NURS 6512 Case Study Assignment: Assessing Neurological Symptoms

NURS 6512 Case Study Assignment: Assessing Neurological Symptoms

NURS 6512 Case Study Assignment: Assessing Neurological Symptoms

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

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To Prepare

• By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

With regard to the case study you were assigned:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Case Study Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

By Day 6 of Week 9

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK9Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 9 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 9 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 9 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 9 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 6 of Week 9

To participate in this Assignment:

Week 9 Assignment 1

 Week 9: Assessment of Cognition and the Neurologic System

A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.

An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life.

This week, you will explore methods for assessing the cognition and the neurologic system.

Learning Objectives

Students will:

• Evaluate abnormal neurological symptoms
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system
• Assess health conditions based on a head-to-toe physical examination

Learning Resources

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 7, “Mental Status”This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.

• ·Chapter 23, “Neurologic System”The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)

Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.

Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.

This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.

• Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.

Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318.

 

Neurologic System – Week 9 (16m)

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 7 and 23 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions on

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Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6512_Week_9_Assignment1_Rubric

		Excellent	Good	Fair	Poor
Using the Episodic/Focused SOAP Template: · Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.·  Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.		Points Range: 45 (45%) – 50 (50%) The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.	Points Range: 39 (39%) – 44 (44%) The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.	Points Range: 33 (33%) – 38 (38%) The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.	Points Range: 0 (0%) – 32 (32%) The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
·   List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.		Points Range: 30 (30%) – 35 (35%) The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study and provides a thorough, accurate, and detailed justification for each of the five conditions selected.	Points Range: 24 (24%) – 29 (29%) The response lists four to five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.	Points Range: 18 (18%) – 23 (23%) The response lists three to four possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or some inaccuracy in the conditions and/or justification for each.	Points Range: 0 (0%) – 17 (17%) The response lists three or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.		Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	Points Range: 3 (3%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	Points Range: 0 (0%) – 2 (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation		Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	Points Range: 3 (3%) – 3 (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	Points Range: 0 (0%) – 2 (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.		Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	Points Range: 3 (3%) – 3 (3%) Contains several (3 or 4) APA format errors.	Points Range: 0 (0%) – 2 (2%) Contains many (≥ 5) APA format errors.
Total Points: 100

Name: NURS_6512_Week_9_Assignment1_Rubric

Week 9 NEURO SOAP Note

 

Patient Initials: T.N              Age: 67 years                        Gender: Male

 

 

SUBJECTIVE DATA:

 

Chief Complaint (CC): “Very Forgetful”

 

History of Present Illness (HPI): N.S is a 67-year-old Asian male who was brought in by his daughter for psychiatric evaluation since he was very forgetful. She reports that the patient has lost his car keys several times. She also reports that sometimes when the patient goes to the store, he forgets his way back and calls for help. The patient claims that he started being forgetful about 2 years back, and it has been getting worse ever since as reported by his daughter. The patient denies any associated symptoms. No hallucination or delirium.

 

Medications:

1. Losartan 50mg PO once daily for the management of his high blood pressure.

 

Allergies:

No known drug, food, or environmental allergies

 

Past Medical History (PMH):

High Blood Pressure

Past Surgical History (PSH):

Denies ever undergoing any surgical procedure in the past.

Sexual/Reproductive History:

Heterosexual

 

Personal/Social History:

Married with a daughter and a son. His wife however passed on 2 years ago.

Retired but owned and ran his café downtown for several years.

He lives by himself, but the daughter lives next door and checks on him now and then.

Confirms taking one or two beers when with friends.

Denies smoking tobacco or using any other recreational drug.

Health Maintenance:

The patient used to exercise before by walking the dog, but ever since he started being forgetful, he does not remember the last time he went for a long walk. He however consumes a healthy diet which his daughter makes sure of. He uses a seat belt when in the care and lives in a well-maintained house. Confirms sleeping for about 8 hours every night.

 

Immunization History:

Flu shot 16/1/2022

Covid Vaccine #1 4/1/2021 #2 2/1/2021 Moderna

All other immunization up to date

Significant Family History:

The patient’s mother passed on at the age of 86 years due to cardiac arrest, upon receiving a report that her grandson had been involved in a car accident. His father is alive at the age of 94 years with a history of diabetes, dementia, arthritis, and thyroid disorder. Both his children are healthy with no significant history of any chronic medical condition.

 

Review of Systems:

General: Appears healthy with no signs of distress. No signs of fatigue, chills, fever, or generalized body weakness.

HEENT: Head: No signs of trauma or headache reported. Eyes: Denies blurred vision, use of corrective lenses, excessive tearing, or redness. Ears: No tinnitus, itchiness, or hearing loss. Nose: no congestion, running nose, sinus problems, or nose bleeding. Throat & Mouth: No sore throat, coughing, swallowing difficulties, or dental problems. Neck: No tenderness, signs of injury, enlarged tonsils, or a history of disc disease or compression.

Respiratory: No wheezing, coughing, shortness of breath, or breathing difficulties.

CV: Denies chest pain, edema, orthopnea, syncope, or palpitations. Dyspnea on exertion

GI: No abdominal tenderness, constipation, diarrhea, distention, changes in bowel movement, or jaundice.

GU: Denies incontinence, urinary frequency, hematuria, dysuria, or burning sensation when urinating.

MS: Denies back pain, with a full range of movement in all the extremities. No signs of spinal code injury.

Psych: Denies paranoia, hallucinations, delirium, suicidal ideation, mental disturbance, memory loss, anxiety or depression, or a history of psychosis.

Neuro: Denies vertigo, tremors, syncope, seizures, paresthesia, or transient paralysis.

Integument/Heme/Lymph: No bruising, ecchymosed, ulcers, lesions, or rashes. No signs of enlarged lymph nodes.

Endocrine: Denies heat intolerance, cold intolerance, polyuria, polyphagia, or polydipsia.

Allergic/Immunologic: Denies hay fever, urticaria, or persistent infections.

 

OBJECTIVE DATA:

Physical Exam:

 

Vital signs: T: 97.7°F (36.5°C), BP: 125/70 mm Hg, HR 70/min, R: 18/min, memory loss 8/10. Ht. 5’9’’, Wt. 179 pounds, BMI: 23.5

 

General: N.S appears healthy and well cooperative through the examination with a pleasant mood. He experiences no chills, fever, fatigue, or recent changes in body weight.

 

Chest/Lungs: Lungs are clear to auscultation and percussion bilaterally. No rhonchi or wheezing.

 

Heart/Peripheral Vascular: S1 and S2 present. No rubs, gallops, or murmurs. Regular rate and rhythm

Lymphatics: No signs of enlarged lymph nodes.

                       

Neurological: The CN II-VII and the DTR are undamaged. Denies headache, syncope, or dizziness. Confirms worsening memory loss for the past 2 years

 

Psychiatric: Denies feeling hopeless, or having suicidal ideations. Confirms being in mild distress due to memory loss leading to cognitive impairment.

 

Diagnostic results:

TSH – To determine if the patient memory loss is associated with hypothyroidism.

MRI of the head – To assess whether there is any form of damage to the neurotransmitters or the presence of any form of brain cell tumor.

Cerebral angiography – To measure the blood flow through the brain for any signs of deficiencies.

Amyloid imaging –

Cognitive test – To determine whether the patient’s memory loss is associated with anxiety or distress (Bruno, 2020).

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ASSESSMENT:

1. Alzheimer’s disease: Alzheimer’s disease is a progressive neurologic disorder that leads to atrophy of the brain and death of brain cells (Glymour et al., 2018). This disorder is the most common form of dementia among the elderly above the age of 65 years. It is characterized by significant cognitive deterioration which undermines the patient’s ability to sustain independent living. The diagnosis of this disorder is based on three stages, with the first stage regarded as the preclinical stage with no symptoms. The second stage which is referred to as the middle stage is characterized by mild cognitive impairment, whereas the final stage is characterized by marked symptoms of dementia. The patient in the provided case study presents with worsening memory loss, for the past two years, which indicates the final stage of Alzheimer’s as the primary diagnosis.
2. Vascular cognitive impairment (VCI): This is a disorder of the mind with undermines the patient’s mental ability to think, feel and be awake (Ghafar et al., 2019). VCI presents with cognitive symptoms ranging from being forgetful in mild cases. However, in severe cases, patients may present with serious cognitive impairments leading to problems with memory, attention, language, and executive functions such as problem-solving. The patient in the provided case study reports being forgetful, However, cognitive testing is required to confirm this diagnosis.
3. Vascular dementia: This refers to a decline in the patients thinking skills due to conditions that reduce or block the flow of blood to various parts of the brain, depriving them of nutrients and oxygen (Bruno, 2020). Patients will present with symptoms such as forgetfulness, poor balance, confusion, and disorientation among others. The patient in the provided case study however presented with forgetfulness only, with no associated symptoms.
4. Idiopathic normal pressure hydrocephalus (INPH): This is a disorder of the brain characterized by impairment of the patient’s gait, urinary incontinence, and decline in cognitive function. It is normally associated with ventriculomegaly in the absence of increased cerebrospinal fluid (CSF) pressure (Kockum et al., 2020). Forgetfulness and confusion are one of the most common early symptoms, among others such as depression, trouble walking, poor balance, and falling. Neuroimaging with either CT or MRI is however required to confirm this diagnosis to assess for hydrocephalus pressure.
5. Lewy body dementia (LBD): It is a rare disease associated with abnormal deposition of alpha-synuclein in the brain. These deposits, known as Lewy bodies lead to a progressive decline in the patient’s cognitive ability (Gan et al., 2021). Patients will present with common signs and symptoms such as memory loss, tremors, slow movement, muscle rigidity, loss of coordination, and reduced facial expression. However, the diagnosis of this disorder requires the patient to present with declining thinking ability in addition to at least two of the following symptoms, parkinsonian symptoms, repeated visual hallucinations, and fluctuating alertness.

 

PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

 

 

References

Bruno, A. (2020). Forgetfulness. The Family Nurse Practitioner: Clinical Case Studies, 245-249.

Gan, J., Liu, S., Wang, X., Shi, Z., Shen, L., Li, X., … & Ji, Y. (2021). Clinical characteristics of Lewy body dementia in Chinese memory clinics. BMC neurology, 21(1), 1-11. https://doi.org/10.1186/s12883-021-02169-w

Ghafar, M. Z. A. A., Miptah, H. N., & O’Caoimh, R. (2019). Cognitive screening instruments to identify vascular cognitive impairment: A systematic review. International Journal of Geriatric Psychiatry, 34(8), 1114-1127.

Glymour, M. M., Brickman, A. M., Kivimaki, M., Mayeda, E. R., Chêne, G., Dufouil, C., & Manly, J. J. (2018). Will biomarker-based diagnosis of Alzheimer’s disease maximize scientific progress? Evaluating proposed diagnostic criteria. European Journal of Epidemiology, 33(7), 607-612. https://doi.org/10.1007/s10654-018-0418-4

Kockum, K., Virhammar, J., Riklund, K., Söderström, L., Larsson, E. M., & Laurell, K. (2020). Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus. PLoS One, 15(4), e0232275.