Weekly Clinical Experience 6

Sample Answer

Did you face any challenges or any success? If so, what were they?

This week, I was honored to care for an old patient with worsening function. It can be hard to evaluate older people whose abilities are getting worse because of things like speech problems, multiple health problems, psychological issues, and social and environmental factors. Nevertheless, I discovered effective approaches include patient and family involvement, adaptive communication methods, and a thorough geriatric evaluation, including multidisciplinary teams.

All-encompassing geriatric evaluation aids in the creation of a well-coordinated treatment strategy and ongoing monitoring, and multidisciplinary teams provide a thorough comprehension of the patient’s requirements (Walle-Hansen et al., 2021). Patients and their families can help with screening, leading to more personalized care plans and useful information. Adaptive feedback methods can help make the review better.

Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least three possible differential diagnoses with rationales.

The patient is a 72-year-old female who has been experiencing a decline in cognitive function for the past three years. At first, she experienced challenges recalling words and names during conversations, leading her work supervisor to suggest retirement. Over time, she started to ask the same questions multiple times and experienced challenges with basic attention or visuospatial functions. Despite the gradual decline in her cognitive symptoms, she and her husband indicated a general ability to perform daily tasks independently. The patient’s medical history included anxiety; however, there was no reported family history of neurological or neurodegenerative disease.

The patient’s neurological examination revealed normal functioning and depressed lower-extremity deep tendon reflexes. Additionally, the presence of a high BMI and apnea indicate a potential underlying diagnosis of obstructive sleep apnea. The results of cognitive testing revealed deficits in memory, executive functioning, and visuospatial abilities, suggesting a potential diagnosis of dementia (Walle-Hansen et al., 2021). One possible explanation for her subpar performance and potential impact on her daily functioning is anxiety, which should be considered as a differential diagnosis.

It was advisable to conduct laboratory tests to identify potential causes of cognitive decline unrelated to neurodegenerative conditions. One such test is a polysomnogram, which can help assess the presence of obstructive sleep apnea. An MRI of the brain was advised to evaluate any potential structural alterations. The patient’s care plan includes carefully planned activities and designated rest periods to stimulate the brain and alleviate fatigue. Additionally, engaging in mentally stimulating tasks such as puzzles or memory games aids in preserving cognitive abilities and slowing down the progression of cognitive impairment (Krivanek et al., 2021).

Mention the health promotion intervention for this patient.

The health promotion intervention for this patient includes daily functioning aids, medication management technologies, and support for carers. It has been shown that delaying cognitive decline may be favorably impacted by regular physical exercise, eating a balanced diet, participating in social activities, engaging in hobbies, and looking for intellectual stimulation (Krivanek et al., 2021). Referring individuals to national and community resources, such as support groups, is advisable. Carers must familiarize themselves with respite care and prioritize their healthcare needs, including mental health and other medical concerns.

What did you learn from this week’s clinical experience that can benefit you as an advanced practice nurse?

Through my recent clinical experience, I have gained an understanding of the importance for APRNs to assess elderly patients experiencing a decline in function. This assessment requires a comprehensive approach, including knowledge of common geriatric syndromes, medication reconciliation, functional assessment tools, effective communication, collaboration with other healthcare professionals, patient and family education, and ethical considerations (Krivanek et al., 2021).

In addition, as advanced practice nurses, we must possess expertise in medication reconciliation and evaluating drug-related issues among older adults. Continuous learning and ongoing professional development improve the quality of care for older patients and strengthen healthcare professionals’ capacity to lead in challenging clinical scenarios.

References

• Krivanek, T. J., Gale, S. A., McFeeley, B. M., Nicastri, C. M., & Daffner, K. R. (2021). Promoting Successful Cognitive Aging A Ten-Year Update. Journal of Alzheimer’s Disease, 81(3), 871–920. https //doi.org/10.3233/jad-201462
• Walle-Hansen, M., Ranhoff, A., Mellingsæter, M., Wang-Hansen, M., & Myrstad, M. (2021). Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalization due to COVID-19. BMC Geriatrics, 21(1). https //doi.org/10.1186/s12877-021-02140-x