Assessing Neurological Symptoms Case Studies Discussion

Assessing Neurological Symptoms Case Studies Discussion

Assessing Neurological Symptoms Case Studies Discussion

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Question Description
I don’t understand this Health & Medical question and need help to study.

Discussion: Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.
In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare:

pick any case study:

Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

template attached

episodic_focus

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Week 9 NEURO SOAP Note

 

Patient Initials: T.N              Age: 67 years                        Gender: Male

 

 

SUBJECTIVE DATA:

 

Chief Complaint (CC): “Very Forgetful”

 

History of Present Illness (HPI): N.S is a 67-year-old Asian male who was brought in by his daughter for psychiatric evaluation since he was very forgetful. She reports that the patient has lost his car keys several times. She also reports that sometimes when the patient goes to the store, he forgets his way back and calls for help. The patient claims that he started being forgetful about 2 years back, and it has been getting worse ever since as reported by his daughter. The patient denies any associated symptoms. No hallucination or delirium.

 

Medications:

  1. Losartan 50mg PO once daily for the management of his high blood pressure.

 

Allergies:

No known drug, food, or environmental allergies

 

Past Medical History (PMH):

High Blood Pressure

 

Past Surgical History (PSH):

Denies ever undergoing any surgical procedure in the past.

 

Sexual/Reproductive History:

Heterosexual

 

Personal/Social History:

Married with a daughter and a son. His wife however passed on 2 years ago.

Retired but owned and ran his café downtown for several years.

He lives by himself, but the daughter lives next door and checks on him now and then.

Confirms taking one or two beers when with friends.

Denies smoking tobacco or using any other recreational drug.

 

Health Maintenance:

The patient used to exercise before by walking the dog, but ever since he started being forgetful, he does not remember the last time he went for a long walk. He however consumes a healthy diet which his daughter makes sure of. He uses a seat belt when in the care and lives in a well-maintained house. Confirms sleeping for about 8 hours every night.

 

Immunization History:

Flu shot 16/1/2022

Covid Vaccine #1 4/1/2021 #2 2/1/2021 Moderna

All other immunization up to date

Significant Family History:

The patient’s mother passed on at the age of 86 years due to cardiac arrest, upon receiving a report that her grandson had been involved in a car accident. His father is alive at the age of 94 years with a history of diabetes, dementia, arthritis, and thyroid disorder. Both his children are healthy with no significant history of any chronic medical condition.

 

Review of Systems:

General: Appears healthy with no signs of distress. No signs of fatigue, chills, fever, or generalized body weakness.

 

HEENT: Head: No signs of trauma or headache reported. Eyes: Denies blurred vision, use of corrective lenses, excessive tearing, or redness. Ears: No tinnitus, itchiness, or hearing loss. Nose: no congestion, running nose, sinus problems, or nose bleeding. Throat & Mouth: No sore throat, coughing, swallowing difficulties, or dental problems. Neck: No tenderness, signs of injury, enlarged tonsils, or a history of disc disease or compression.

 

Respiratory: No wheezing, coughing, shortness of breath, or breathing difficulties.

 

CV: Denies chest pain, edema, orthopnea, syncope, or palpitations. Dyspnea on exertion

 

GI: No abdominal tenderness, constipation, diarrhea, distention, changes in bowel movement, or jaundice.

 

GU: Denies incontinence, urinary frequency, hematuria, dysuria, or burning sensation when urinating.

 

MS: Denies back pain, with a full range of movement in all the extremities. No signs of spinal code injury.

 

Psych: Denies paranoia, hallucinations, delirium, suicidal ideation, mental disturbance, memory loss, anxiety or depression, or a history of psychosis.

 

Neuro: Denies vertigo, tremors, syncope, seizures, paresthesia, or transient paralysis.

 

Integument/Heme/Lymph: No bruising, ecchymosed, ulcers, lesions, or rashes. No signs of enlarged lymph nodes.

 

Endocrine: Denies heat intolerance, cold intolerance, polyuria, polyphagia, or polydipsia.

 

Allergic/Immunologic: Denies hay fever, urticaria, or persistent infections.

 

OBJECTIVE DATA:

 

Physical Exam:

 

Vital signs: T: 97.7°F (36.5°C), BP: 125/70 mm Hg, HR 70/min, R: 18/min, memory loss 8/10. Ht. 5’9’’, Wt. 179 pounds, BMI: 23.5

 

General: N.S appears healthy and well cooperative through the examination with a pleasant mood. He experiences no chills, fever, fatigue, or recent changes in body weight.

 

Chest/Lungs: Lungs are clear to auscultation and percussion bilaterally. No rhonchi or wheezing.

 

Heart/Peripheral Vascular: S1 and S2 present. No rubs, gallops, or murmurs. Regular rate and rhythm

 

Lymphatics: No signs of enlarged lymph nodes.

                       

Neurological: The CN II-VII and the DTR are undamaged. Denies headache, syncope, or dizziness. Confirms worsening memory loss for the past 2 years

 

Psychiatric: Denies feeling hopeless, or having suicidal ideations. Confirms being in mild distress due to memory loss leading to cognitive impairment.

 

Diagnostic results:

TSH – To determine if the patient memory loss is associated with hypothyroidism.

MRI of the head – To assess whether there is any form of damage to the neurotransmitters or the presence of any form of brain cell tumor.

Cerebral angiography – To measure the blood flow through the brain for any signs of deficiencies.

Amyloid imaging –

Cognitive test – To determine whether the patient’s memory loss is associated with anxiety or distress (Bruno, 2020).

 

ASSESSMENT:

 

  1. Alzheimer’s disease: Alzheimer’s disease is a progressive neurologic disorder that leads to atrophy of the brain and death of brain cells (Glymour et al., 2018). This disorder is the most common form of dementia among the elderly above the age of 65 years. It is characterized by significant cognitive deterioration which undermines the patient’s ability to sustain independent living. The diagnosis of this disorder is based on three stages, with the first stage regarded as the preclinical stage with no symptoms. The second stage which is referred to as the middle stage is characterized by mild cognitive impairment, whereas the final stage is characterized by marked symptoms of dementia. The patient in the provided case study presents with worsening memory loss, for the past two years, which indicates the final stage of Alzheimer’s as the primary diagnosis.
  2. Vascular cognitive impairment (VCI): This is a disorder of the mind with undermines the patient’s mental ability to think, feel and be awake (Ghafar et al., 2019). VCI presents with cognitive symptoms ranging from being forgetful in mild cases. However, in severe cases, patients may present with serious cognitive impairments leading to problems with memory, attention, language, and executive functions such as problem-solving. The patient in the provided case study reports being forgetful, However, cognitive testing is required to confirm this diagnosis.
  3. Vascular dementia: This refers to a decline in the patients thinking skills due to conditions that reduce or block the flow of blood to various parts of the brain, depriving them of nutrients and oxygen (Bruno, 2020). Patients will present with symptoms such as forgetfulness, poor balance, confusion, and disorientation among others. The patient in the provided case study however presented with forgetfulness only, with no associated symptoms.
  4. Idiopathic normal pressure hydrocephalus (INPH): This is a disorder of the brain characterized by impairment of the patient’s gait, urinary incontinence, and decline in cognitive function. It is normally associated with ventriculomegaly in the absence of increased cerebrospinal fluid (CSF) pressure (Kockum et al., 2020). Forgetfulness and confusion are one of the most common early symptoms, among others such as depression, trouble walking, poor balance, and falling. Neuroimaging with either CT or MRI is however required to confirm this diagnosis to assess for hydrocephalus pressure.
  5. Lewy body dementia (LBD): It is a rare disease associated with abnormal deposition of alpha-synuclein in the brain. These deposits, known as Lewy bodies lead to a progressive decline in the patient’s cognitive ability (Gan et al., 2021). Patients will present with common signs and symptoms such as memory loss, tremors, slow movement, muscle rigidity, loss of coordination, and reduced facial expression. However, the diagnosis of this disorder requires the patient to present with declining thinking ability in addition to at least two of the following symptoms, parkinsonian symptoms, repeated visual hallucinations, and fluctuating alertness.

 

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

 

 

References

Bruno, A. (2020). Forgetfulness. The Family Nurse Practitioner: Clinical Case Studies, 245-249.

Gan, J., Liu, S., Wang, X., Shi, Z., Shen, L., Li, X., … & Ji, Y. (2021). Clinical characteristics of Lewy body dementia in Chinese memory clinics. BMC neurology21(1), 1-11. https://doi.org/10.1186/s12883-021-02169-w

Ghafar, M. Z. A. A., Miptah, H. N., & O’Caoimh, R. (2019). Cognitive screening instruments to identify vascular cognitive impairment: A systematic review. International Journal of Geriatric Psychiatry34(8), 1114-1127.

Glymour, M. M., Brickman, A. M., Kivimaki, M., Mayeda, E. R., Chêne, G., Dufouil, C., & Manly, J. J. (2018). Will biomarker-based diagnosis of Alzheimer’s disease maximize scientific progress? Evaluating proposed diagnostic criteria. European Journal of Epidemiology33(7), 607-612. https://doi.org/10.1007/s10654-018-0418-4

Kockum, K., Virhammar, J., Riklund, K., Söderström, L., Larsson, E. M., & Laurell, K. (2020). Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus. PLoS One15(4), e0232275.

 

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