Exam (elaborations) NR 507 PATHOPHYSIOLOGY WEEK TD2 Behavioral, Neurologic, and Digestive Disorders Discussion Part Two

Discussion Part Two (graded) Responses Lorna Durfee 6/13/2016 2:50:10 PM Discussion Part Two aYnodu rt opladt iheenrt disa uag 7h7t-eyre sahre- ohladd w noomt abne ewnh foe ehlainsg b weeenll .m Hoerre dsoacuigahlltye rw hiathsd nroatwicne dla ate ly ssteeppawraistee dd efrcolimne d. aWughhiltee rs hino ptphien agi sfolers g. rSohcee brieecsa wmieth c ohnerfu dsaedu gahntder a, nsghrey b wechaemn es tore eHmydplrooycehelso raontdh ioatzhideres, Ltriiseidn otop rails,s aisntd h Aert.o Hrvears medications are • What is your differential diagnosis based on the information you now have? • What other questions would you like to ask her now? (Questions can be asked of patient first, and then of reliable historian separately.) • How would you treat this patient and discuss why you give each medication or therapy you give. Doctor Brown: fTihnidsi npga thieenr tw aapyp.e aSrhs eto a lbseo edxehmibointisntgra steigs nsso mofe l oasgsi toatfi omne. mFororym a hnedr hsayvminpgto dmifsf iacnudlt y sbieg nthse, sshtaer ti so ef xAhlizbhiteiinmg efro’rsg oert fduelnmeesns with confusion and irritability; this could When evaluating this patient consideration of current medications are be drug interactions and toxic effects of certain medications. This pat iveintat lm. aTyh beree can emxehdiibciatitniogn ssi gans se aosfi tloyx aisc wdrhuegn rweaec wtioenre. aAt sa wyoeu anggee, ro augre b. o Tdyh edroee cso nuoldt fbilet ear soiduet effect or interaction occurring with her medications. rAesc ofomrm heenr dmse tdhiacta itnio pnast,i Tenhtes Aovmeer r6ic5a yne Garesr ioaft raigces Stoo cuiseet yc,a auntido nB weehres nC prirteesrciari bing dhiyuproentiactsr.e mTihae wreh iesn a ursisinkg o Hf tyhder osychnldorroomthei aozfi dinea (pDpyronparmiaetde ,a 2n0ti1d6i)u.r eTsihsi,s o pra tient could ibned eicxahtiibointi nofg wthhea bt ehgeirn fnluinidg coof npsoutmaspstiiuomn hdaesp lbeetieonn o orr w hhyapto hneart reelmeciatr.o lTyhtee rlee vise lnso a re. Twhitehr eo rctahno sbtea taicd vheyrpsoe teefnfseicotns wwiitthh athne e uxscee sosfi vHey rderdoucchtlioorno tihni abzloidoed. p Creosnsfuursei osunc cha nas b e a symptom of adverse effects from the drug (Dynamed, 2016). Lmiesdinicoaptriioln –, wThhiesn i su saend A inC tEh ein gheirbiiattorri ca npdo paunltaihtiyopne, rnteenedsisv teo m bee duisceadti owni.t h T chaiust ion. cAanrdoitahce rf uthnicntgio tno. cTohnissi dmeerd, iwcahteino nu scianng a tlhsios cmaeudseic haytipoont,e inss dioencr (eDasyenda mheepda,t i2c0, 1r6en).a l and fAotro mrvyaostpaattihny - i nA tnh eH gMerGia-tCriocA p oRpeudluactitoanse. IBnehfiobrieto trh. e T uhsies omf ethdiisc amtieodni ccaatni obne tah efa ctor aaldsvoe arsne aenftfielicptse,m dircu gag ienntet.r aAcsti oa nssid, ea nedf fpeactti efrnotm p rtehfiesr emnecdeisc sahtioounl,d t hbee preavtiieenwt emda. yIt ailss o rbaer eelxyp reerpieonrcteindg w hiythp eursgel yocfe tmhiisa mefefdeicctast. i oTnh. e B siedcea uesfefe tchte oref ciso gan ciotimvep oimnepnati romf ecnotg insi tive iamsspeasisrmmeenntt tians kth fios rpcaet ireencto, mthme eNnadtsi oenvaall uLaitpiindg Athsisso pcaiatiteionnt f(oNrL aA s)ta sttiant.i n T shaefyet ayl so rneecuormopmsyecnhdi aetvraiclu caatuiosnes f o(Dr nyonnam-steadt,i n2 0c1au6s).e s, such as other medications, systemic or pWahtiaetn ot tfhiresrt ,q aunedst tihonens wofo ureldli aybolue lhikiset otori aansk s hepear rnaotewly?. ) (Questions can be asked of cWohnfeuns aesdk ainngd tohvies rpwahtieelnmt eqdu.e Wstieo ncso uwlde ucoseu lad vbeergyi nc ablym a dsekminega hneorr .i f W shee wiso fueledl iansgk aabnsowute hr ethr oesaeti nqgu,e sstlieoenpsi,n tgh,e b coawreegl imveorv wemhoe natcsc, oamndp adnoi eas s hyesrte cman r ehveilepw w. i tIhf sthhies .c aWnneo t ewxoaumld. Walseo c noeueldd tuos ed oth ae pFhoylsstiecianl mexianmi-.m Tenhteanl qwuee swtioounlnda nireee.d tWo ed oc oau mldi nais-km heenrt aifl she aknndo whes rw nhaemree .s Whee i sc.o uWlde hcaovuel dh earls sop aesllk a i f“ WsheO kRnLoDw”s bthaec kdwataer,d t.h eW tiem me,u tsht ea sPsreesssi dheenrt , vmiseintt caol ustladt ufisl la unsd irne voine wde htaeirl sm oefd wichaatito tnhse.y T hhaev fea ombisleyr mveedm abnedr sg itvhea ta a dcceotamilpedan hyi stthoirsy . cWoned citoiounld u rnudne srloymineg f tuhritsh ecrh abnlogoed. tests to determine if there is any metabolic What is your differential diagnosis based on the information you now have? Io ft hdienmk ethnatita t.h Tish pe aAtileznhte sihmoewr’ss sAigsnsso coifa tmioinld e cxopglaniintisv teh iamt dpeamirmenetniat aisn dn opto as ssipbelec iofincs et ddiescelainsee ibnu tm aenm oovreyr aolrl ttherinmk itnhga.t oDuetlmineenst iaa rlainmgiets o tfh esy pmerpstoonm’ss athbailti tayp ptoe apre wrfiotrhm a activities of daily living. Alzheimer’s accounts for 60 to 80 percent dementia, however, vascular dementia is the second most common toyfp teh we ocarssee s of (Alzheimer's Association, 2016). pTrhoebrlee marse. o Tthheer Acolznhdeitiimonesr’ ssu Achss aosc itahtyioroni dli sotrs vsiotmame ionf d tehfei ccioenndciietiso tnhsa ut ncdaner c wauhsaet is cmounssti dbeer eimd pdaeimreedn. t iTa.h eI fc poareti emnetsn thaal vfeu ndcetmioennst iaar ea;t mleeamst otwryo, ccoomrem muennictaalt ifounn,c atinodn s lpaenrgceupatgieo,n a. bTilhietyre t oc afno cbues parnodb lpeamys a wtteitnht isohno, rrte-taesromn imnge manodr yju, dpgayminengt b ainllds ,v pirseupaal ring amneda ltsh ea nsdy mtrpavtoemlins gc ainnt ost aurntk snloowwlny aanndd rtehceong gneizt ewdo arrseea (sA. lDzheemimenetri'ass A asreso pcrioagtiroens,s ive, 2m0e1d6ic).a Ttiohner sei daree e offthecetrs p, reoxbcleesmsisv eth uast ec aouf sael cmohemolo, rthyy irsosiude sa,n sdu vchit aams;i dne dperfeiscsiieonnc,i es (Alzheimer's Association, 2016). DMiisleda csoe.g nTithievree i ims pmaiilrdm menetm iso ray s lyomssp tfoomr r eficresnt ts eaennd inne twh ei npfroorgmreastisoionn i no fe aArllzyh setiamgee r’s pAllaznhneiinmge arn’sd D diisseoariseen. t aInti oonth teor lwocoartdios,n t.h eTrhee irse sihso arlts-ote prmos smibelme odreyp rloessssi, odni fafincdu lmtyi lwd ith (aMnxciCetayn. c Te,h Heruee itsh earl,s o& m Birldas ihnesrtsr,u 2m0e1n4t,a lp a. c5t5iv0i) of daily living tHhoerwa pwyo yuoldu ygoivue t?r eat this patient and discuss why you give each medication or pEasttiaebnltiss hsihnogu tlhde b cea euvsael ufoart etdh iws ditehm laebnotirnagto pryro acnedss n meuaryo pbsey vcehroyl ocgoimc ptelisctiantegd a. nHdo bwraeivne r, idmepargeisnsgio. n T thhee uussee ooff naenutirdoeleppretiscs amnetsd iccaanti boen sa pcopuroldp rbiaet ec o(nMsicdCearendc.e , I fH thueerthe eirs, & Brashers, 2014, p. 546). pMeooypeler a( r2e0 a1 4k)n oanwdn T rihsek Ufancittoerd fSotra cteosg Pnirteivveen itmatpivaeir mTaesnkt. F Torhceer es taartee oththaet ro rldisekr faagcetdo rs shuecahd atrsa duimabae, tdeesp, rteosbsaicocno, aunsde ,p hhyypseicrcahl ofrleasiltteyr.o lAemlsioa,, tahned l ahcykp eorft ean psrioopne. r Asu hpipsotorrt y of tsayssktes mth. aTt hreeq sucirreee antitnegn ttieosnts, msuegmgoesryte,d l aanrge ufaogr ec oangdn ivtiivseu aiml-sppaaitrimale anbt,i laintide st.h aTt hine cmluodset s tuessetd, 7m-metihnoudte i ss cthreee Mn, ianni-dM qeunetsatli oSntnataei rEe xoanm ciongantiiotinv.e Tdhecelrien ies ianl sthoe t heeld celrolcyk. dTrhaew ing irnechoibmitmoresn adnedd mtreeamtmanetnint ew. i tThh pehya arlmsoa croelcoogmicm aegnedn tcso ignnciltuivdee st raacinetiynlgc,h loifleinsteysltee rase 2m0o1d4i,f ipc.a 7ti9o2n)s. a nd behavioral, exercise, education and multidisciplinary care (Moyer, aTphper oNvaetdio bnyal t Ihnes Utitnuittee do nS tAatgeisn gF o(2o0d1 a6n)d t eDllr uugs Athdamt tihneirsetr aarteio mn etod itcraetaito tnhse t hsyamt aprteo ms of Amlozdheeriamtee rA’sl zDheisiemaesre’.s .T Aheryic aerpet; aDnodn Mepeemzialn (tAinreic (eNpat)m, reinvdaast)i gcamni nbee fuosre md tiold t rtoea t severe uAnlzdheertiamkeern’ si.n Bcleinhiacvailo trraila lasn tdo ciongclnuidtiev;e i mtraminuinnigz actaionn h tehlper aasp yw, edlrl.u gR tehseeraarpcihe si,s being t2r0e1at6m).ents used for cardiovascular disease and diabetes (National Institute on