Date of Completion

May 29, 2020 09:23 AM

George Palo

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Age: 90 years

Diagnosis Adjustment Disorder with

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: Depressed Mood
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Score
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0
1
1
89%
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Feedback Log

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 0:00 Patient

0:00 You checked scene safety. It was correct to check scene safety in order to
maintain your own safety.

0:07 You introduced yourself.

0:38 You washed your hands.

0:45 You identified the patient.

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1:25 You asked the patient: Is it OK for your daughter to be here, while we talk? The

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patient said: Yes. It was correct to let the patient give his consent for letting his

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daughter be a part of the interview.

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1:34 You asked if the patient had any known allergies.
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1:54 You asked the patient: Have you taken your medication?

2:12 The patient said: The medicine is worthless; these pills all look the same.\nYou
answered: Let's take a look at these pills and go over your medications
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together. \nYou used the therapeutic technique of suggesting collaboration.

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2:21 You performed medication reconciliation.

2:41 You assessed the respiration.

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2:53 You checked the pulse oximetry.

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3:10 You checked the radial pulse.

3:23 You measured the blood pressure.

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3:40 You measured the temperature.

3:57 You auscultated the lung sounds.

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4:10 You auscultated the heart sounds.

4:25 You checked the patient's skin.

4:46 You observed the appearance.

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 4:58 You assessed the attention.

5:05 You observed the motor activity.

5:13 You assessed the speech.

5:20 You assessed the thought processes.

5:33 You made a safety check of the surroundings and the patient's belongings.

6:09 You asked the patient: What is your full name? The patient said: My name is
George Palo.

6:20 You asked the patient: Can you tell me a little bit more about what's going on
with you today? It was appropriate to ask the patient what was going on with him
to get an understanding of this.

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6:55 The patient said: Sometimes I'm not sure where I am or what is happening. It

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scares me.\nYou answered: What seems to lead up to those feelings? \nYou used

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the therapeutic technique of placing the event in time or sequence.

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7:14
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You asked the patient: Over the past year, when did you feel your best? It was
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appropriate to ask the patient about when he felt his best.

7:35 The patient said: Max gave me a reason to live and now he's gone too.\nYou
answered: Are you saying you feel hopeless? \nYou used the therapeutic
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technique of translating to feelings.

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7:37 You asked the patient: Do you have any difficulty with your breathing? The
patient said: No.

7:48 You asked the patient: Do you have any pain? The patient said: No, I don't have
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any pain.
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8:06 You asked the patient: Would you like a tray with some food? The patient said:
No.
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8:15 You asked the patient: Have you had any changes in your appetite over the past
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month?

8:40 The patient said: If I try to eat or shower, I get so tired that I give up.\nYou
answered: Physical symptoms are often related to grief. You must miss your wife
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and Max very much. \nYou used the therapeutic technique of giving information.

8:41 You asked the patient: Do you get hungry? The patient said: Not really.

8:48 You asked the patient: How many meals do you eat each day? The patient said:
Maybe three.

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 9:00 You asked the patient: Do you eat between meals? The patient said: No.

9:08 You asked the patient: Have you been eating much less or much more over the
past few weeks?

9:25 The patient said: I'm not hungry and I'm tired all the time.\nYou answered:
Maggie and I are here today. Let's eat our lunch together. \nYou used the
therapeutic technique of offering self.

9:44 You asked the patient: Have you lost or gained weight over the past month? The
patient said: I think I have lost weight, but I don't really weigh myself.

9:56 You asked the patient: Do you notice that your clothes are fitting looser or tighter
than they were a few weeks ago? The patient said: Come to think of it, I did have
to move the notch over in my belt to tighten up my pants.

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10:15 You asked the patient: Tell me about any changes you have had in your sleep

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over the past few weeks? The patient said: I have a hard time falling asleep.

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Sometimes I lay in bed for quite some time staring at the clock before I go to

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sleep, and then I wake up a few times during the night.

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10:48
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You asked the patient: Do you nap during the day? If so, how often and for how
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long? The patient said: No. Sometimes I get tired in my chair, but not really
sleeping.
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11:16 You asked the patient: Do you have nightmares or vivid dreams on a regular
basis? The patient said: No.
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11:39 You asked the patient: Approximately how many hours of sleep do you get each
night? The patient said: I'm not sure
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11:51 You asked the patient: Do you have energy to do the normal activities necessary
to get through the day? The patient said: No, it is not as good as it was, and now I
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don't have Max to nudge me along, so I find myself sitting on that sofa most of
the day.
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12:12 You asked the patient: Do you have energy to do the activities that give you
enjoyment? The patient said: I would like to go take walks like I used to, but I
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don't do it so much anymore.

12:52 You asked the patient: I would like to ask you a series of questions about how
you are feeling to help me better understand how together we can start to plan
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your care. These are questions I ask all of the patients I see. May I ask you these
questions?

13:23 The patient said: Why are you asking me so many questions? There is nothing
wrong with me.\nYou answered: I am the nurse here to check up on you. I have

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 to ask you these questions to complete my assessment. \nYou used the
therapeutic technique of giving information.

13:29 You asked the patient: Do you feel alert to answer questions?

13:47 The patient said: The best times of my life are past.\nYou answered: Are you
suggesting that you feel hopeless? \nYou used the therapeutic technique of
translating to feelings.

13:58 You asked the patient: Please tell me your name. The patient said: George Palo.

14:25 You asked the patient: Can you tell me where we are? The patient said: We are in
my new apartment. I forget the name of the building. They keep telling me but I
can't remember.

14:49 You asked the patient: Please tell me what today's date is. The patient said: It is

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the.... Oh, I am not sure. I think it is the 29th.

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15:05 You asked the patient: How would you describe your mood?

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15:18 The patient said: Anna was my entire life.\nYou answered: I know you miss Anna
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very much. \nYou used the therapeutic technique of accepting.
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15:21 You asked the patient: Have you lost interest in activities that you once enjoyed?
The patient said: I used to love to go hunting, but I couldn't really manage that
over the past few years so I would watch hunting shows on television. At least it
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made me remember what it was like to be back there in the woods. But lately I
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don't even turn the television on.

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15:52 You asked the patient: Name an activity that you enjoy. The patient said: Well,
when my daughter comes over I enjoy that...while she is here.
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16:10 You asked the patient: Can you name the last five American presidents starting
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with Barack Obama and going back? The patient said: No.

16:23 You asked the patient: Can you tell me what you ate for breakfast? The patient
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said: Oh gee, what did I have? I usually have oatmeal and some fruit, but now
that I think about it, I can't remember.
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16:44 You asked the patient: Do you have any thoughts or wishes to harm or kill
yourself? The patient said: Oh no, I wouldn't do that. I would never take my own
life.
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17:01 You asked the patient: Have you ever tried to harm or kill yourself?

17:26 The patient said: Why should I care about myself? I have nothing else to live
for.\nYou answered: Mr. Palo, are you considering hurting yourself? \nYou used

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 the therapeutic technique of seeking information.

17:33 You asked the patient: Do you think it would be better if you were not alive?

17:53 The patient said: It would be easier for everyone if I was not here anymore.\nYou
answered: Mr. Palo, are you considering hurting yourself? \nYou used the
therapeutic technique of seeking information.

18:03 You asked the patient: Can you tell me what a desired outcome of treatment
would be for you? The patient said: No.

18:16 You asked the patient: How do you understand your problems?

18:32 The patient said: You should mind your own business!\nYou answered: Are you
saying that you are feeling frustrated? \nYou used the therapeutic technique of
verbalizing the implied.

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18:37 You asked the patient: Do you ever see or hear things that other people do not?

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The patient said: No.

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18:47 You asked the patient: Do you find that you worry more than others?
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19:04 The patient said: I'm not going to a nursing home, not now and not ever!\nYou
answered: Mr. Palo, my purpose for being here is to complete your assessment.
\nYou used the therapeutic technique of giving information.
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19:05 You asked the patient: Are you frightened of anything? The patient said: No, not
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really.
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19:46 You supported the patient about loss of dog.

20:05 You supported the patient about loss of wife.

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21:18 You supported the patient about leaving home.

21:34 You supported the patient about frustrations.

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22:13 You supported the patient's daughter about visiting dad.

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22:26 You supported the patient's daughter about seeing dad ill.

22:49 You educated about coping.

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23:24 You educated about getting active.

24:00 You educated about home care needs.

24:35 You educated about the difference between grief and depression.

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 25:22 You said: I would like to ask you a few questions and for you to draw a specific
thing, which will help me to better assess you. May I ask you these questions?
The patient said: Yes.

You should have removed potentially dangerous items for the patient.

You should have completed the Mini-Cog© assessment tool.

25:41 You said: Please listen carefully. I am going to say three words that I want you to
repeat back to me now and try to remember. The words are banana, sunrise, chair.
Please say them for me now. The patient said: Banana, sunrise, chair.

26:04 You said: I want you to draw a clock for me. First, put in all of the numbers
where they go. Then, set the hands to ten past eleven. The patient said: Ok.

26:29 You said: What are the three words I asked you to remember? The patient said:

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Banana...chair.... I don't know.

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26:53 You called the community nurse.

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27:15 You referred the patient to a physician.
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It is important to differentiate between depression and neurocognitive disorder.
Sometimes the symptoms of depression can mirror symptoms of neurocognitive
disorder. Depression may also exacerbate some of the behavioral and cognitive
symptoms that accompany neurocognitive disorder, resulting in some instances
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in increased aggression, confusion, problems with sleeping and nutrition, or

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forgetfulness. Changes in speech, inability to reason, or lack of spatial perception

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would be unusual features of depression but could be impairments seen with

neurocognitive disorder. With cases of severe depression, lack of reasoning and
memory may mirror that of neurocognitive disorder; however, with appropriate
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treatment for depression, this feature often reverses, whereas it does not with
neurocognitive disorder.lt;/p>lt;p>The relationship between grief and depression
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is complex, yet the two can be differentiated. Responding to loss of any kind can
precipitate feelings of sadness, changes in sleeping and eating patterns, etc. These
are not unusual symptoms and generally resolve. Grief symptoms that persist
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longer than a few months have likely triggered the onset of a depressive episode.
Patients should then have a more extensive evaluation, as treatment for
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depression and grief can significantly improve outcomes.lt;/p>lt;p>Note that

changes in physical appearance will require the completion of a physical
assessment in addition to assessing mental and cognitive health. The physical
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assessment will inform how severe the mental and cognitive health deficits
are.lt;/p>

You got 89%

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