Review the case study and then answer the questions that follow.
You are with your preceptor, Dr. Mark Parr, in clinicals. One of the people you see today is Rose Lee Strom, a 73-year-old woman. Rose Lee was brought in for a psychological evaluation by her brother Robert Chang because of a three-year history of memory impairment. Rose Lee completed high school and then worked in a clerical position until her retirement in 1997. Since the death of her husband in 2005, she has lived alone and maintained her own home and financial affairs.
Robert has noticed that Rose Lee has a gradually worsening memory impairment and has difficulty finding words, but Rose Lee became angry at the suggestion that she may have a progressive impairment. Robert says that other family members and friends have noted a decline in her housekeeping and financial affairs, but Rose Lee herself has no complaints.
Elevated arterial blood pressure was documented on several occasions, but Rose Lee never took medication. She has no children and had a hysterectomy in her thirties. She is a well-groomed woman who is alert and friendly. General and elemental neurological exams are normal.
About five minutes after coming in, having already greeted everyone and exchanged names, your preceptor asks Rose Lee to state her name and age.
Rose Lee: Pleased to meet yu-you. I’m Rose Lee Ruth Strom. I’m… I’m about 8?
Robert: You’re 73, Rose Lee.
Mark: Robert , please let Rose Lee answer all of my questions so that I can get a better sense of what is going on. I know that can be difficult when she struggles, but it is important.
Mark: Rose Lee, when is your birthday?
Rose Lee: [pause] Juggle… July. … No, wait. [pause] That’s not right. Fla… flamingo. Oh, I don’t know.
Mark: Let me ask that in a different way. Were you born in February, June, or November?
Rose Lee: Oh, yes, February! Things don’t… matter.
Mark: Can you tell me what year you were born and what year it is today?
Rose Lee: Ahhh, I was born in… 19… fifty… one. 1944. 2020? I’m not sure. It was so long ago. [laughs]
Rose Lee: The pah– pred– president is John F. Kennedy. Such a wonderful thing he is!
Rose Lee: He’s coming to my birth—day party tomorrow. Are you? We’ll have lots of stuff.
Robert: See what I mean? It’s not her birthday tomorrow.
Mark: Robert, it’s okay. Let’s do something else. Rose Lee, what is this? [A purple pen is displayed.]
Rose Lee: That’s a thing you can do stuff with.
Mark: Can you tell me what it looks like?
Rose Lee: It’s long and thin. And it’s a pretty color, like a… a bird.
Mark: What would you use it for, Rose Lee?
Robert: Come on, dear, you know what this is
Rose Lee: Oh, my dear brother, it’s to write stuff with.
Mark: Good. Do you know where you would use it?
Rose Lee: Ummmm, at worth… world … whu whu … work. At work.
Mark: Yes, that’s right. Here, take it your hands and feel it.
Rose Lee: It’s a pe-pen!
From your perspective as Rose Lee’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) in APA (7th edition) format. Include at least three peer-reviewed, evidence-based references.
- Identify three differential diagnoses (one medical and two psychiatric) for Rose Lee. What is your provisional diagnosis for her?
- How can you differentiate normal age-related decline from pathological signs and symptoms associated with neurocognitive disorders?
- Rose Lee needs formal screening and/or testing. What screening tools and testing would you have her complete?
- What medication(s) would you start her on, if any? Why? Include the name (generic and brand), dose, route, and frequency/timing for all medications.
- What education would you provide Rose Lee and Robert?
- What referral(s) would you give Rose Lee? Why?
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