NU-664B Week 8 QBank Questions

Value: 100 points

Due: Day 7

Gradebook Category: QBank

Please navigate to your APEA learning portal and complete a 20-question practice quiz related to the body system/topics covered this week. You may choose whichever test mode you like. You may complete as many 20-question quizzes as you like to improve your score. Once you are satisfied with your score, please take a screenshot of the quiz score you would like to count and submit to the Moodle dropbox. Please be sure the following are visible in your screenshot:

nu-664b week 8 qbank questions

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  2. Date (must be completed in the week it is due)
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  1. Alzheimer’s Dementia (AD)-  This is the most common cause of dementia, it is a progressive loss of neurologic function from an unknown etiology (Wolk & Dickerson, 2023). The main symptom of AD is decreased memory, and other symptoms include decrease motor skills and a lack of awareness of deficits (Wolk & Dickerson, 2023). Britt reports her mother’s memory has progressively declined and she has to help her with a lot, which has changed within the past year. Saleh is at risk for developing AD because she has diabetes, hypertension, and a history of TIAs and concussions (Keene, Montine & Kuller, 2023). AD is an important diagnosis to consider and is highly likely based on Saleh’s symptoms and risk factors. Testing to diagnose AD includes neuropsychologic evaluation, and neuroimaging (Wolk & Dickerson, 2023).
  1. Vascular Dementia- This is a type of dementia that is caused by a cerebrovascular accident or diminished blood flow in the cerebral area (Smith & Wright, 2023). Family members may notice a sudden or gradual change in behavior (Uwagbai & Kalish, 2022). Saleh has had two TIAs and two falls resulting in concussions. Her recent memory loss coupled with a history of TIA makes this type of dementia a likely diagnosis. Saleh is seventy years old, she has hypertension, diabetes, and most likely decreased mobility, these are risk factors that put her at risk for developing vascular dementia. To rule this out a physical exam that includes scoring tools such as the Hachinki ischemia scale, cognitive tests, a full set of labs to rule out other etiology, computed tomography (CT), and magnetic resonance imaging (MRI) are needed (Smith & Wright, 2023). 
  1. Depression- This is a continual mood disorder that can cause sadness and loss of interest (Chand & Harif, 2022). Some symptoms of depression can affect sleep, energy, concentration, and psychomotor function (Chand & Harif, 2022). Saleh has some of the symptoms mentioned above, and her daughter reports she seems sad all the time, making this diagnosis likely. There are no diagnostic tests to rule out depression, but a full workup should be done to exclude other origins (Chand & Harif, 2022). Saleh’s age places her at risk for depression, depression at times is confused with AD because the symptoms can be similar (Dunphy et al., 2019, p. 107). 
  2. Post-Concussion Syndrome – This can happen after a traumatic brain injury (TBI) from head trauma, it is also known as post-TBI syndrome (Evans, 2023). Some of the symptoms are headache, dizziness, memory loss, irritability, depression, and insomnia (Evans, 2023). Saleh has fallen twice, which can place her at risk of developing some of the symptoms she is experiencing. According to Evans (2023), there are studies that show that falls place patients at risk for lengthy symptoms after a concussion. She is also at risk as a female and her age (Evans, 2023). Due to Selah’s symptoms, post-concussion syndrome is a possible diagnosis, however, it is unlikely because Selah has been experiencing progressive memory change for over a year. To rule out post-concussion syndrome it would be important to know when Selah was diagnosed with concussions, a thorough history is important, and an MRI may be useful in detecting evidence of a TBI (Evans, 2023). 

Final Diagnosis- Alzheimer’s Dementia 

Plan

Pharmacology- 

  1. (Cholinesterase inhibitor) Donepezil 5 mg PO QD (Press & Alexander, 2023)
  2. Vitamin E 1000 IU PO BID ( Press & Buss, 2023) 

Non-Pharmacology-

  1. Exercise (Press & Buss, 2023) 
  2. Increase nutrition intake, and help the patient feel comfortable and relaxed by eating with them or if in a facility eating with others (Press & Buss, 2023) 
  3. Occupational Therapy- This helps patients with their activities of daily living (ADLs) (Press & Buss, 2023) 
  4. Cognitive rehabilitation- The earlier the better, this can help patients with their memory recall (Press & Buss, 2023). 

Diagnostics

  1. Basic metabolic panel (BMP) (Smith & Wright, 2023)
  2. Liver panel (Smith & Wright, 2023)
  3. Thyroid panel (Smith & Wright, 2023)
  4. Complete Blood Count (CBC) (Smith & Wright, 2023)
  5. B12 (Smith & Wright, 2023)
  6. MRI & CT scan (Smith & Wright, 2023). 
  7. Rapid plasma reagin (RPR) (Chand & Arif, 2022)
  8. HIV test (Chand & Arif, 2022)
  9. Blood alcohol level (Chand & Arif, 2022)
  10. Blood and urine toxicology (Chand & Arif, 2022)
  11. Dexamethasone suppression test (Chand & Arif, 2022)
  12. Arterial blood gas (ABG) (Chand & Arif, 2022)
  13. Cosyntropin (ACTH) stimulation test (Chand & Arif, 2022)

Consults/Referrals-

Referral to Neuropsychology and case management is best when done early when recognizing possible signs of Alzheimer’s Dementia (Press & Buss, 2023). It is also helpful to have a geriatric care manager, they can assist with planning and offering guidance to patients and families (Press & Buss, 2023). 

Patient Education-

  1. Please take the medication exactly as prescribed (Press & Alexander, 2023)
  2. Donepezil may cause gastrointestinal symptoms such as nausea, vomiting, and diarrhea (Press & Alexander, 2023). 
  3. Donepezil can make you lose weight (Press & Alexander, 2023). 
  4. Monitor your heart rate and blood pressure once a day, Donepezil can lower your blood pressure and heart rate (Press & Alexander, 2023).
  5. Change positions slowly, Donepezil can cause you to be light-headed increasing your risk for falls. 
  6. Take Donepezil in the morning, if taken at night this medication can cause vivid dreams or insomnia (Press & Alexander, 2023). 
  7. Please contact us if the side effects persist and are affecting your day-to-day (Press & Alexander, 2023).  
  8. Please try to take Donepezil for at least six months to monitor its effects, this medication works slowly ( Press & Alexander, 2023). 
  9. It may be helpful to secure rugs or remove them to prevent falls (Patient Education, 2023)
  10. Remove or tuck in wires or cords to prevent falls ( Patient Education, 2023)
  11. Keep a nightlight in the bathroom and hallways well-lit to prevent falls (Patient Education, 2023) 
  12. Alzeihemers causes memory loss, so it is important to plan early with decisions such as designating a power of attorney, finances, living situation, and driving (Patient Education, 2023b). 

Follow Up-

  1. Telehealth or phone call two weeks after medication initiation to monitor (Press & Alexander, 2023). 
  2. Once medications are stable follow up in three months, and then every six to twelve months after (Press & Alexander, 2023).  

Health Maintenance- 

Patients with AD slowly lose their memory and eventually decline physically, it is beneficial to promote physical activity so that they do not lose their range of motion and mobility. (Press & Buss, 2023). With supervision, exercise such as walking at least three times a week can prevent falls and prevent physical decline (Press & Buss, 2023). 

Social Determinants of Health –

Patients with AD are vulnerable as they are at risk for isolation, loss of control, and negligence (Press & Buss, 2023). It is important to follow up and assess the patient’s disposition, doing so can help recognize symptoms such as signs of depression and negligence. As a provider, it’s important to continuously assess patients to provide appropriate referrals based on needs to prevent negative experiences such as negligence ( Press & Buss, 2023). 

REFERENCES 

Chand SP, Arif H. Depression. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430847/ 

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary care: Art and science of advanced practice nursing – An interprofessional approach. (5th ed.). Philadelphia, P.A., F.A. Davis.

Evans, W. (2023). Postconcussion syndrome. UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/postconcussion-syndrome?search=TBI%20&source=search_result&selectedTitle=8~117&usage_type=default&display_rank=8 

Keene, C., Montine, J., Kuller, J. (2023). Epidemiology pathology, and pathogenesis of alzheimer disease. UpToDate. Retrieved on February 24, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/epidemiology-pathology-and-pathogenesis-

of-alzheimer-disease?topicRef=5071&source=see_link#H951835456 

Press, D., Alexander, M. (2023). Cholinesterase inhibitors in the treatment of dementia. UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regisc

ollege.idm.oclc.org/contents/cholinesterase-inhibitors-in-the-treatment-of-dementia?search=vascular%20dementia&topicRef=5086&source=see_link#H362013293 

Press, D., Buss, S. (2023). Management of the patient with dementia. UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/management-of-the-patient-with-dementia?search=alzheimer%20dementia&topicRef=5073&source=see_link#H3881191591 

Smith, E., Wright, C. (2023). Etiology, clinical manifestations and diagnosis of vascular dementia. UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/etiology-clinical-manifestations-and-diagnosis-of-vascular-dementia?search=vascular%20dementia&source=search_result&selectedTitle=1~63&usage_type=default&display_rank=1#H2770421555 

Patient education (2023a). Dementia (including alzheimers disease) (The basics). UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/dementia-including-alzheimer-disease-the-basics?search=vascular%20dementia&topicRef=5072&source=see_link 

Patient education (2023b). Tips for caregivers of people with alzheimer disease, the basics. UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/tips-for-caregivers-of-people-with-alzheimer-disease-the-basics?search=vascular%20dementia&topicRef=15523&source=see_link 

Uwagbai O, Kalish VB. Vascular Dementia. [Updated 2022 Jan 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430817/ 

Wolk, D., Dickerson, B. (2023). Clinical features and diagnosis of alzheimer’s disease. UpToDate. Retrieved on February 23, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/clinical-features-and-diagnosis-of-alzheimer-disease?search=ALZHEIMERS&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1