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:
1. Differential Diagnosis: Based on Mr. Thompson’s presentation and background, what psychiatric and medical conditions might be contributing to his sudden change in behavior?
2. 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?
3. 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?
4. 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?
5. 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:
1. Understand the unique challenges in managing geriatric psychiatric patients, especially those with comorbid medical conditions.
2. Recognize the importance of thorough medication reviews in geriatric patients to prevent or address potential adverse effects or interactions.
3. Emphasize the value of interdisciplinary collaboration in managing complex geriatric cases.
4. 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.
Case Study Analysis Rubric
Case Study Analysis Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeAccuracy and Detail
Part 1: Understand of Case Details 40 pts
Excellent
Demonstrates the comprehensive criteria of the DSM-5, meticulous recap of all case details. 30 pts
Good
Demonstrates the comprehensive criteria of the DSM-5 and main points of the case but may miss or misinterpret some nuances. 20 pts
Needs Improvement
Demonstrates some of the comprehensive criteria of the DSM-5, Frequently misses or misinterprets important case details.
40 pts
This criterion is linked to a Learning OutcomeDiagnostic Assessment
Part 2: Clinical Reasoning 20 pts
Excellent
Provides a comprehensive diagnostic assessment based on presented information. 15 pts
Good
Provides a mostly accurate diagnosis but may miss a few subtleties. 10 pts
Needs Improvement
Struggles to provide an accurate diagnosis or misses key diagnostic criteria.
20 pts
This criterion is linked to a Learning OutcomeTreatment Options
Part 2: Clinical Reasoning 20 pts
Excellent
Thoroughly analyzes and recommends appropriate treatment options with a clear rationale. 15 pts
Good
Generally recommends appropriate treatments but may lack detailed reasoning. 10 pts
Needs Improvement
Misses or recommends inappropriate treatment options without sufficient justification.
20 pts
This criterion is linked to a Learning OutcomeRecognition of Issues
Part 3: Ethical and Cultural Considerations 15 pts
Excellent
Clearly identifies any ethical or cultural issues present in the case. 10 pts
Good
Recognizes some issues but may miss subtleties or depth. 7.5 pts
Needs Improvement
Struggles to identify clear ethical or cultural issues present.
15 pts
This criterion is linked to a Learning OutcomeAddressing Concerns
Part 3: Ethical and Cultural Considerations 15 pts
Excellent
Demonstrates a sensitive and informed approach to addressing these issues. 10 pts
Good
Addresses concerns but may lack depth or clarity. 7.5 pts
Needs Improvement
Fails to adequately address or respond to the recognized concerns.
15 pts
This criterion is linked to a Learning OutcomeRecognition of Need
Part 4: Interdisciplinary Collaboration 10 pts
Excellent
Clearly identifies when and why interdisciplinary collaboration is necessary. 8 pts
Good
Clearly identifies when and why interdisciplinary collaboration is necessary. Mostly recognizes the need but may lack detailed rationale. 4 pts
Needs Improvement
Frequently overlooks the importance or relevance of interdisciplinary collaboration.
10 pts
This criterion is linked to a Learning OutcomeEffective Collaboration
Part 4: Interdisciplinary Collaboration 10 pts
Excellent
Provides detailed strategies for effective collaboration with other professionals. 8 pts
Good
Generally outlines collaboration, but strategies may lack depth. 4 pts
Needs Improvement
Struggles to provide clear or actionable strategies for collaboration.
10 pts
This criterion is linked to a Learning OutcomePresentation of Analysis
Part 5: Clarity and Organization 10 pts
Excellent
Analysis is clear, well-organized, and logically structured. 8 pts
Good
Analysis is mostly clear, but may have minor organizational issues. 4 pts
Needs Improvement
Analysis is disorganized or lacks a clear structure, making it hard to follow.
10 pts
This criterion is linked to a Learning OutcomeWriting Style
Part 5: Clarity and Organization 10 pts
Excellent
Writing is concise, free of errors, and uses appropriate clinical terminology. 8 pts
Good
Writing is mostly clear with minor errors or inconsistencies. 4 pts
Needs Improvement
Writing contains multiple errors, lacks clarity, or does not use appropriate terminology.
10 pts
Total Points: 150
