NUR 612 Assessment of Neurologic Function Case Study Leah Smith an 87 year old Patient- University of New Hampshire

Assessment of Neurologic Function: Case Study of Leah Smith, an 87-Year-Old Patient

Neurological assessment is a cornerstone of advanced nursing practice, particularly in evaluating geriatric patients who present with cognitive or neuromuscular impairments. In the case of Leah Smith, an 87-year-old patient, a comprehensive assessment is vital to understanding her neurologic status and determining an appropriate plan of care. As part of the NUR 612 curriculum, this case study offers an opportunity to apply theoretical knowledge to clinical practice, reinforcing the skills necessary for accurate diagnosis and management.

Clinical Presentation

Leah Smith arrives at the clinic accompanied by her daughter, who reports progressive forgetfulness, intermittent confusion, and episodes of imbalance over the past six months. The patient’s medical history is significant for hypertension, type 2 diabetes mellitus, and osteoarthritis. Her medication regimen includes metformin, amlodipine, and acetaminophen. She denies recent falls but admits to feeling "unsteady" while walking.

The initial examination is structured using the NUR 612 UAB assessment framework, incorporating cognitive testing, cranial nerve evaluation, and motor function analysis. Given the patient’s advanced age, differential diagnoses include mild cognitive impairment (MCI), Alzheimer’s disease, vascular dementia, and Parkinsonian syndromes.

Neurological Examination

A meticulous neurological assessment follows, focusing on key domains:

1. Mental Status Examination

The Mini-Mental State Examination (MMSE) is administered, yielding a score of 22/30, suggestive of cognitive impairment. Leah demonstrates difficulty with short-term memory recall and attention span. She struggles with serial subtraction but retains basic language comprehension.

2. Cranial Nerve Evaluation

• CN I (Olfactory): The patient correctly identifies coffee and peppermint, indicating an intact olfactory function.

• CN II (Optic): Visual acuity is 20/40 bilaterally; no visual field deficits are noted.

• CN III, IV, VI (Oculomotor, Trochlear, Abducens): Extraocular movements are intact, with no evidence of nystagmus.

• CN VII (Facial): Symmetric facial expressions and preserved taste suggest intact function.

• CN XII (Hypoglossal): No evidence of tongue deviation or fasciculations.

3. Motor System Assessment

Motor strength is graded as 4/5 in the upper extremities and 3/5 in the lower extremities, with mild rigidity noted in the left arm. Deep tendon reflexes are brisk (3+) in the patellar and Achilles tendons bilaterally. A positive Romberg test and slow, shuffling gait raise suspicion of early Parkinsonian changes or sensory ataxia.

4. Sensory Function Testing

Light touch and proprioception are diminished in the lower extremities, possibly indicative of peripheral neuropathy related to her diabetes.

5. Coordination and Gait Analysis

Finger-to-nose and rapid alternating movement tests reveal mild dysmetria. Leah’s gait is hesitant, with reduced arm swing and a tendency toward retropulsion, necessitating further investigation for Parkinson’s disease.

Differential Diagnosis and Diagnostic Workup

Based on the NUR 612 questions and clinical findings, several potential diagnoses emerge:

1. Mild Cognitive Impairment (MCI) vs. Dementia – Further neurocognitive testing, including the Montreal Cognitive Assessment (MoCA) and clock-drawing test, is warranted.

2. Parkinson’s Disease – The presence of bradykinesia, rigidity, and gait disturbances necessitates dopamine transporter imaging (DaTscan) for confirmation.

3. Vascular Dementia – Given her history of hypertension, a magnetic resonance imaging (MRI) scan should be considered to assess for ischemic changes.

4. Diabetic Neuropathy – Electromyography (EMG) and nerve conduction studies may clarify the extent of sensory deficits.

Management Plan

1. Pharmacologic Interventions

If Parkinson’s disease is confirmed, a trial of levodopa-carbidopa may improve motor symptoms. For cognitive impairment, cholinesterase inhibitors (e.g., donepezil) could be beneficial. Blood pressure control remains a priority to mitigate vascular contributions to her cognitive decline.

2. Physical and Occupational Therapy

A referral to physical therapy aims to improve balance and gait mechanics. Occupational therapy may assist with home safety modifications to prevent falls.

3. Lifestyle and Supportive Measures

Leah’s daughter is encouraged to implement cognitive stimulation activities and monitor medication adherence. Dietary modifications, such as increased omega-3 intake, may support brain health.

4. Follow-Up and Monitoring

Regular follow-up is essential to assess disease progression and medication efficacy. The NUR 612 practice test emphasizes ongoing patient education and interdisciplinary collaboration to optimize outcomes.

Case Discussion and Clinical Implications

This case underscores the complexity of neurological assessments in older adults, as cognitive and motor deficits often overlap. The NUR 612 exam 1 emphasizes integrating evidence-based practice with clinical reasoning to differentiate between neurodegenerative conditions. Early identification and intervention remain pivotal in preserving function and quality of life.

By synthesizing theoretical knowledge with real-world application, advanced practice nurses refine their diagnostic acumen, ultimately enhancing patient-centered care. The case of Leah Smith exemplifies the nuanced approach required in geriatric neurology, reinforcing the significance of comprehensive assessments in achieving optimal health outcomes.

Below are sample Questions and Answers:

Neurology CASE STUDY
1. Leah Smith, an 87-year-old patient, is at the clinic receiving an annual physical checkup. The patient
is wearing a sweater, but complains that the room is cold. The thermostat reads 70°F. The patient has
a slow, wide-based gait, and she is flexed forward slightly when she walks. She opens her purse and
tries to find the bottle of herbals she bought to make sure it is alright to take the supplement and has
problems locating it by feeling for the bottle. She states that she is all thumbs. She complains that
food does not smell or taste like she remembered it smelling and tasting 10 years ago. She wonders if
it is because she used to grow her food and that is why it had a better taste and smell. She also stated
that her family is concerned because she does not seem to have enough peripheral vision to drive, and
she wiped out the mailbox yesterday when backing out of the driveway. The nurse performs a
neurologic exam.
a. Explain the changes in the patient’s neurologic function that are related to aging and what risks
the patient has related to age-related changes.
 Changes in the patient’s neurologic function related to aging includes decreased sensory
perception of touch, taste and smell, altered balance and gait, and decreased coordination.
She’s at risk for hyperthermia, falls, malnourishment, difficulty smelling smoke.
b. Because age-related changes have an impact on the neurologic assessment, for what additional
areas should the nurse assess the patient, and what findings reflect normal aging?
 The nurse should also assess the patient for risk factors (trauma, hemorrhage, tumors,
infection, toxicity, metabolic disorders, hypoxic conditions, hypertension, cigarette
smoking, stress, aging process, and chemicals), vision changes due to vision field
changing, memory, hearing, vital signs (blood pressure, respirations, temperature),