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Please reply to each discussion 150 words each with one reference eachThank you
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Reply to Ayida
The patient, Ms. Richardson, is a 74-year-old African American. Police have brought her to
the emergency room. She has been wandering around the neighborhood and couldn’t care for
herself. When police broke into her apartment, she was hiding in the corner wearing nothing but
a bra. She couldn’t remove dog feces, making the apartment filthy. When brought to the hospital,
she is unkempt, dirty and fouled-smelling. Ms Richardson can’t look at the interviewer, looks
confused, can’t respond to most of the questions, doesn’t know the day of the month, and can’t
describe the events that led to her being in the hospital. Additionally, she says the neighbors
called the police since she was “sick”; she felt sick and weak, had painful shoulders, had not
eaten for three days, and can remember the police shot her dog.
Ms. Richardson can’t give the name of a friend neighbor, denied being in a psychiatric
hospital, hearing voices, and says she had seen a psychiatrist one time as she couldn’t sleep,
couldn’t take the prescribed medication as it was strong, and couldn’t recall its name. she nodes
to the name mentioned by the doctor although she could say yes to anything. She said the gun
found in her house was a toy that her dead brother had brought. The patient also had trouble
swallowing and finally smiled when the team left her bedside.
Generate a primary and two differential diagnoses. Use the DSM5 to support the
assessment. Include the DSM5 and ICD 10 codes.
According to the patient’s signs and the objective and subjective data, the primary diagnosis
would be delerium ICD: F05.9 or dementia ICD 10: F0.90. A thorough evaluation of her
medication, medical and psychiatric history is needed to distinguish a proper diagnosis. The
differential diagnosis would be schizoaffective disorder (DSM5 – F25 ICD10 – F25) and major
depressive disorder (DSM5 – F32.9 ICD10 – F32.9) (Mayo Clinic, 2022).
Discuss a pharmacological treatment would you prescribe
I would prescribe medication to improve her symptoms. Cholinesterase, such as
galantamine and rivastigmine, can be prescribed to enhance the degree of a chemical messenger
that helps with judgment and memory (Mayo Clinic, 2022). Another medication includes
memantine to help with memory (NIH, 2022). I might also need to prescribe agitation and
depression medications.
Discuss the non-pharmacological treatment would you prescribe
I would prescribe non-pharmacological treatment to treat some symptoms and behaviors
initially. I can prescribe occupational therapy to help the patient cope and manage her behaviors.
It can also help Ms. Richardson make her home safer to prevent accidents.
Describe a health promotion intervention that would be appropriate for this patient.
A health promotion intervention can include cognitive stimulation therapy, where the patient
participates in team exercises and activities meant to enhance memory. She can also make
environmental changes, like decreasing clutter and noise (Mayo Clinic, 2022). This will help the
patient function and focus. It may involve hiding safety-threatening things like car keys and a
monitoring system that can alert the family of neighbors when the patient wanders.
Reminiscence and life story work can promote the patient’s health (NIH, 2022). It will involve
discussing her past events and things using props like her favorite possessions and photos (NIH,
2022). A life story can be notes from childhood. Reminiscence and life story work can promote
well-being and mood.
References
Mayo Clinic. (2022, October 12). Dementia – Symptoms and
causes. https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc20352013Links to an external site.
NIH. (2022, December 8). What Is Dementia? Symptoms, Types, and Diagnosis. National Institute on
Aging. https://www.nia.nih.gov/health/what-is-
dementia#:~:text=Dementia%20is%20the%20loss%20of,and%20their%20personalities%20may
%20changeLinks to an external site.
Reply to Yanet
The patient is a 74-year-old African American woman who was brought to the hospital
emergency room by the police. She is unkempt, dirty, and foul-smelling, and appears to be
confused and unresponsive to most questions. She knows her name and address, but not the day
of the month, and is unable to describe the events that led to her admission. The police report that
they were called by neighbors who reported that the patient had been wandering around the
neighborhood and not taking care of herself. The medical center mobile crisis unit went to her
house twice but could not get in and presumed she was not home. Finally, the police came and
broke into the apartment, where they were met by a snarling German shepherd. They shot the
dog with a tranquilizing gun and then found the patient hiding in the corner, wearing nothing but
a bra. The apartment was filthy, the floor littered with dog feces. The police found a gun, which
they took into custody. The following day, while the patient was awaiting transfer to a medical
unit for treatment of her out-of-control diabetes, the psychiatric provider attempted to interview
her. Her facial expression was still mostly unresponsive, and she still didn’t know the month and
couldn’t say what hospital she was in. She reported that the neighbors had called the police
because she was “sick,” and indeed she had felt sick and weak, with pains in her shoulder; in
addition, she had not eaten for 3 days. She remembered that the police had shot her dog with a
tranquilizer and said the dog was now in “the shop” and would be returned to her when she got
home. She refused to give the name of a neighbor who was a friend, saying, “he’s got enough
troubles of his own.” She denied ever being in a psychiatric hospital or hearing voices but
acknowledged that she had at one point seen a psychiatrist “near downtown” because she
couldn’t sleep. He had prescribed medication that was too strong, so she didn’t take it. She didn’t
remember the name, so the interviewer asked if it was Thorazine. She said no, it was “allal.”
‘Haldol?”, ask the interviewer. She nodded.
The primary diagnosis would be major depressive disorder, single episode, with psychotic
features. The differential diagnoses would be schizoaffective disorder, bipolar disorder, with
psychotic features. The DSM5 and ICD 10 codes for these diagnoses are: Major depressive
disorder, single episode: DSM5 – F32.9 ICD10 – F32.9 Schizoaffective disorder: DSM5 – F25
ICD10 – F25 Bipolar disorder, with psychotic features: DSM5 – F31.5 ICD10 – F31.5 . ( DelBen, C. M.,2010 )
The most likely diagnosis for Ms. Richardson is dementia, given her confused state and
inability to remember recent events. Given her age, it is also possible that she has underlying
medical conditions that are contributing to her cognitive decline. As such, treatment should focus
on managing her medical conditions and providing supportive care. For her dementia,
cholinesterase inhibitors (such as donepezil or rivastigmine) may be prescribed in an effort to
improve cognitive function. These medications can help to improve memory, attention, and
language skills. In addition, Ms. Richardson will likely require close supervision and assistance
with activities of daily living. For her diabetes, Ms. Richardson will need to be started on insulin
therapy. This will help to control her blood sugar levels and prevent further complications from
her disease. In addition, she will need to be educated on how to properly manage her diabetes.
This will include information on diet, exercise, and blood sugar monitoring. ( Marneros, A.
(2003).
Given that Ms. Richardson is unkempt, dirty, and foul-smelling, it would be appropriate to
prescribe a non-pharmacological treatment such as a course of antibiotics to clear any infection
she may have. In addition, given her apparent confusion and lack of response to questions, it
would be appropriate to refer her for a cognitive assessment to rule out any underlying
dementia.( Bußhoff, J., & Baethge, C. (2015).
A health promotion intervention that would be appropriate for this patient would be to
provide them with information on how to take care of their diabetes and how to improve their
overall hygiene. Additionally, the patient should be given information on how to access mental
health services if they are needed.
Reference:
Del-Ben, C. M., Rufino, A. C. T. B. F., Azevedo-Marques, J. M. D., & Menezes, P. R. (2010).
Differential diagnosis of first episode psychosis: importance of optimal approach in psychiatric
emergencies. Brazilian Journal of Psychiatry, 32, S78-S86.
Marneros, A. (2003). Schizoaffective disorder: clinical aspects, differential diagnosis, and
treatment. Current Psychiatry Reports, 5(3), 202-205.
Santelmann, H., Franklin, J., Bußhoff, J., & Baethge, C. (2015). Test-retest reliability of
schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar
depression—a systematic review and meta‐analysis. Bipolar disorders, 17(7), 753-768.
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