Written Assignment: Case Study: Managing a Geriatric Psychiatric Inpatient – Mr. Albert Thompson
Patient Profile:
Name: Albert Thompson
Age: 78 years old
Gender: Male
Occupation: Retired engineer
Medical History: Type 2 Diabetes Mellitus, Hypertension, Alzheimer’s Disease (early stage), and a history of a minor ischemic stroke two years ago.
Presenting Complaint: Mr. Thompson was admitted to the geriatric psychiatric ward after his daughter reported a sudden and severe change in his behavior. Over the past two weeks, he’s become more agitated, especially in the evenings, expressing paranoid beliefs that his family is plotting against him. He also had an episode where he left his home in the middle of the night, wandering the streets, and had to be brought back by the police.
Medication History:
Metformin 500mg twice daily
Lisinopril 10mg daily
Donepezil 10mg daily
Physical Examination:
Vital Signs: BP: 160/95 mmHg, Pulse: 86 bpm, Temp: 98.7°F, Resp: 19 breaths/min
General: Appears distressed, pacing around, poor eye contact
Neurological: Alert, oriented to person but not to time or place, cranial nerves intact, mild right-sided weakness from a previous stroke.
Cardiovascular: Regular rhythm, no murmurs
Laboratory Findings: Blood glucose is elevated; all other parameters, including electrolytes, are within normal limits.
Clinical Questions:
Differential Diagnosis: Based on Mr. Thompson’s presentation and background, what psychiatric and medical conditions might be contributing to his sudden change in behavior?
Medication Management: How might Mr. Thompson’s current medications or potential drug interactions be influencing his psychiatric symptoms? Would you consider any changes or additions to his regimen?
Interdisciplinary Collaboration: Given his multifaceted presentation, which other specialists or care providers would you collaborate with in managing Mr. Thompson’s care, and how would you approach this collaboration?
Therapeutic Interventions: Beyond pharmacological interventions, what therapeutic modalities and strategies would you recommend for Mr. Thompson’s management while he’s in the inpatient setting?
Discharge and Follow-up: When it’s time to consider discharging Mr. Thompson, what steps and precautions would you take to ensure his safety and well-being at home?
Learning Objectives:
Understand the unique challenges in managing geriatric psychiatric patients, especially those with comorbid medical conditions.
Recognize the importance of thorough medication reviews in geriatric patients to prevent or address potential adverse effects or interactions.
Emphasize the value of interdisciplinary collaboration in managing complex geriatric cases.
Develop a comprehensive approach to inpatient care, including pharmacological, therapeutic, and discharge planning strategies.
Purpose:
This case study is designed to provide nurse practitioner students with a comprehensive view of managing geriatric psychiatric inpatients, integrating medical, psychological, and social considerations.