Name: Kirstin Ansley Date: 12/15/2024
Scenario
You are the nurse working in the outpatient clinic. This afternoon, a woman brings in her father, K.B.,
who is 74 years old. The daughter reports that over the past year she has noticed her father has
progressive problems with his mental capacity. These changes have developed gradually but seem
to be getting worse. At times, he is alert, and at other times he seems disoriented, depressed, and
tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the
cupboard and sugar in the refrigerator. K.B. reports that he has been having memory problems for
the past year and at times has difficulty remembering the names of family members and friends. His
neighbor found K.B. down the street 2 days ago, and he did not know where he was. This morning he
thought it was nighttime and wondered what his daughter was doing at his house. He could not pour
his own coffee, and he seems to be getting more agitated. A review of his medical history is
significant for hypercholesterolemia and coronary artery disease.
1. What are some cognitive skills that may decline in an older adult?
When a patient increases in age they may experience short term memory loss such as, forgetting
appointments and scheduled events. They also may experience a slow thought process, decreased
ability in learning skills, perceptual speed, verbal ability, as well as troubles with naming objects.
2. Physiologic age-related changes in an older adult can influence cognitive functioning. Name and
discuss one.
Decreased cerebral blood flow and brain volume. This can lead to a decrease in the speed of nerve
conduction which can cause the patient to become slow at responding to others, learning new
things and reacting to situations.
3. For each finding listed, specify whether it is associated with delirium or dementia or both.
Assessment finding Delirium Dementia Both
a. Gradual onset x
b. Hallucinations, delusions x
c. Sudden, acute onset x
d. Progressive functional impairment x
e. Personality changes with lability x
f. Sleep problems x
g. Possible wandering behavior x
h. Symptoms fluctuate during day, often worse at night x
, 4. Based on the information provided by K.B.’s daughter, do you think he is showing signs of delirium
or dementia? Explain.
I believe that K.B. is showing signs of dementia because as his daughter stated he has been
showing signs gradually and has been getting progressively worse as well as this has been
happening over a span of a year. This would not indicate delirium as delirium happens fairly quickly
and K.B. has been having memory problems for what appears to be a long time. He has also been
misplacing things in inappropriate areas and is having a hard time remembering names of family
members and friends which aligns with a dementia diagnosis over a delirium diagnosis.
5. How does the health care team determine the degree of cognitive impairment?
There are many tests that can be administered for cognitive screening, one example is a mini-cog
which involves memory recall, and drawing a clock. A healthcare provider such as a geriatric
specialist or a psychologist will use different types of cognitive screening tools to assess changes in
memory and thinking, verbal and expressive abilities, executive functions and constructional
functions. These tests will allow the provider to determine the degree of impairment and also allow
them to determine the patients ability to do things on their own such as driving, managing finances
and even the ability to live alone and complete ADLs.
CASE STUDY PROGRESS
K.B.’s vital signs are within normal limits. He is pleasant, with coherent speech, although he does not
speak unless asked specific questions. General and neurologic assessment findings are normal.
You perform the Mini-Cog screening. He repeated 1of the 3 unrelated words correctly. He draws the
following clock:
6. Interpret K.B.’s results on the Mini-Cog.
As the scoring system is set up the patient gets one point for each word recalled correctly which
would allow K.B. one point total for that section. The clock section must include all numbers 1-12 in
Scenario
You are the nurse working in the outpatient clinic. This afternoon, a woman brings in her father, K.B.,
who is 74 years old. The daughter reports that over the past year she has noticed her father has
progressive problems with his mental capacity. These changes have developed gradually but seem
to be getting worse. At times, he is alert, and at other times he seems disoriented, depressed, and
tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the
cupboard and sugar in the refrigerator. K.B. reports that he has been having memory problems for
the past year and at times has difficulty remembering the names of family members and friends. His
neighbor found K.B. down the street 2 days ago, and he did not know where he was. This morning he
thought it was nighttime and wondered what his daughter was doing at his house. He could not pour
his own coffee, and he seems to be getting more agitated. A review of his medical history is
significant for hypercholesterolemia and coronary artery disease.
1. What are some cognitive skills that may decline in an older adult?
When a patient increases in age they may experience short term memory loss such as, forgetting
appointments and scheduled events. They also may experience a slow thought process, decreased
ability in learning skills, perceptual speed, verbal ability, as well as troubles with naming objects.
2. Physiologic age-related changes in an older adult can influence cognitive functioning. Name and
discuss one.
Decreased cerebral blood flow and brain volume. This can lead to a decrease in the speed of nerve
conduction which can cause the patient to become slow at responding to others, learning new
things and reacting to situations.
3. For each finding listed, specify whether it is associated with delirium or dementia or both.
Assessment finding Delirium Dementia Both
a. Gradual onset x
b. Hallucinations, delusions x
c. Sudden, acute onset x
d. Progressive functional impairment x
e. Personality changes with lability x
f. Sleep problems x
g. Possible wandering behavior x
h. Symptoms fluctuate during day, often worse at night x
, 4. Based on the information provided by K.B.’s daughter, do you think he is showing signs of delirium
or dementia? Explain.
I believe that K.B. is showing signs of dementia because as his daughter stated he has been
showing signs gradually and has been getting progressively worse as well as this has been
happening over a span of a year. This would not indicate delirium as delirium happens fairly quickly
and K.B. has been having memory problems for what appears to be a long time. He has also been
misplacing things in inappropriate areas and is having a hard time remembering names of family
members and friends which aligns with a dementia diagnosis over a delirium diagnosis.
5. How does the health care team determine the degree of cognitive impairment?
There are many tests that can be administered for cognitive screening, one example is a mini-cog
which involves memory recall, and drawing a clock. A healthcare provider such as a geriatric
specialist or a psychologist will use different types of cognitive screening tools to assess changes in
memory and thinking, verbal and expressive abilities, executive functions and constructional
functions. These tests will allow the provider to determine the degree of impairment and also allow
them to determine the patients ability to do things on their own such as driving, managing finances
and even the ability to live alone and complete ADLs.
CASE STUDY PROGRESS
K.B.’s vital signs are within normal limits. He is pleasant, with coherent speech, although he does not
speak unless asked specific questions. General and neurologic assessment findings are normal.
You perform the Mini-Cog screening. He repeated 1of the 3 unrelated words correctly. He draws the
following clock:
6. Interpret K.B.’s results on the Mini-Cog.
As the scoring system is set up the patient gets one point for each word recalled correctly which
would allow K.B. one point total for that section. The clock section must include all numbers 1-12 in
