Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia. Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.  

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CASE STUDY

Requirements

  1. Read the case study below.
  2. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
  3. Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario

A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.

His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.

Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression

Allergies: No known allergies

Medications: None

Family History

  • Father deceased at age 78 of decline related to Alzheimer’s disease
  • Mother deceased at age 80 of natural causes
  • No siblings

Social History

  • Denies smoking
  • Denies alcohol or recreational drug use
  • Retired lawyer
  • Hobby: Golf at least twice a week

Review of Systems

  • Constitutional: Denies fatigue or insomnia
  • HEENT: Denies nasal congestion, rhinorrhea or sore throat.
  • Chest: Denies dyspnea or coughing
  • Heart: Denies chest pain, chest pressure or palpitations.
  • Lymph: Denies lymph node swelling.
  • Musculoskeletal: denies falls or loss of balance; denies joint point or swelling

General Physical Exam  

  • Constitutional: Alert, angry but cooperative
  • Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
  • 178 lbs., Ht. 6’0″, BMI 24.1

HEENT

  • Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact

Neck/Lymph Nodes

  • No abnormalities noted

Lungs 

  • Bilateral breath sounds clear throughout lung fields.

Heart 

  • S1 and S2 regular rate and rhythm, no rubs or murmurs.

Integumentary System 

  • Warm, dry and intact. Nail beds pink without clubbing.

Neurological

  • Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia

Diagnostics

  • Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
  • MRI: hippocampal atrophy
  • Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.

 

Discussion Questions

  1. Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
  2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.
  3. Explain one hypothesis that explains the development of Alzheimer’s disease
  4. Discuss the patient’s likely stage of Alzheimer’s disease.

 

Identify local, state, and national resources which facilitate safe and effective transitions of care for older adults.

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Coronary artery disease

Course Competency:

Identify local, state, and national resources which facilitate safe and effective transitions of care for older adults.

Your supervisor at Rasmussen Home Health Services is satisfied with the resources described in your annotated bibliography and is eager for you to continue your work. As a next step, your supervisor wants you to develop and share the following items with them.

  • Write an introduction about your in-service presentation topic.
  • Create an outline that identifies and describes the important content areas for your in-service presentation topic.
  • Write a conclusion.
  • Provide an APA formatted References list that contains at least 2 credible references that you intend to cite in your presentation.

 

When thinking of the change process, what is the role of the nurse leader/manager in the change process? What impact does change have within healthcare organizations as a whole?

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Change process

Change is inevitable in healthcare and in nursing. When thinking of the change process, what is the role of the nurse leader/manager in the change process?

What impact does change have within healthcare organizations as a whole?

 

Identify a bill that relates to health care, a social issue, or nursing practice. Develop a poster presentation, infographic, FAQ document, or pamphlet which outlines how the bill was introduced and the process for approval.

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Week 8 Assignment: Tracing a Piece of Legislation

Due: Sunday night at 11:59pm Mountain Time
In order to influence policy, you have to understand how a bill is started, moves through the legislative system, and finally enacted. In this assignment, you will trace a piece of legislation from introduction to how it impacts health care or nursing practice. Develop the assignment as if it will be used during a presentation at a conference or poster presentation.

Step 1: Identify a bill that relates to health care, a social issue, or nursing practice. You may select a federal or state bill

Step 2: Develop a poster presentation, infographic, FAQ document, or pamphlet which outlines how the bill was introduced and the process for approval by including answers to the following questions:
State the legislation name and summarize the purpose of the bill
Who introduced/sponsored the bill?
Where was it introduced? (U.S. Congress or a state legislature)
Who helped to draft the legislation?
Did nursing organizations such as the American Nurses Association identify support or opposition for the law? Look at two or more organizations, and you may need to review their lobbying information. If you can not find any evidence related to the legislation, list the organizations that you reviewed.
Which congressional or legislature committees were involved?
What happened to the legislation after it was introduced? Was it passed, enacted, or funded? If yes, when did it take effect?
What is the impact on health care or nursing practice?
*Because this is not a typical paper format style, you may simply put weblinks for your reference at the bottom of your assignment for full APA formatting credit.

Step 3: Submit the written assignment using this assignment box.

Do you agree or disagree with the Humphrey statement? Why or why not? State your reasons based on your knowledge of the health care system, current research, observations in the clinical area, and personal experience.

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Week 8 Discussion: Role of Government in Providing Health Care 2 2

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Step 1: Read the following quote by Hubert H. Humphrey, United States politician (1911-1978).

“It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.”

Step 2: Post a response to the discussion board by addressing the following questions:
1. Do you agree or disagree with the Humphrey statement? Why or why not?
2. State your reasons based on your knowledge of the health care system, current research, observations in the clinical area, and personal experience.
3. Justify your responses with appropriate resources.

Step 3: Read other students’ posts and respond to at least two of them by Friday at 11:59 pm MT Cite any sources in 7th ed. APA format
Response Posts: In your responses to your classmates, contribute to the discussion with your own original opinions or interpretation of the course materials.
See rubric (https://dcn.instructure.com/courses/174/rubrics/81404) for grading details

Using your reading in this course so far and other research, discuss the ethical ramifications of this statement.

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Week 8 Discussion: Economics and Ethics 2 2

Due: Post your initial response by Wednesday night at 11:59pm Mountain Time.
Your instructor will post a response to your post by Friday 11:59 pm MT. Respond to your instructor’s comments by Sunday 11:59pm Mountain Time.

Step 1
Choose either Option A or Option B and post a 150+ word discussion by Sunday, 11:59 pm MT, Be specific and give examples, using at least two outside references, to buttress your argument. Cite all sources in APA format.

Option A:
“The method of health care in the US is despicable because it forces too many to choose between health and survival (medicine and eating). Given modern science, health care should be a right not a privilege.”

Discussion:
Using your reading in this course so far and other research, discuss the ethical concepts referred to in this statement – NOT your opinion of the Healthcare System!

 

Option B:
“Economic inequality is the most destructive force in any society. However, any forcible means to equalize economic situations are destructive to both innovation and civic responsibility. Civic responsibility should mean that those who are at the extreme high end of the wealth bell curve willingly share their good fortune with those who are at the bottom of the wealth bell curve. Any failure to do so should be considered a betrayal of citizenship in favor of the self.”

Discussion:
Using your reading in this course so far and other research, discuss the ethical ramifications of this statement.

Examine factors that must be considered in planning and implementing online learning, and describe online course design issues. Explore evidence of the effectiveness of online teaching and learning. Analyze how online learning has revolutionized higher education in nursing.

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Mini-Presentation

Last week you learned how to develop a teaching plan and infuse advanced technology into your nurse educator role.

This week we will be focusing on teaching and learning through distance and online learning modalities. You will also submit a Teaching Plan Video Presentation. This presentation is based on the teaching plan developed in week 6.

Present this to your peers and professor as if you were explaining how and what you will facilitate teaching in this particular class. You are NOT presenting the course contents to a class of students. Note: Visual aids and creativity are encouraged.

The learning objectives include:

Examine factors that must be considered in planning and implementing online learning, and describe online course design issues.
Explore evidence of the effectiveness of online teaching and learning.
Analyze how online learning has revolutionized higher education in nursing.
Investigate how faculty can evaluate outcomes and report results to stakeholders.
Discuss the uses, advantages, disadvantages, and issues related to a variety of strategies that faculty can use to assess student learning.
Explain how nursing faculty can select learning strategies, improve their validity and reliability, and increase the effectiveness of their use.
Examine delivery strategies used to educate nursing students in a distance education program and discuss the advantages and disadvantages.

You will develop a 5- to 8-minute mini-presentation of your teaching plan that you developed during week 7. Your presentation must include both audio and visual components. The presentation is a summary of your teaching plan. Guidelines for your presentation are listed below

Compare normal anatomy and physiology to alterations in function and regulation of body organs and systems in response to stressors.

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Patho-Reflection

Respond to the following questions based upon these course objectives:

Integrate nursing and related sciences into the delivery of advanced nursing care to diverse populations. (AACNI.1)

Incorporate current and emerging genetic/genomic evidence in providing advanced nursing care to individuals, families, and communities while accounting for patient values and clinical judgment. (AACN I.2)

Compare normal anatomy and physiology to alterations in function and regulation of body organs and systems in response to stressors. (AACN I.1)

Answer the following questions with supporting examples and full explanations.

For each of the learning objectives, provide an analysis of how the course supported each objective.

Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.

 

What are the attributes of the learning organization and how does it align (or support) the complex adaptive healthcare system?

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Week 7

Answer the below questions:

1.What are the attributes of the learning organization and how does it align (or support) the complex adaptive healthcare system?

2.What leadership styles are inherent in learning organizations that may not be totally supported in a traditional organizational culture?

3. Using the cultural assessment you did a few weeks ago, how does your current organizational culture and climate align with the learning organizational attributes?

4.What other information might you need before you could make that determination?

5. Where would you obtain it?

6. How does your philosophy of leadership and personal leadership profile align to the attributes of the learning organization?

7. What is the role of the nurse leader in leading and creating a shift toward becoming a learning organization?

Critically analyse the role of the nurse, throughout each section of the framework and consider the learning outcomes when writing your report.

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Case study details:

Freda is 55years old, terminally ill with breast cancer that has progressively spread. She came to Nursing Home for End of Life Care. She has capacity and made decision to put DNAR in place. She has husband. She belongs to Christian religion.

Ethical Dilemma is Do Not Attempt Resuscitation

Four Quadrant Approach Ethical Framework has to be used in this case study.  (Johnsen and Winslade)

Detailed Assignment Guidelines

Introduction

(200 words)

 

 The introduction offers a general statement to introduce the main subject area and to set the context for the discussion. Including a broad background of information into your key ethical challenges and outlines all the ideas you are going to present in the assignment, such as:

–          A statement/ definition of the importance of the topic and the context, background of and care delivery

–          Introduce the framework and link the learning outcomes

–          Introduce the service user/child you have chosen

–          Include statements dealing with confidentiality were necessary (NMC)
Background

(250 words)

 

Background information refers to a concise summary of the clinical & wider detail of this persons’ care which is relevant to the issues that you later discuss:

–          Physical health

–          Mental health

–          Family and other relationships

–          Social circumstances- employment, religious/spiritual beliefs, sexuality etc.

–          Age and development (where appropriate)

  
Key ethical challenge / Framework

(200 words)

 Short paragraph identifying what your key ethical challenge is, this is then expanded in your framework below. Outline the use of ethical frameworks and present reasoning for your preferred framework(s).  
Main discussion

(1400 words)

 Utilise your preferred ethical framework(s) as the structure to aid the discussion and identifying key issues regarding this person/child’s treatment, while using the legislation and ethical theories to support throughout.

Suggested structure to use combined 4 quadrant approach (Jonsen, Siegler, and Winslade, 2006) with considering of 4 principles of bioethics (Beauchamp and Childress, 2019) frameworks:

–          Medical indications (Beneficence and Non-maleficence)

o   Is the problem acute or chronic and / or reversible? What are the goals to treatment? Will treatment be successful? How can this patient benefit from medical / nursing care, and can harm be avoided?

–          Patient Preferences (Autonomy)

o   Does the patient have capacity? How do you determine this? What is the patient’s wishes / preferences with the treatment? Is it an informed choice? Is the shared decision making? Is there any advance directives? Is there someone making the decisions for the patient (LPA)? Is the patient’s right to choose being respected to the extent possible within ethics and law? Risk of paternalism?

–          Quality of life (Beneficence and Non-maleficence)

o   Can the patient return to normal life? Are there any expected deficits expected to the patient’s physical, mental and social life? Is there any biases that may cause prejudice to the evaluation of the patient’s life? Is there any plan to forgo treatment? Any comfort or palliative care plans? Could there be any harm / is the intent good for the patient?

–          Contextual Features (Justice)

o   Any family issues to consider? Are there any nursing issues that may influence treatment decisions? Financial factors? Religious / cultural factors? Confidentiality / information sharing issues? Law effecting treatment options (especially palliative care)? Any conflict of interest? Is the treatment fair?

In each of these sections you need to be drawing upon the relevant legislation / policies / theories to critically discuss the key ethical challenge; Utilising them to support all your points / discussions (as references).

 

Critically analyse the role of the nurse, throughout each section of the framework and consider the learning outcomes when writing your report.

 

The Key Legislation, Policies / Guidelines and Ethical Theories, will be discussed throughout the module with dedicated revision session to collate all the information together towards the end of the module. See key legislation on AULA.

  
Nurses Role

(300 words)

 Appraise the nurses’ role throughout – you may also want to also include a section at the end to discuss this concept more generally. Be careful not to repeat yourself – from discussions within the framework(s).

Consider – if not done previously:

–          Accountability and Advocacy

–          Risk of Paternalism

–          Virtue Ethics / the need for nurse to be ethical practitioners / compassion fatigue?

–          Are there limitations to the nurses’ role within decision making?

–          How is this relevant to the changing role of the nurse and future standards of education and proficiencies/competencies?

–          Resolving Conflict

–          What legislation / guidelines exist to support nurses and others in managing complex ethical, legal and policy issues? (The Constitution, the Code, etc.)

Reflect on professional/national guidance to support practitioners in your field and draw from other’s where appropriate.

 

  
Conclusion

(200 words)

 No new information is required within the conclusion.

Summarise your discussions and highlight some of the key points.

  
CU APA Referencing No less than 20 relevant references – ensure you reference the framework(s) and all legislation used. You can directly reference the legislation i.e. Human Rights Act (1998).  

 

Recommended Reading and Reference Material

Avery, G. (2016). Law & Ethics in Nursing and Healthcare – An Introduction, 2nd edition. Essex University: Sage

Framework – Beauchamp, T., and Childress, J. (2013) 7th edition. Principles of Biomedical Ethics. New York: Oxford University Press 

Bradshaw, P., and Bradshaw, G. (2010) Health Policy for Health Care Professionals. London: Sage

Cranmer, P. and Nhemachena, J. (2013) Ethics for Nurses- Theory and Practice. University of Huddersfield: Open University Press

Cuthbert, S. and Quallington, J. (2017) Values and Ethics for Care Practice. Lantern

Dimon, B. (2011) Legal Aspects of Nursing. England: Pearson Longman

Dimond, B. (2016) Legal Aspects of Mental Capacity: A Practical Guide for Health and Social Care Professionals, 2nd ed, Oxford: Wiley-Blackwell Publishing.

Graham, M. and Cowley, J. (2015) A Practical Guide to the Mental Capacity Act 2005. Jessica Kingsley Publishers.

Griffin, R. and Tengnah, C. (2020) Law and Professional Issues in Nursing, 5th edition. Swansea Univeristy: Sage.

4 Quadrant Approach – Jonsen, A., Siegler, M. and Winslade, W. (2010). Clinical Ethics, 7th ed. UK: McGraw-Hill

Seedhouse, D. (2009) Ethics: The Heart of Health Care. Chichester: John Wiley and Sons

Selman, D. (2011) What makes a Good Nurse- Why the Virtues are Important for Nurses. London: Jessica Kingsley Publishers.