Case Study: Assessment and Management of Severe Paranoia in an Elderly Patient

Running head: BLOG 1 CASE STUDY
Blog 1: Case Study
Name of the student
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BLOG 1 CASE STUDY
Student name: Renji Roshin, student id :c3309102
Question 1: After reviewing the information available, what other
information needs to be gathered at this point?
The information gathered so far is only the symptomsof the patient Mrs. B. First her vital
signs should be assessed. This includes making documented recording of the patient’s heart
rate, blood pressure, respiratory rate and body temperature. Besides assessing vital signs,
professionals can also conduct urine tests and blood tests. These diagnostic tests can also help
them to know if any certain factors are contributing to such health condition of the patient .
(Vieira et al., 2013). Apart from this, there is not much evidence of Mrs. B’s medical history.
After death of her husband she developed a depressive disorder and had a major episode with
psychotic features. Here more information is needed regarding the type of the disorder she
developed and also detailed description of her episode and exactly the kind of features she
showed are necessary for her disease evaluation and treatment. Therefore, a detailed
description of Mrs. B’s medical history is required. One of the important risk assessments
that professionals can conduct during this time is the completion of the delirium as well as
cognitive screening when such patients are admitted to the centre. Mini-mental State
Examination (MMSE) as well as the Confusion Assessment Method (CAM) can also be
conducted to get a detailed idea about what the patient’s present mental health condition.
(Rosenthal & Kamboh, 2014).
Question 2: What are the important immediate issues?
From the brief assessment it has been found out that Mrs. B is currently suffering from severe
paranoia and she is having visual hallucinations and feeling agitated at all times. She is 85
years old and 2 years ago she was diagnosed with late onset Alzheimer’s type dementia. She
has recurrent delusions and several behavioural disturbances. Even when she was brought to

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BLOG 1 CASE STUDY
Student name: Renji Roshin, student id :c3309102
the emergency department by her son and was examined by the general practitioner or the
GP, she started to accuse the GP of trying to euthanase her. This showed that the patient’s
condition is severely worsening. This is a classic sign of delusion that expressed that Mrs. B
was completely misinterpreting the situation and having false beliefs about the GP who was
just trying to assess her situation (Reitz & Mayeux, 2014). A “Delirium screening” should be
also conducted seeing the recent mental deterioration of the patient. This is because
symptoms of delirium are seen to be present among 15 to 35% of the older patients either
during the time of readmission or within the 3 days of being admitted to the general
hospitals.This behaviour may have resulted from increased stress and anxiety in the patient.
This kind of violent behaviour is quite common in patients with mental disorders like
Schizophrenia, dementia or Alzheimer’s(Lambert et al., 2014). Mostly this type of anger is
triggered by medications containing psychological or some chemical stimulants. Therefore
this is an important issue that needs immediate attention and treatment. The GP was right to
admit her immediately to the emergency department (Langbaum,et al., 2014).
Studies suggest that mental health patients have poor health outcomes in ED. The
services that are provided in ED do not align with their needs of care. (Cervellati et al., 2015).
Therefore, it seems that the patient in the case study might not be benefitted if kept admitted
to the ED. They might harm others or themselves unintentionally out of aggression and
confusion. Therefore, nurses need to conduct risk assessment for self-harm and others to
ensure safety of the patient. They need to undertake clinical reasoning cycle and develop
collaborative care plans ensuring best interventions for her (Reuben et al., 2013).