NSG 3370 WEEK 7 PART 1 DISCUSSION
You are at the local mall and you see a patient who appears to be homeless by his physical
appearance and you witness the person “walk 50 feet to a table sit down, and after 5 seconds he
gets up and walks to a tree and urinates on it” He repeats this action 5 times apparently oblivious
to his surroundings. When the police come he ignores them as if they aren’t there. Later, you go
to work and sitting in exam room 3 is the same person! Now, he is your patient, when you talk to
him he has no recollection of his behavior by the mall.
• What is your differential diagnosis?
• What tests do you order?
• An MRI comes back and there seems to be a lesion in the temporal lobe does this change
your differential? The EEG also comes back with unusual excitatory activity. What is
your definitive diagnosis? In retrospect did anything bias your first differential?
This case study is complex due to little information on the patient. The only information to assist
in making a differential diagnosis is assuming he is homeless due to his physical appearance, his
repetitive state of mind and oblivious to his surroundings, and now the patient is unaware of his
actions. Several differential diagnosis comes to mind. Such information to assist in making a
definitive diagnosis would be the patient’s age and history of his past medical, family, and social.
Assuming this patient is homeless, many factors aid in his behaviour. Differential diagnosis are
as follows:
Traumatic Brain Injury
Mental Illness
Korsakoff syndrome
Traumatic brain injury (TBI) can be caused by many factors such as falls, motor vehicle
accidents, and assaults. Short term and long term deficits can alter neurological function that are
caused by direct blow to the head. TBI is defined as a “blow or jolt to the head or a penetrating
head injury that disrupts the [normal] function of the brain” (Anderson et al., 2014, p. 2210). The
pathological aspect of TBI depends on the structural changes from head injury whether open or
closed; damage to the cortical tissue; and hematoma formation that can damage subcortical
structures leading to ischemia (Mott, McConnon, & Rieger (2012). Considering the patient
exhibits no open head injury, the assumption is he possibly is suffering from closed head injury
due to trauma/blow to the head. With a closed head injury, the frontal and temporal lobes are
predominantly susceptible for severe damage (Anderson et al., 2014). TBI symptoms depending
on severity of damage can affect concentration, fatigue, memory lapse, confusion, and difficulty
sleeping. Along with TBI there may also be impaired decision making and the ability to solve
You are at the local mall and you see a patient who appears to be homeless by his physical
appearance and you witness the person “walk 50 feet to a table sit down, and after 5 seconds he
gets up and walks to a tree and urinates on it” He repeats this action 5 times apparently oblivious
to his surroundings. When the police come he ignores them as if they aren’t there. Later, you go
to work and sitting in exam room 3 is the same person! Now, he is your patient, when you talk to
him he has no recollection of his behavior by the mall.
• What is your differential diagnosis?
• What tests do you order?
• An MRI comes back and there seems to be a lesion in the temporal lobe does this change
your differential? The EEG also comes back with unusual excitatory activity. What is
your definitive diagnosis? In retrospect did anything bias your first differential?
This case study is complex due to little information on the patient. The only information to assist
in making a differential diagnosis is assuming he is homeless due to his physical appearance, his
repetitive state of mind and oblivious to his surroundings, and now the patient is unaware of his
actions. Several differential diagnosis comes to mind. Such information to assist in making a
definitive diagnosis would be the patient’s age and history of his past medical, family, and social.
Assuming this patient is homeless, many factors aid in his behaviour. Differential diagnosis are
as follows:
Traumatic Brain Injury
Mental Illness
Korsakoff syndrome
Traumatic brain injury (TBI) can be caused by many factors such as falls, motor vehicle
accidents, and assaults. Short term and long term deficits can alter neurological function that are
caused by direct blow to the head. TBI is defined as a “blow or jolt to the head or a penetrating
head injury that disrupts the [normal] function of the brain” (Anderson et al., 2014, p. 2210). The
pathological aspect of TBI depends on the structural changes from head injury whether open or
closed; damage to the cortical tissue; and hematoma formation that can damage subcortical
structures leading to ischemia (Mott, McConnon, & Rieger (2012). Considering the patient
exhibits no open head injury, the assumption is he possibly is suffering from closed head injury
due to trauma/blow to the head. With a closed head injury, the frontal and temporal lobes are
predominantly susceptible for severe damage (Anderson et al., 2014). TBI symptoms depending
on severity of damage can affect concentration, fatigue, memory lapse, confusion, and difficulty
sleeping. Along with TBI there may also be impaired decision making and the ability to solve
