Dementia is often a serious issue that many run into during practice.
Here is where a history can play a part. Aside from using scans or other tests to confirm cases there have been times that a client displays symptoms with no positive scans.
We had an 83 YO client that presented with symptoms of forgetting and repeating themselves and the caregiver had done all the scans that showed no pathology. What did this patient have?
After reviewing the history a fast decline seemed to occur after the client lost a loved one and therefore depression came into play as a possibility.
Also upon a review of history the client was always dehydrated and was taking medications for frequent urination and a beta blocker for HTN. It seems the client did not truly have high blood pressure as all the readings were only done in the Doctors office. When a BP was take at home without a few days of meds it was actually lower than normal.
So what was going on? It seems the B blocker was reducing perfusion to the brain in an already dehydrated patient who was also severely depressed. After getting the client off the B blocker, adding an antidepressant (low dose mirtazipine) and having them drink 60-80 ounces of water a day her symptoms got much better.
This client is only one example of how things can get out of hand without looking at the history or whole picture.
Does anyone want to share research or an experience they had?
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Psychopharmacologic Approaches to Treatment
Psychopharmacologic Approaches to Treatment
Elderly patients require specialized and in-depth analysis to determine the conditions they are suffering from. Clinicians remain cautious to diagnose accurately and provide medication that will improve their condition (Ginoux et al., 2018). Healthcare workers also know that elderly patients require extra care to avoid the negative effects of the wrong medication.
One of the case studies I have experienced is a 68-year old female patient who had various symptoms of forgetting. For example, they forgot their name, their home, and their children. In most cases, the patient would get lost while driving leading to panic among the family members. During the diagnosis, one of the major questions was whether the patient was suffering from dementia, Alzheimer’s disease, or depression (Chiu et al., 2019). The various symptoms are evident that clinicians should take an in-depth. The conditions share several symptoms thus making it crucial for them to determine the distinguishing factor.
One of the best reactions to the case study was to check the history of the patient. It was also easy to check the medications that the patient is taking currently. The assessment shows that the patient had experienced trauma over a road accident at a young age. The conclusions show that clinicians should do more than diagnose and prescribe medications. Nurses need to ensure they link the past medical history with the symptoms of a patient (Novak et al., 2017). It helps in identifying the underlying conditions that the normal diagnosis process cannot identify. Although the symptoms of various conditions are similar, it is evident that clinicians need extra skills (Anderson et al., 2016). The skills involved in diagnosing health conditions among elderly patients require an analysis of health conditions and past medical conditions. Accurate diagnosis is important in reducing medical errors that can cause adverse effects or death.
Anderson, D. S., Sydor, M. J., Fletcher, P., & Holian, A. (2016). Nanotechnology: The risks and benefits of medical diagnosis and treatment. J Nanomed Nanotechnol, 7, 143.
Chiu, C. D., Tollenaar, M. S., Yang, C. T., Elzinga, B. M., Zhang, T. Y., & Ho, H. L. (2019). The loss of the self in memory: Self-referential memory, childhood relational trauma, and dissociation. Clinical Psychological Science, 7(2), 265-282.
Ginoux, M., Turquier, S., Chebib, N., Glerant, J. C., Traclet, J., Philit, F., … & Cottin, V. (2018). Impact of comorbidities and delays in diagnosis in elderly patients with pulmonary hypertension. ERJ Open Research, 4(4).
Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., … & De Vries, L. S. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics Essay, 171(9), 897-907.