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HISTORY: The daughter has noticed increased anxiety and confusion in her mother on several occasions

Read the given information and answer the following questions:

HISTORY:
The daughter has noticed increased anxiety and confusion in her mother on several occasions
No personal or family history of psychological illness
Problems with abstract thinking
Poor or decreased judgment
Disorientation to time and place
Changes in mood and behavior
Changes in personality

FURTHER HISTORY:
No history of trauma or recent infection
Family history; father and brother have died from stroke and heart disease; mother had Alzheimer disease

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Current medications: aspirin, 325 mg. daily; hydrochlorthiazide, 25 mg. bid
No other medical history
No known allergies

Question part 1:
Now what do you think about her history?

PHYSICAL EXAMINATION
Alert, elderly woman in no acute distress
T = 37 C orally; P = 85 and regular, RR = 15 and unlabored; B/P 158/88 right arm (sitting)
HEENT, skin, and neck:
Pupils are small, equal, and react to light sluggishly
Ocular fundus is pale; vessels are narrow and attenuated
Dentures present, buccal and pharyngeal membranes are moist without lesions or exudates
Skin pale, dry with senile lentigines
Skin is transparent with decreased turgor
Minor multiple ecchymosis noted on both forearms, no other lesions or abrasions
Trachea is midline, and no lymphadenopathy or thyromegaly noted
Carotid pulses full and equal bilaterally without bruit
No jugular venous distension
Lungs:
Increased anterior/posterior diameter with mild kyphosis
No shortness of breath, lungs clear to auscultation bilaterally
Cardiac:
Apical pulse (PMI) at the 5th ICS, left mid-clavicular region
Normal S1, S2; no murmurs, clicks, or rubs
Abdomen, Extremities, Neurological:
Abdomen round, symmetric with no apparent masses, hernias, scars, or lesions
Bowel sounds present and normal; no bruits
Tympanic to percussion in all quadrants with no masses or organomegaly
Extremities symmetric with no swelling, atrophy, redness, cyanosis, or skin lesions, warm bilaterally and all pulses present and equal bilaterally
No lymphadenopathy noted
Orientation to time, person, and place are inconsistent—does not know the day or date
Pinprick, light touch, vibration sensation are intact, and able to identify a key
Motor: no atrophy, weakness or tremor; rapid alternating movements smooth
DTR’s all 2 + with no Babinski noted
Musculoskeletal:
Gait slightly wide based and unable to tandem walk
No Romberg
Joints and muscles symmetric; no swelling, masses, deformities, or tenderness
Mild spinal kyphosis
Joints: smooth range of motion; no crepitation or tenderness noted
Extremities: able to maintain flexion and extension against resistance without tenderness

What studies would you initiate now while preparing for intervention?

What therapies would you initiate immediately while awaiting lab work?

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