Geriatrics Case Study Analysis-65yrs Old Male

Geriatrics Case Study Analysis-65yrs Old Male

Falls occur due to various reasons. The approach to management is multidisciplinary. In the case of Mr. Smith, I would proceed to use the Comprehensive Geriatric Assessment. It is a multidisciplinary evaluation and therapeutic process that distinguishes the clinical, psychosocial, and functional constraints of a delicate older individual (Garrard et al., 2020). It helps to create an organized management plan that boosts well-being with advancing age. Furthermore, it helps in short-term and long-term follow-up of patients. Pain assessment is also important for Mr. Smith. Acute pain can be dependably evaluated with numeric rating scales or visual analog scales. Other scales like the Berg Balance Scale, Falls Efficacy Scale, and Timed Up and Go Test can be used to assess balance, fear of falling, and mobility, respectively.

There are no definitive tests to assess individuals who have had a fall. However, the cause of a fall can be determined from history, physical examinations, and laboratory tests. Laboratory investigations include complete blood count, liver and renal function tests, inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, urinalysis, blood glucose, and electrolyte levels such as magnesium. Imaging investigations that can be done are chest radiography and computed tomography scans of the head.

The management of falls can be difficult. For groups of elderly individuals, a mix of therapies such as treatment regimen evaluation, a workout routine, Vitamin D supplements, and home environment evaluation has been recommended (Bolding & Corman, 2019). There are different causes of falls. Therefore, treatment is personalized based on the individual. It is also based on findings after history taking and physical examination. Mr. Smith’s treatment regimen should include a workout plan. It should also include a balanced diet, and supplements like vitamin D. Other components that can be included in his treatment regimen are home visits and visual aids.

Mr. Smith should also be screened for Alcohol Use Disorder (AUD). A standardized screening tool is used, and if the results are positive, a clinical assessment is done in addition to laboratory and imaging tests (Lisko et al., 2021). Laboratory tests include a complete blood count and liver function test. For imaging, an abdominal ultrasound can be performed. Mr. Smith can benefit from screening and brief one-on-one counseling sessions. The goal of the sessions is to moderate Mr. Smith’s alcohol consumption to reasonable levels that do not cause harm to him. Medication can also be given if indicated. Other treatment modalities, such as self-help groups, are also important.

References

Bolding, D. J., & Corman, E. (2019). Falls in the geriatric patient. Clinics in Geriatric Medicine, 35(1), 115-126. https://doi.org/10.1016/j.cger.2018.08.010

Garrard, J. W., Cox, N. J., Dodds, R. M., Roberts, H. C., & Sayer, A. A. (2020). Comprehensive geriatric assessment in primary care: a systematic review. Aging Clinical and Experimental Research, 32(2), 197-205. https://doi.org/10.1007/s40520-019-01183-w

Lisko, I., Kulmala, J., Annetorp, M., Ngandu, T., Mangialasche, F., & Kivipelto, M. (2021). How can dementia and disability be prevented in older adults: where are we today and where are we going? Journal of Internal Medicine, 289(6), 807-830. https://doi.org/10.1111/joim.13227.

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Mr. Smith is a 65-year-old male that is accompanied by his wife to your clinic. He is following up after an ER visit for a fall at home that resulted in 6 stitches to his forehead. He admits that he had a few drinks that night before tripping over his dog. His wife adds that he has “a few drinks” every night.

How will you proceed with Mr. Smith? What diagnostics will you perform? What will potentially be part of your treatment plan?
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years
EXAMPLE
The management of an intoxicated patient requires a better understanding of the
clinical and medico-legal principles. In the presented case, I will proceed with Mr. Smith by
interviewing the patient on his general status especially where he fell, the surface of the fall,
the time when he fell, and his reflex action when he fell. I will also observe his level of
cooperation to some tests on his cognitive skills. I will also evaluate his cultural beliefs and
any involvement in violence. Apart from the physical violence ideation, most intoxicated
patients have altered mental status and express suicidal ideation. Because she was brought by
her wife, I will ask her if she brought him against his wishes because he could also be
difficult in accepting the medical care. This could be very difficult in accurately diagnosing
and treating the underlying medical condition. To protect the safety of patients and
employees, I must be aware of the medicolegal principles and be prepared to use physical or
chemical restraint as well as isolation when the situation requires it. With a thorough
knowledge of medical and legal concerns, I will be more confident and competent in
delivering optimum patient care while also preventing harm and potential lawsuits.
The diagnostics that I will conduct will include blood tests, a CT scan to evaluate any
signs of blood clotting or internal injury, and an electroencephalogram. Blood tests are
necessary to determine blood alcohol levels and alcohol impairment. Parrillo & Dellinger
(2019, pg.1106) notes that ethanol levels must be determined as a selective CNS depressant atlow doses and as a general depressant at high levels. When blood alcohol levels are at their
maximum, a patient loses protective reflexes and has a higher risk of mortality due
to respiratory depression. Johnson (2020, pg.236) states that the difference between the
anesthetic dosage and the fatal dose is razor-thin; individuals who are profoundly intoxicated
are on the verge of death and must be treated quickly. Individuals who have attained a
tolerance to alcohol may seem sober if their blood alcohol level is at 300 mg/dL. An EEG test
will be performed to assess the brain’s electrical activity. Electrical activity is the main
mechanism by which brain cells communicate with one other. It may be possible to identify
potential issues with this behavior using an EEG. A functional electroencephalogram
monitors and records brainwave patterns.
My treatment plan will involve managing alcohol intoxication as the patient takes
drinks every night which led to his loss of reflex action. The nonpharmacological treatment
plan will involve giving the patient coffee to help him feel alert. I will also recommend that
the patient takes some rest after receiving treatment for the injuries he encountered during the
fall. The patient should also take a lot of water for hydration due to the high alcohol content
in his blood. I will also recommend a psychiatric examination for deaddiction to alcohol. A
psychiatrist and alcohol counselor will help with the behavioral treatment of the patient if he
was involved in violence. To treat alcohol dependence, medications like naltrexone at a
dosage of 50 mg orally once a day for 12 weeks will help the patient in reducing heavy
drinking (Lesch et al., 2020, pg.238). Acamprosate (666mg 3 times daily) will help the
patient in maintaining abstinence from alcohol