness that primarily affects adults and keeps on progressing from worse to worst. As the condition advances, brain cells die, making cognitive function increasingly tricky. Individuals with Alzheimer's disease lose their capacity to do daily duties and can no longer care for themselves in the later stages of the disease. The condition is a pitiful one that, if not treated promptly, can easily lead to death.
Symptoms
The most primary symptom of the disease is the patient's ability to forget easily. This symptom is particular associated with the early stages of the disease. Others include forgetting important events and the tendency to repeat questions over and over again. A patient with this disease will rely on memory aids such as technological devices to remember some activities happening within their environment (Lahiri & Maloney, 2004). Additionally, the patient will depend on family members to help them perform simple tasks since they can no longer perform such tasks independently. Alzheimer's disease patients will acquire adverse memory impairment and lose the capacity to carry out daily duties as the disease develops. That is similar to President Ronald Reagan, who suffers from severe memory loss and cannot carry out routine chores without assistance.
Another symptom of Alzheimer's disease is a patient's or client's inability to connect with the family. Alzheimer's patients may lose track of their close family members, and this brings the family disconnection. More symptoms include mood swings, frustration, confusion, disorientation, trouble facing, and extreme difficulties in maneuvering regular daily routines.
Case Formulation
The patient is 83 years old and presents with difficulty remembering things. The patient struggles with remembering people's names, although he can remember his wife's name most of the time. The patient is also suffering a fractured hip after a fall and is presenting a problem to the family since he cannot perform simple activities independently.
VI . DSM-IV Multiaxial Assessment (OR DSM-5 Equivalent)
Axis I: __________
Axis II: __________
Axis III: _________
Axis IV: _________
G.A.F.: _________
VII. Treatment Plan
Alzheimer's disease is a hard-to-treat disease. The condition is unlikely to be treated with a single medication and requires combinations of both medicines and none-medication approaches. The existing treatments to the disease only aim to manage patients' behavioral problems, improve mental function, and lessen the disease symptoms. Treating the disease symptoms provides the patient with dignity, more comfort, the ability to perform simple tasks independently, and, most importantly, enables them to reconnect with their loved ones.
The majority of medications used to treat the disease are only most effective during the middle of the early stages of the disease. The medications temporarily alleviate symptoms associated with this disease. If a patient has the disease and is in the mild to moderate stage, cholinesterase inhibitors may be provided. Cholinesterase inhibitors aid in lessening the adverse effects and also help control some behavioral problems. The most effective inhibitors include Razadyne®, Exelon®, and Aricept® (Cummings, 2004). These drugs stop acetylcholine from being broken down in the brain, which is vital for memory and thinking. Their usage is that the brain produces less acetylcholine, and with prolonged use, the inhibitors might finally be ineffective.
In cases where the patient is moderate to severe stage, Namenda® is prescribed. The significant impact of this medication is to lessen the symptoms (Tuszynski, 2007). The medicine is also able to enable patients to perform tasks on their own. A patient who was previously unable to use the bathroom can use it at ease after or during the taking of the drugs—the Namenda® medication functions by modulating glutamate, a critical neurotransmitter. When glutamate is produced in excess, the chances are that it will result in the death of brain cells, and that is why patients need to use Namenda®so to regulate the production of glutamate. Under the doctor's prescription, both Namenda and cholinesterase inhibitors function in various ways and can be recommended to be used simultaneously.
Other than medications, non-pharmacological therapy can be used to improve cognitive performance, quality of life, and depression levels. The most effective therapies on an Alzheimer's patient are music intervention, reminiscence therapy, and peer social engagement (Cummings, 2004). This kind of non-pharmacological treatment help to improve an Alzheimer's patient's quality of life. The music intervention permits patients to recall past events that have been prompted by music associated with a specific feeling. The nurse should inform the patient about non-pharmacologic treatments and what therapies and approaches are available to them.
References
Cummings, J. L. (2004). Long-term treatment for patients with Alzheimer disease. Alzheimer Disease & Associated Disorders , 18 , S1. https://doi.org/10.1097/01.wad.0000127491.57408.4c
Lahiri, D., & Maloney, B. (2004). Dedication of the third issue of ‘Current Alzheimer Research’ to President Ronald Reagan (1911-2004). Current Alzheimer Research , 1 (3), iii-iii. https://doi.org/10.2174/1567205043332153
Tuszynski, M. H. (2007). Nerve growth factor gene therapy in Alzheimer disease. Alzheimer Disease & Associated Disorders , 21 (2), 179-189. https://doi.org/10.1097/wad.0b013e318068d6d2
