NU 664B Week 8 Discussion 1: Memory Loss
Regis University NU 664B Week 8 Discussion 1: Memory Loss-Step-By-Step Guide
This guide will demonstrate how to complete the Regis University NU 664B Week 8 Discussion 1: Memory Loss assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NU 664B Week 8 Discussion 1: Memory Loss
Whether one passes or fails an academic assignment such as the Regis University NU 664B Week 8 Discussion 1: Memory Loss depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NU 664B Week 8 Discussion 1: Memory Loss
The introduction for the Regis University NU 664B Week 8 Discussion 1: Memory Loss is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NU 664B Week 8 Discussion 1: Memory Loss
After the introduction, move into the main part of the NU 664B Week 8 Discussion 1: Memory Loss assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NU 664B Week 8 Discussion 1: Memory Loss
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NU 664B Week 8 Discussion 1: Memory Loss
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NU 664B Week 8 Discussion 1: Memory Loss
HPI: 70-year-old African American woman, Selah, who is accompanied by her daughter, Britt, to the appointment. The PMH of the patient includes HTN, DM, Hyperlipidemia, TIA × 2, and Osteoarthritis of both knees, with multiple falls resulting in two diagnosed concussions. The daughter is concerned because she feels as if her mother’s memory isn’t what it used to be. Britt states that her mother sometimes misplaces things and forgets events, as well as the names of people she has known for a long period of time.
Differential Diagnoses
Alzheimer’s Disease. AD has an insidious and progressive onset for symptoms (Dunphy et al., 2019). Common signs of the onset of disease are seen by family members who start noticing changes over time. Cognitive decline often seen in AD patients are an inability to learn new information or recall things they knew previously, aphasia, apraxia, agnosia, and weaknesses with executive function (Dunphy et al., 2019). This patient is displaying signs of learning and memory deficits. She is having issues with misplacing familiar items and forgets events, and names of people she knows well. These are all signs for further assessment of AD (Dunphy et al., 2019).- Depression. Symptoms of depression can mimic AD (Dunphy et al., 2019). Once older adults have multiple falls, they can be fearful of falling again (Kiel, 2022). Fears of falling are associated with depression as well as cognitive impairments (Kiel, 2022). Increased depression can be a sign of increasing dementia with AD (Dunphy et al., 2019).
- Head Injury. Head injuries are a risk factor for Alzheimer’s disease (Dunphy et al., 2019). She takes two antihypertensive medications, an opioid for pain, and a blood thinner. Antihypertensive medications should be closely monitored in older adults due to the increased risk for falls (Kiel, 2022). I would want to check PT/PTT and platelets as well as a head CT to ensure she does not have any intracranial bleeding.
- Drug-related dementia. Opioids can negatively affect cognitive function in older adults (Dunphy et al., 2019). However, this can be ruled out in this patient because she was prescribed pain meds a couple of months ago, and her daughter states her memory issues started 6 months ago. Another drug to be weary of is the Plavix. This is a blood thinner and she has two recent falls.
Final Diagnosis: Alzheimer’s Disease
Pharmacology
Donepezil (Aricept) (Dunphy et al., 2019).
• Vitamin E (Dunphy et al., 2019)
Non-Pharmacology
Keeping a Routine
• Memory training
• Daily exercise
• Good nutrition/hydration
• Keeping up with preventative care (Dunphy et al., 2019).
Labs/Diagnostics
CBC, CMP, serum Ca, TSH, FT4, Vitamin B12, UA, non-contrast CT brain (to rule out any surgically treatable lesions or vascular disease), PET scan (detect amyloid deposits) (Dunphy et al., 2019).
Referrals
Memory disorder center
• Neurology for PET scan and evaluation
• Social services (Dunphy et al., 2019).
Patient Education
Use memory aids and modify the environment at home so that her independent functioning can be maximized. By this I mean, declutter the house, make sure she uses proper footwear to avoid falls, keep important things she uses all the time out in the open where it can easily be found, etc. (Dunphy et al., 2019).
• Stick to routine. The more familiar her day to day is, the longer her cognitive function will remain intact (Dunphy et al., 2019).
• You can practice memory training to help with recall (Dunphy et al., 2019).
• Exercise and enroll in recreation activities she would enjoy to help with socialization (Dunphy et al., 2019).
• Have discussions about legal and financial issues related to decisions she is able to make and ones that should be left to someone she trusts, this includes end-of-life decisions (Dunphy et al., 2019).
• Be sure to keep a closer eye on her; memory issues can be dangerous if she starts to wander and cannot remember where she is (Dunphy et al., 2019).
• Donepezil (Aricept) common side effects are nausea, diarrhea, anorexia, and weight loss. We will monitor her liver function on this medication (Dunphy et al., 2019).
• Donepezil does not prevent progression of AD, but can slow the rate of decline in cognitive function (Dunphy et al., 2019).
• Donepezil reaches its therapeutic level with consistent administration. This means that she should not start and stop this medication as it will not allow her to reach the level of function she had before stopping the medication (Dunphy et al., 2019).
• Make sure she is eating a well- balanced diet (Dunphy et al., 2019).
Follow-up
Placed referral to memory disorder center. This will give you resources which are multidisciplinary, to include counseling and support groups. These can be beneficial for your mother and you as her caregiver (Dunphy et al., 2019).
• Follow-up with social services so that an evaluation can be done for yours and her needs at home (Dunphy et al., 2019).
• Follow-up by returning to the clinic or urgent care if you notice aggressive changes in her behavior, increased depression, or changes involving loss of functional daily living (incontinence) or anything that may require more assistance from services or medical providers (Dunphy et al., 2019).
References
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care: The Art and Science of Advanced Practice Nursing-An Interprofessional Approach. (5th ed.). F.A. Davis.
Kiel, D. P. (2022). Falls in older persons: Risk factors and patient evaluation. UpToDate. Retrieved from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/falls-in-older-persons-risk-factors-and-patient-evaluation?search=Falls%20on%20blood%20thinners&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3
Sample Answer 2 for NU 664B Week 8 Discussion 1: Memory Loss
Differential Diagnosis:
- Dementia – This is the most likely diagnosis for this patient. A patient with dementia may present with worsening memory and cognition. They may exhibit problems with language and alterations in personality. The dementia may be related to Alzheimer’s disease or multi-infarct dementia, or vascular dementia which may result after CVA (Dunphy et al.,2019). When formulating a differential, it is always important to foremost consider the most common diagnoses. This patient is 70 years old, and it is important to note that almost 15% of people older than 70 years old have dementia (Dunphy et al.,2019). In order to make the diagnosis the patient must have a disturbance in activities of daily living related to functional decline (Dunphy et al.,2019). This patient does display these criteria as her daughter reports she has started to need help with grocery shopping, she is forgetting to take her medications, she needs assistance with managing finances, and there are concerns related to her cooking due to an episode of leaving the stove on. The concussions that she experienced increase her risk for developing Alzheimer’s disease (June et al., 2020). In order to diagnose dementia, other neurocognitive disorders need to be ruled out (Dunphy et al.,2019). In order to rule in the diagnosis, I would need to have the patient complete a MMSE or MoCA screening (Dunphy et al.,2019).
- Depression with anxiety- Depression is an extremely common psychiatric disorder in the geriatric population with 11-35 % of older adults experiencing significant depressive symptoms. Deteriorating cognitive function is frequently seen in older adults experiencing depression (Muhammad & Meher,2021). This patient does exhibit some signs of depression such as fatigue and sleeping more during the daytime. She reports some loneliness since her husband passed away. In order to rule in or out this diagnosis I would want her to complete a PH9 questionnaire for further evaluation.
- Metabolic disturbance- Metabolic problems can result in fluid-electrolyte, and acid-base imbalances which can cause confusion. To rule in this diagnosis the provider would look for signs of dehydration on exam such as dry skin, poor skin turgor, or low-grade fever. Labs would need to be ordered for further evaluation such as a comprehensive metabolic panel, urinalysis, and thyroid function. There may also be other signs such as dizziness, altered level of consciousness, and hypotension (Dunphy et al.,2019). In this particular patient, I would be more concerned about dementia than a metabolic disturbance causing her symptoms because they have been gradual in onset and the patient is still alert. However, she is on chlorthalidone which can cause electrolyte disturbances so that is a risk factor for her. I would order labs for further evaluation and if they were normal that would rule out a metabolic disturbance and help to rule in dementia by exclusion.
- Infectious process- Confusion can be caused by infectious processes due to tissue and organ impairment from release of toxins or ischemia which produces cell injury and death. Septicemia or bacteremia can present as delirium (Dunphy et al.,2019). I would suspect this to be less likely in this patient due to the fact that she is alert and the symptoms have been gradual in onset. However, I would still rule out infectious processes before confirming diagnosis of dementia. On physical exam I would be looking for signs of infection such as hypotension, tachypnea, tachycardia, abnormal lung sounds, or fever (Dunphy et al.,2019). I would order labs for further evaluation such as a CBC to determine if there is any leukocytosis and a urinalysis and culture to make sure there are no signs of infection.
Plan:
Primary Differential Diagnosis: Dementia
Pharmacology
If the patients MMSE or MoCa were positive and other causes of memory loss were ruled out as above, then I would discuss with the patient and daughter risks vs benefits of starting Aricept 5 mg orally daily.
I would have her continue her home medications as below based on results of labs.
Atorvastatin 40 mg one tab by mouth once a day
Metformin 500 mg one tab by mouth once a day
Aspirin 81 mg one tab by mouth once a day
Amlodipine 5 mg one tab by mouth once a day
Chlorthalidone 25 mg one tab by mouth once a day
I would recommend using Tylenol extra strength 2 caps every 8 hours as needed in place of ibuprofen due to her history of hypertension.
Non-Pharmacology
I would encourage the patient to continue exercising as being physically active is important. I would encourage the patient to be socially active as well by recommending joining local senior center to be involved with activities with others and keep the mind stimulated. I would recommend getting involved in Tai-Chi which could help with balance and help to prevent falls. I would refer the patient for home health services including nursing which could provide a home safety assessment and help with medication management and organizations such as the VNA may be able to offer home health aid services to assist with ADLs and IADLs. Elder Services would be another option. Physical therapy could help prevent falls related to her osteoarthritis.
Diagnostics: CBC with diff, CMP, A1C, lipids, TSH reflex FT4, B12, RPR, urinalysis reflex to culture.
Consults/Referrals: Referral to neuropsychiatrist to further evaluate for dementia vs. depression.
Referral to neurology
Referral for home health services/ elder services.
Referral for safety driving assessment
Would offer referral to therapist/ grief counselor.
Patient education: 1. Continue physical exercise 2. Do mind exercises such as puzzles or games 3. Be socially active 4. Follow a health diet such as the DASH diet to keep blood pressure well controlled 5. Continue to avoid alcohol 6. Have annual eye exam to reduce the risk of falls 7. Avoid sleeping for long periods during the day to help promote restful sleep at night and reduce night time awakening 8. I would educate the patient and daughter on the importance of establishing advance directives at this time such as health care proxy and MOLST 9. Would discuss need for driving safety assessment 10. Would discuss long term health care planning discuss that dementia is progressive and need for home safety assessment at this time but need to consider future living arrangements if becomes no longer safe for patient to be alone 11. Would discuss that Aricept starting dose is 5 mg but if tolerating may consider increasing to 10 mg daily 12. Would discuss that most common side effects are nausea, vomiting, and diarrhea and they should call office with development of side effects. 13. I would instruct the daughter to monitor for effectiveness of the drug by assessing if there is any improvement in functioning at home. 14. Would discuss need to report any worsening of condition and would make sure daughter and patient know to report any sudden changes in cognition right away.
(Arvanitakis et al., 2019).
(Dunphy et al.,2019)
Follow up: Would follow up in 1-2 weeks to discuss results of labs and see how patient is doing on new medication.
Health Maintenance: Would discuss the importance of continuing to exercise and discuss following a health diet such as the DASH diet. Would make sure she is up to date on all vaccinations including covid-19, flu, pneumonia, shingles, and TDAP.
(Dunphy et al.,2019).
Social Determinants of Health: It is important to consider the social determinants of health as they relate to the aging process when caring for this patient. Pain, fatigue, and weakness can lead to decreased social engagement and result in isolation and loneliness ( Perez et al.,2022). It would be important to consider that if the patient loses her license related to her memory problems this could put her at increased risk of isolation due to lack of transportation. It would be important to connect this patient with elder services for resources.
References
Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia:
review. JAMA, 322(16), 1589–1599. https://doi.org/10.1001/jama.2019.4782
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care (5th
ed.). F. A. Davis Company.
June, D., Williams, O. A., Huang, C. W., An, Y., Landman, B. A., Davatzikos, C., Bilgel, M.,
Resnick, S. M., & Beason-Held, L. L. (2020). Lasting consequences of concussion on the aging brain: Findings from the Baltimore Longitudinal Study of Aging. NeuroImage, 221, 117182. https://doi.org/10.1016/j.neuroimage.2020.117182
Muhammad, T., & Meher, T. (2021). Association of late-life depression with cognitive
impairment: Evidence from a cross-sectional study among older adults in India. BMC Geriatrics, 21(1). https://doi.org/10.1186/s12877-021-02314-7
Perez, F. P., Perez, C. A., & Chumbiauca, M. N. (2022). Insights into the social determinants
of health in older adults. Journal of biomedical science and engineering, 15(11), 261–268. https://doi.org/10.4236/jbise.2022.1511023