Alzheimer’s Disease Case Study

Alzheimer’s Disease Case Study B. Trimble Case Study M. T. an 86-year-old Asian male is brought into the geriatric clinic by his daughter because he is becoming more forgetful. The daughter explains that the patient often does not even recognize his own grandson. When asked, however, the patient denies memory impairment. The daughter states that her father has been having trouble for almost four years now. She said she did not realize how much her father had changed until she watched a home video of her father with his grandson from six years ago. â€Å"His personality has even seemed to have changed, said the daughter. M.T. is no longer able to take care of his house and household chores and is sometimes slow to respond to questions. Past Medical History Peptic Ulcer Disease (PUD) with the last occurrence three years ago. Social History Retired sanitation worker times fifteen years. Lives with his daughter since his wife died five years ago. Previous cigarette smoker quit fifteen years ago. Denies ethyl alcohol (ETOH), and intravenous drug abuse. Family History Father died in combat in Korea Mother died at age 92, unknown cause Medications and allergies NKDA Prevacid 30 mg orally once daily Mylanta 30 ml orally as needed for stomach upset Aspirin EC 81 mg orally once daily Tylenol 325 mg orally as needed for headache Physical Examination General – patient is a thin, pleasant man, with working memory in no acute distress. Vital signs – BP 145/78 , pulse 80 RR 17 , WT 70 kg , Ht 6’2† BMI 19.8 HEENT- Pupils PERLA Ears with cerumen Neck no bruit no JVD Cardiovascular – Normal sinus rhythm, S1 S2, negative for S3/S4, resp RRR Neuro – Aox1 (Oriented to person only), CN – XII – XII intact, reflex normal Abdomen – positive bowel sounds, non-tender, non-distended External – WNL, no clubbing, cyanosis, or edema Laboratory Tests Albumin – (3.6-5 g/dL) 3.6g/dL total protein – (6.3-8.2g/dL) 6.8g/dL Alk Phos – (38-126U/L) 41U/L ALT – (7-58 U/L) 21 U/L AST – (7-58 U/L) 21 U/L bilirubin – (0.2-1.3ug/dL) 0.3ug/dL BUN – (8-25mg/dL) 11mg/dL HgB – (13.2-15.2 g/dL) 13.5g/dL SCr- (0.5-1.4mg/dL) 0.7mg/dL Hct (40-52%) 39% Na+ (134- 146 mEq/dL) 136 mEq/dL Plts – (140-450 mm3) 300,000/mm2 Cl-(98-107mEq/dL) 103 mEq/dL WBC – (4.1-10.9mm3) 8700/mm2 Bicarb – (22-26 mEq/dL) 24 mEq/dL ESR – ( Glucose – (65-110mg/dL) 101mg/dL B12 – (223-1132 pg. /ml) 452pg/ml Ca- (8.9-10.4 mEq/dL) 8.5 mEq/dL folate – (3.6-20ng/dL) 6.4ng/dL Mag – (1.6-2.4mEq/dL)1.9 mEq/dLFTI – (4-11) 6.3 Phos (2.5-4.5 mg/dL) 3.3 mg/dLT3 – (75-220ng/dL) 101ng/dL Cholesterol- (T4 – (4-11mEq/dL) 6.1 mEq/dL TSH – (0.35-6.2 microU/uL) 2.0 micro Unit/uLRPR – non-reactive Radiology Testing CT scan impression mild cortical atrophy Diagnosis Dementia (senile dementia) is a syndrome rather than a distinct disease entity. It is usually progressive and irreversible. It is characterized by a general decline in cognitive abilities that may include losses of memory, abstract reasoning, judgment, and impulse control, as well as changes in personality. It is usually subtle in onset and often progresses slowly until symptoms are very obvious and profoundly devastating. The three most common dementias are Alzheimer’s disease, multi-infarct dementia, and a mixed Alzheimer’s disease and multi-infarct dementia (Cayton, Graham, Warner, 2004). Alzheimer’s disease is sometimes called primary degenerative dementia or senile dementia of the Alzheimer’s type. It accounts for at least 80 percent of all the dementias suffered by the elderly (Whalley, Lawrence, Breitner, 2009). It is a progressive, irreversible, degenerative neurologic disease of unknown origin that begins insidiously. The highest incidence is among persons 65 years and older with increasing incidence after age 70. The life expectancy following the diagnosis varies from six to twenty years (Whalley, Lawrence, Breitner, 2009). The etiology of the disease is unknown, but there are specific neuropathologic and biochemical changes. These include neurofibrillary tangles and senile or neuritic plaques. This neuronal damage occurs primarily in the cerebral cortex and results in decreased brain size. These changes are found to a lesser extent in normal brain tissue of older adults. Cells principally affected by this disease are the ones that use the neurotransmitter acetylcholine. Biochemically, the enzyme active in producing acetylcholine is decreased. Acetylcholine is specifically involved in memory processing (Whalley, Lawrence, Breitner, 2009). Clinical manifestation Symptoms of Alzheimer’s disease are highly variable. Early in the disease, forgetfulness and subtle memory loss occur, but the victim has adequate cognitive function to hide the loss. Social skills and behavior patterns remain intact; problems are difficult to detect on casual observation (Cayton, Graham, Warner, 2004). With further progression of the disease there is an inability to conceal the deficits. Forgetfulness is manifested in many daily actions. The victim may lose his way in a familiar environment. He may repeat the same stories because he forgets that he told them. Reasoning and reality orientation by caregivers increase the patient’s anxiety without increasing function, because this is also forgotten (Cayton, Graham, Warner, 2004). Conversations become difficult because the victim forgets what he was about to say or may not be able to remember words. Ability to formulate concepts and think abstractly disappears (Cayton, Graham, Warner, 2004). The person can interpret a proverb only in concrete terms. The victim is often unable to appreciate the consequences of his actions and will therefore exhibit impulsive behavior. He will have difficulty with everyday activities such as working simple appliances and handling money (Cayton, Graham, Warner, 2004). Personality changes are usually negative. The patient may become depressed, suspicious, paranoid, hostile, and even combative (Whalley, Lawrence, Breitner, 2009). Progression of the disease intensifies the symptoms. Speaking skills deteriorate to nonsense syllables; agitation and physical activity increase. A voracious appetite often develops because of the high activity level. The patient may wander at night for hours. Eventually he will need help in all areas of personal care including toileting and eating; dysphagia occurs and incontinence develops. The terminal stage may last for months (Cayton, Graham, Warner, 2004). Treatment Treatment for dementia of the Alzheimer’s type will be Aricept 5 mg once daily at bedtime. After four weeks symptoms will be reviewed, and titration to ten mg once daily may be initiated, depending upon results. Maximum dosage of 23 mg daily if needed after three months of 10-mg treatments (Katzung, Mastes, Trevor, 2012). Follow up in office in four weeks. Discontinued use of Prevacid, as the medication is implicated in low platelet, WBC, HgB and Hct, calcium, and B12 levels (Brunton, Chabner, Knollman, 2011). Follow-up blood work in four weeks, should include CBC with differential, CMP, liver panel, weight, and blood pressure. Patient is borderline hypertensive and increase in fluid volume may correct this issue. Patient should be encouraged to change diet to a high-protein diet with adequate hydration. If platelet count and WBC count continue to be below normal a hematology consult will be discussed. Referral to Alzheimer’s support group will be given to the daughter. References Brunton, L., Chabner, B., Knollman, B. (2011). Goodman Gilmans: The pharmacological basis of therapeutics (12 ed.). McGraw-Hill. Cayton, H., Graham, N., Warner, J. (2004). Dementia: Alzheimers and other dementias: At your fingertips guide (2 ed.). London: Class. Katzung, B., Mastes, S., Trevor, A. (2012). Basic clinical pharmacology (12 ed.). McGraw-Hill. Whalley, L., Lawrence, J., Breitner, J. (2009). Dementia (2 ed.). Health Press.

Self Reliance – a Key to Success

When you don’t have to rely on someone else, you are the master of your own destiny. That’s really the secret to everything in life. If you’re OK with yourself and you don’t need others approval for your happiness, then you are happy. Self reliance comes with self confidence. Self reliance helps a person to prepare for life challenges. Rest your mind and imagine a situation where you are confident and successful. Go over the details thoroughly in your mind. What did you do? What did you say? You can also try to remember a time in the past when you acted with a lack of confidence. Go over the situation in your mind, changing whatever details you would need to alter the outcome to a desired one. Visualize yourself strengthening your self-confidence and acting the way you wish you would have acted. Don't judge yourself – simply re-create the situation and envision yourself with strong self-confidence, and having the outcome be better. To build on self improvement one needs to love him/herself. Leaning to love yourself is fundamental in self improvement and building good self esteem. You need to improve yourself by first understanding yourself and accepting the way you are. Self improvement brings happiness and satisfaction to one’s life. Though the road to self improvement is not easy, it is compulsory for one to experience happiness in life. When you stop and deal with your issues and insecurities, you are on the road to a more well and vibrant you and hence achieving success will be easy. â€Å"Nothing at last is sacred but the integrity of your own mind. † – Ralph Waldo Emerson

Functionalist View Of The Family - 1473 Words

Murdock (1949) studied 250 different societies, he concluded that society could not survive without the family as it was so functional. He argued there were four essential functions, without these society would not survive: sexual, reproductive, economic and education. Without sex and reproduction there would be no new members, without economic and education, the family providing for its members, the young socialised to norms and values, cultures would not exist. In the absence of this human society would cease (Haralambos and Holborn, 2008). 83 Evaluate the functionalist view of the family by referring to for example, the view that the family has lost functions/role due to structural differentiation. Parsons (1955) studied the modern†¦show more content†¦220 Discuss an additional sociological theory on the role of the family, e.g. feminist, Marxist or the New Right. Where functionalism believes the nuclear family is positive, marxism argues from a negative viewpoint seeing an extended and reproduced conflict between classes. Marxist dispute the belief of family having equal benefit for all and argue the capitalist economy depends on the family to buy and work, to produce goods which benefits the capitalist. Although the nuclear family is responsible for socialisation, it must be considered that not all norms and values are positive. They oppose the functionalists who paint a rosy view, who forget to account for issues that arise possibly leading to divorce or separation, as not all families are the same (Taylor and Richardson et al,. 2002). The increase of economic pressure from unemployment and people living longer seen to impose pressure on relationships leading to breakdown. The socialisation process seen to result in the spreading of the ruling class philosophy, individuals being deceived into accepting a capitalist system of leadership and dominance. Those Bourgeois benefitting from a created labour force with the proletariat exploited. Engels (1972) saw the bourgeois form of nuclear family as oppressing women, who were dependent financially on their spouse and expected child bearers. Family being designed to control women, protect property and for men to know theirShow MoreRelatedFunctionalist View of the Family1317 Words   |  6 Pagesusefulness of the functionalist view for an understanding of the family today? Functionalism is a structural theory. In functionalism, social institutes like families are the key parts of the structure/system. These institutions are seen as working in an integrated way that keeps society in a state of consensus. Functionalists stress the positive role of a family for society and its members. They argue that the families’ role is universal and functional. A famous functionalist, called Murdock believedRead MoreAssess the Functionalist View of the Family.1031 Words   |  5 Pages‘Assess the functionalist view of the family?’ Functionalist looks at society on a macro level. It is a consensus theory and structuralists prefer to use functionalism as it agrees with their ideals and models and they prefer to look at society as a whole. Functionalists are interested in studying what family is most functional. 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Functionalists would say that if Read MoreCompare and Contrast the Functionalist and Marxist views on the Family1508 Words   |  7 Pagesï » ¿Compare and Contrast the Functionalist and Marxist views on the Family Functionalists argue that societies consist of inter-related social institutions such as schools, mass media, political systems, the Church and the family each of which contribute positively to the maintenance of stability of society as a whole. Broadly speaking it is assumed by functionalists that societies operate in the interests of all of their members so that there is no reason for fundamental conflict in society. InsteadRead More Functionalist View on Same-Sex Families Essay1162 Words   |  5 Pages Functionalist View on Same-Sex Families What is Functionalism? Functionalism is the belief that members of society form relationships with each other through rules and regulations i.e. the law. They also believe society is based on a consensus and there is no time for conflict, although it is acknowledged but is seen as only a temporary disturbance, which can be resolved. They believe it is the basis of social life without it there would be conflict and disorder.Read MoreOutline and Evaluate Functionalist Views of the Role of the Family in Society.1570 Words   |  7 PagesOutline and evaluate Functionalist views of the role of the family in society. [33 marks] Functionalism is a structuralist theory; this meaning that it sees social structure (the social organisation of society) as more important than individuals. Functionalist sociologists believe that people have a range of basic needs that must be met if society is to run smoothly. Different groups and individuals in society are important because they perform certain functions which meet societys needs. FunctionalismRead MoreFunctionalist View Of The School As Secondary Socialisation And Acts As A Bridge Between The Family And Wider Society Essay1744 Words   |  7 PagesAnother functionalist view is that of Talcott Parsons, who focuses on the function of the school as being secondary socialisation and acts as a bridge between the family and wider society. In the family we gain ascribed status and are judged on particularistic terms, this means that we are seen as a particular person, i.e. son/daughter, and as such receive specific treatment. When we move into wider society we are judg ed in terms of our achieved status, that which we have gained through our own meritsRead MoreAssess the View That the Nuclear Family Functions to Benefit All It Members and Society of a Whole1216 Words   |  5 PagesAssess the view that the nuclear family functions to benefit all its members and society as a whole. 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Other people’s outlooks disagree with this view, such as the Marxists, the Marxist FeministsRead MoreFunctionalist Perspective On Society As A Macro Institution1056 Words   |  5 PagesThe functionalist perspective In this essay I will outline and evaluate the functionalist perspective. This will include exploring the origins of the perspective, while explaining and evaluating how functionalists see society as a macro institution, rather than its many constituent parts. Further to this I will explore how functionalists deem the way society should be maintained and organised to maintain a functionalist’s ideal society. The consensus perspective is predominantly concerned with the

Origins Of The World War - 1796 Words

Origins of the World War 1 General Theory of the War The First World War occurred when Britain went to war with Germany in the year 1914. During that time, the government led by the Prime Minister called Andrew Fisher pledged to completely support Britain. Globally, the war affected Australia and other nations with a lot of enthusiasm. It lasted for 5 years from the year 1914 to 1919. It was a battle between the allies and the central powers. It is believed to have involved a lot of soldiers and military warfare. It is one of the bloodiest warfare in the history of the world as far as global warfare is concerned. Military troops were placed in trenches which was a strategy that ensured that there was tight defense (Lecture notes: August†¦show more content†¦Shifting in the balance of power in Europe can also be attributed to triggering the war. Every country and nation wanted to prove that it was powerful and capable of defending itself. No nation wanted to be dominated and bullied by another one which also resulted in securi ty dilemma (Lecture notes: August 4th, 3). Clashes due to the territory in the Balkans can also be blamed for the eruption of the war. The alliances and treaties that were formed amongst the nations also resulted in others participating in the war. Nationalism The growth and spread of nationalism throughout Europe also contributed to the start of the war; in addition, unresolved disputes also played a major role (Lecture notes: August 18th, 5). Other contributing factors included: the formation of alliances, threats from each other and the perceived collapse of the balance of power throughout Europe. Convoluted and divided governance also acted as another contributing factor to the breakout of the war. This is because some governments were beginning to breakdown and divide which led to a weak system of governance. Imperial as well as colonial rivalry due to wealth, power, and prestige were also involved in the occurrence of the world war. Economic and military rivalry and clashes also led to the eruption of this war. Industrialization of War The fact that Germany was rising quickly in terms of the economic, industrial and military skills made the