Case:
Margaret Mae is a 70-year-old retired therapeutic recreation university professor. She has no siblings or family members but maintains a close relationship with her best friend and colleague, Cheryl. She has two dogs that she loves deeply and has kept horses and an array of pets for years. Cheryl is her primary caregiver and support. She lived on a ranch in a rural community and was recently relocated to the assisted living facility. She enjoyed walks, visits to old friends, church, and concerts while able to travel. Margaret was highly respected in the field of recreation and very social. Cheryl first noticed Margaret showing signs of memory lapses; for example, losing reader glasses, poor driving judgment and position on the road, difficulty with checkbook calculations, forgetfulness, changes in reasoning capabilities, unnecessary purchases including a second home approximately two years prior to diagnosis. Cheryl voiced concerns to her primary care physician, but no testing was done until much later. Diagostic MRI confirmed Cheryl’s suspicion of senior vascular dementia and Alzheimer’s dementia. Margaret became unable to care for herself and was placed in an assisted living facility. She was moved to your facility after an incident of elopement. You are a CTRS at the assisted living facility where Margaret now resides. You review
Significant past medical history:
– Family history of Alzheimer’s dementia, father and maternal grandmother.
– Mild hypothyroid treated with medication.
-Rheumatoid arthritis with minimal impact to mobility.
– Client had an incident of being overmedicated with psychotropic drugs, which led to a period of severe reduction in her overall function and ability to communicate and ambulate and masked a stroke that occurred; stroke induced aphasia.
– Once taken off these drugs, she began a 6-month period of regaining better overall functioning but never fully recovering
Medications: Levothyroxine (Synthroid) once daily.
Cognition/perception:
-Alzheimer’s dementia. Client has been admitted nonverbal but is alert and aware of environment.
– She reacts with head nods and smiles.
-She communicates with body language and occasionally will speak a few simple words.
Aphasia is present.
Physical examination:
-Client was examined upon entrance to the assisted living facility all physical functions with in normal limits.
-Stroke affected her left side minimally and she can ambulate without assistance.
Client Goals
1- Opportunities to socialize without pressure of speaking
2- Meaningful and safe activities to pass the time
3- Physical activity to assist with balance and coordination
1. Create a treatment plan for Margaret Mae, using evidence-based practice to guide your decision on appropriate interventions following the DENT problem solving method.
a. Define the problem: Clearly identify and articulate the specific problem or challenge that needs to be addressed. This involves understanding the current situation, desired outcomes, and any constraints or limitations (1 paragraph)
b.Explore possible solutions: Generate a range of potential solutions or approaches to solving the problem. Encourage creative thinking and consider different perspectives or alternative options.(1 paragraph)
c. Narrow down options: Evaluate the potential solutions and select the most feasible and effective ones. Consider the advantages, disadvantages, and potential risks associated with each option.(1 paragraph)
d. Take action: Implement the chosen solution or solutions. Develop a plan, allocate resources, and set specific goals and timelines for execution. (1 paragraph)
2. What assessment would be most appropriate for you to give to Margaret? (1 paragraph: Question 2 and Question 3)
3. What factors must be considered when planning Margaret’s treatment
4. What is your PICO question? (1 paragraph: Question 4 and Question 5)
5. “What outcomes do you anticipate from your treatment plan?
6. How will you evaluate the outcomes of your treatment plan? (1 paragraph: Question 6 and Question 7)
7. How will you evaluate the outcomes of your treatment plan?
8. What contraindications should you consider in Margaret’s treatment? (1 paragraph: Question 8 and Question 9)
9. What recreational activities would be appropriate considering Margaret’s interests, goals, and current functioning level?
10. How would you communicate your recommendations to Margaret? (1 paragraph: Question 10 and Question 11)
11. How will you include Cheryl, Margaret’s caregiver, in your intervention plan?
