MODULE 23: CONCEPT OF COGNITION

Case Study: Parts 1, 2, and 3

Case Study, Part 1 (pp. 1715–1716)

Victor Wallace is a 74-year-old Caucasian male who was diagnosed with moderate Alzheimer disease 2 years ago. Mr. Wallace lives with his 50-year-old daughter, Anne Marie, who is his primary caretaker. His wife of 52 years died of pancreatic cancer 18 months ago.

Mr. Wallace presents at his gerontologist’s office at 9:30 on Thursday morning. Ms. Wallace requested the appointment because she is concerned about the changes she has seen in her father over the past month. As the nurse working with Mr. Wallace’s gerontologist, you conduct an initial assessment and interview with Mr. Wallace and Ms. Wallace. Ms. Wallace reports that Mr. Wallace has exhibited increased confusion and anxiety at home and at the adult day care center he attends each day while she is at work.

In the past, Mr. Wallace only had these problems in unfamiliar settings. He is also experiencing a decline in language, increasingly using the wrong words to describe common objects and relying on scanning speech to find words. However, Ms. Wallace’s main concern is her father’s refusal to carry out the basic activities of daily living (ADLs) he is still capable of performing. When you ask Mr. Wallace about the ADLs, he says, “There’s no point in trying because I won’t be able to do them much longer.” As you observe Mr. Wallace, you note that he seems agitated. He is sitting on the edge of his chair, tapping his foot and rapping his hands on his knees. When you ask him basic questions, he has a hard time coming up with answers. When he can’t find the words he wants, he just repeats the phrase “That’s how it is.”

Mr. Wallace’s vital signs and weight are normal, and his physical condition is good for a man his age. You administer the Cornell Scale for Depression in Dementia and his score is 17, indicating high probability of depression. The gerontologist maintains Mr. Wallace’s current dose of 28 mg of memantine (Namenda) per day to slow the progression of his Alzheimer symptoms. She then adds sertraline (Zoloft), an SSRI, to treat his depression symptoms. Mr. Wallace is to start out taking 50 mg of sertraline per day, gradually working up to 150 mg per day over a 6-week period.

Question 1

How do your observations of Mr. Wallace correlate with the changes Ms. Wallace reports?

Question 2

What aspects of Mr. Wallace’s presentation prompt you to test him for depression?

Question 3

Why might Mr. Wallace’s increased confusion in familiar settings be a concern for Ms. Wallace?

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Question 4

Why is it important to distinguish between Mr. Wallace’s refusal to perform ADLs and an inability to do so?

Question 5

Would speech therapy be an appropriate intervention for Mr. Wallace? Why or why not?

Question 6

Refer to the exemplar on Alzheimer disease in this module: How would a change in Mr. Wallace’s Alzheimer medication from an NMDA receptor antagonist like memantine to an acetylcholinesterase inhibitor like donepezil affect the doctor’s choice of SSRI for depression?

Case Study, Part 2 (p. 1723)

In the winter after his visit to the gerontologist, Mr. Wallace begins experiencing increased agitation and wandering in the afternoons and evenings. One afternoon at the adult day care center, Mr. Wallace slips out the door undetected. By the time the day care providers realize he’s gone, he has left the grounds and is wandering the neighborhood. The day care providers call Ms. Wallace and 911, and a search for Mr. Wallace commences. Ms. Wallace and two police officers find Mr. Wallace 2 miles from the day care center. He has no idea where he is or how he got there. He has taken a fall, and his face and hands are covered in scrapes.

The officers radio for an ambulance as Ms. Wallace attempts to talk to Mr. Wallace. He panics because he does not recognize his daughter, and he pushes her to the ground. He then throws punches at the officers when they prevent him from running away. The paramedics arrive and restrain Mr. Wallace. Once he is restrained, Ms. Wallace is able to calm him down. He is then transported to the emergency department, where you are the admitting nurse.

Mr. Wallace is calm upon his arrival at the hospital, and you are able to treat his injuries without incident. You attempt to speak with him, but he indicates he is tired and promptly falls asleep. You use this opportunity to interview Ms. Wallace. She states that aggression has become common during her father’s increasingly frequent periods of confusion. Sometimes he doesn’t recognize her; other times, he mistakes her for his sister. He is also increasingly unable to use basic objects—such as pencils, toothbrushes, and combs—and relies on Ms. Wallace for many basic ADLs. In addition, he occasionally experiences urinary and fecal incontinence. Ms. Wallace is shaken by the day’s events and the situation in general, and she begins to cry.

When Mr. Wallace’s gerontologist arrives in the ED, you inform her of these developments. She adds 20 mg of buspirone (BuSpar) three times daily (tid) to Mr. Wallace’s treatment regimen to lessen his agitation and aggression. The doctor also tells Ms. Wallace that Mr. Wallace is starting to transition from moderate to severe Alzheimer disease, and she recommends that Ms. Wallace begin looking for a nursing home that specializes in the care of individuals with this condition.

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Question 1

What are the priorities for Mr. Wallace’s care to decrease his risk of wandering and injury during his remaining time at home?

Question 2

What independent interventions can you perform to address the caregiver role strain felt by Ms. Wallace?

Question 3

What additional information or education do you anticipate Ms. Wallace will need in light of the doctor’s recommendation?

Question 4

Which of Mr. Wallace’s symptoms indicate he is transitioning from moderate to severe AD?

Question 5

What steps can Ms. Wallace take at home to lessen the incidence and severity of Mr. Wallace’s sundowning episodes?

Question 6

Why is it important for Ms. Wallace to find an institutional care situation for Mr. Wallace now rather than waiting until he reaches a more severe stage of AD?

Case Study, Part 3 (p. 1728)

After his wandering episode, Mr. Wallace’s condition rapidly declines. His communication skills are almost completely gone; he speaks infrequently and uses only two- or three-word sentences. He no longer recognizes Ms. Wallace, cannot perform ADLs, and is indifferent to food. His tendency toward wandering and aggression has disappeared. In fact, he rarely leaves his room. For his safety and to allow for provision of the care he needs, Mr. Wallace is admitted to an extended care facility that specializes in treating patients with Alzheimer disease.

You are the nurse assigned to care for Mr. Wallace. As part of his daily assessment, you obtain his vital signs, which include temperature 99.8°F oral; pulse 92 bpm; respirations 32/min; and blood pressure 108/74 mmHg. Auscultation of Mr. Wallace’s lungs reveals faint bibasilar crackles. On reviewing his chart, you note that he has experienced a 5% weight loss since the previous month. You notify the attending physician about Mr. Wallace’s vital signs, breath sounds, and weight loss. The physician orders a chest x-ray and complete blood count (CBC).

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Question 1

What is the significance of Mr. Wallace’s vital signs and breath sounds?

Question 2

What effect might Mr. Wallace’s weight loss have on his cognitive condition?

Question 3

What important pieces of information might be gleaned from tracking Mr. Wallace’s food intake and weight?

Question 4

What is the priority nursing diagnosis for Mr. Wallace at this time?

Question 5

What independent interventions can you perform to optimize Mr. Wallace’s respiratory status? What positive effects might these have on other aspects of his health?

Question 6

Refer to the exemplar on Alzheimer disease in this module: Would Mr. Wallace’s condition improve with the addition of a cholinesterase inhibitor to his treatment regimen? Why or why not?

Touchstone 1.1: Engage with a Work of Research

ASSIGNMENT: For this essay, you will select one of the articles provided below and engage in a 2-3 page summary and response dialogue with the source. This will involve providing a detailed summary of the source’s argument and responding to that argument with your position based on the information provided in the source.

In order to foster learning and growth, all essays you submit must be newly written specifically for this course. Any recycled work will be sent back with a 0, and you will be given one attempt to redo the Touchstone.

Article Option 1: “The Recess Debate: A Disjuncture between Educational Policy and Scientific Research”
Article Option 2: “Sugar in School Breakfasts: A School District’s Perspective”

Sample Touchstone

A. Assignment Guidelines

DIRECTIONS: Refer to the list below throughout the writing process. Do not submit your Touchstone until it meets these guidelines.

1. Article Summary

❒ Have you communicated the source’s purpose?❒ Have you included all of the source’s main points?❒ Have you restated the source’s argument in your own words?

2. Article Response

❒ Have you provided your perspective on the source’s argument?❒ Have you used specific examples from the source to illustrate why you either agree or disagree with the argument?

3. Reflection

❒ Have you answered all reflection questions thoughtfully and included insights, observations, and/or examples in all responses?
❒ Are your answers included on a separate page below the main assignment?

B. Reflection Questions

DIRECTIONS: Below your assignment, include answers to all of the following reflection questions.

1. What ideas originally came to mind when you first read through the article? Did your initial response to the article change after reading it for a second time? (3-4 sentences)
2. How does paying attention to the way you respond to a source help you formulate your stance on a topic? (2-3 sentences)

Portion of the project work( Check very bottom)

After going through the content, answer the below questions

 Company Overview:

• Company A has hired your team because you are experts in defining a process and delivering projects on time.  Company A has only been in business for ten years, and they have experienced a large turnover in the project management area;which has prompted senior leadership to investigate.  
• Senior leadership has determined that Project Managers are frustrated with the amount of required documentation, which has impacted their ability to successfully manage projects.  In addition, project budgets are coming in over budget, and projects are being delivered late, also resulting in PMs’ inability to meet performance guidelines. 
• A recent review of the current process has determined that Company A has spent between 30-40% of its total project budget on projects’ overhead costs to include project management costs, which are typically between 20-25%.  Project Management overhead includes the PM’s time to manage the project, attend meetings, and develop the required documentation.   
• Company A has hired your team to create a new project management process to meet the strategic goals and ensure the project meets the financial objectives.
  • Goals of the new process
    • The company must have a view into total life cycle project costs to include what has been spent to date, baseline budget, any changes to the budget, remaining budget, and cost of the project at completion
    • The company must have a view into the project activities to include what has been completed, what is remaining
    • The company must have a view into project status issues, risks, any changes to dates

Project Description

• Company A has been hired to develop an algorithm(s) to combat fake news on the internet .  The contract developed by the company has identified multiple popular platforms that the algorithm must work on to include:
  • Facex
  • Tickbox
  • Application X
  • Application Y
  • Application Z

Assignment

• Identify a project manager.  This individual will ensure that a schedule is created for each item and that team members are completing their assigned work on time.  
• I will act as the sponsor both for the project and for the methodology build-out.  Any questions should be directed to me.

            Part 1. Build a Methodology 

 This below questions need to be answered and write about 750 words

• What process can be used to identify the order of implementation for each of the platforms, which should include rationale?  Look at options like PV, IRR, NPV, Pay Back Period
• Identify and describe any risks you see with the new process. Ensure that you have mitigation strategies included
• Identify and describe the optimum organization layout for your methodology and why. 
• Identify and descripe how life cycle costing will be handled for your methodology
• Identify and describe when project reviews will be conducted

PEER REPLIES Respond to  peer main posts with replies of 100-150 words each, answer the following questions:

• Was the situation described clearly and with enough detail to envision the situation?
• Reflect on the results. Could the situation been handled differently? If so, how?
• Identify areas of Ethos-Logos-Pathos and specify which of the three your peer’s argument relied on most heavily.
• Suggest areas of Ethos-Logos-Pathos that could have been used to make your peer’s argument successful or stronger.
• Have you ever encountered or witnessed a similar situation? How did you handle it?                               BY, Anhelika Covington

I could recall one situation that between my husband and I. My husband loves dogs. He feels as though they are protectors and a mans best friend. While I don’t totally disagree with the statement he made, I am completely afraid of every animal there is. So I wasn’t going for it. I try to keep my distance from animals because I don’t trust them. At all. He says it’s al; about how you train the dog is how it will act. Understandable. But an animal still has a mind of it’s own like us humans. We were raised by our parents a certain way and when we got old enough we didn’t;it always apply what was taught. We didn’t forget it but some of us did it any way, So that’s how I feel about an animal.

We kept this up for a while. The same argument that we needed a dog. I think that puppies are beautiful. However, I am too afraid to have one of our own. My husband told me the benefits of having animal can do. I agree to it in some aspects but my trust level for animals is at an all time low. I don’t want to clean up poop, I’ll be too afraid to wash it, I’ll be afraid to feed it. All these factors played in my head over and over again. The last conversation we had was about a month ago. He promised me I wouldn’t have to do anything when it came to the dog. He assured me of this. The only thing he requested was for me to let the dog dog get use to my scent. I guess so it would get used to me. He convinced me to get the dog dog and so far he has held up to his word.

Now that you have run descriptive statistics with your data, it is time to create a hypothesis and test your hypothesis. This part of the Statistics Project will take you through the process of creating and testing your hypothesis through statistical methods, using Microsoft® Excel®. Creating hypotheses provides you the opportunity to think like a researcher and help you understand and critique research articles you read.

Create a hypothesis for the Happiness and Engagement Dataset from Part 1 of the Statistics Project. Your hypothesis can be anything based on the variables you have in your dataset. One example: Teaching Method X provides higher test scores than Teaching Method Y.

Create a null hypothesis. (Example: Teaching Method X scores are equal to Teaching Method Y scores.)

State your null and alternate hypotheses.

Identify and justify which type of statistical analysis will be appropriate for this data.

Review the steps beginning on pp. 202 in Statistics Plain and Simple describing how to run an independent samples t test.

Run an independent samples t test on the data in your dataset.

Write a 125- to 175-word summary of your interpretation of the results of the t test, and copy and paste your Microsoft® Excel® output below the summary.