Medicaid is:
A) funded by payroll taxes?
B) ?funded by the states
C) ?funded by the federal government and the states
D) ?funded by corporations
C
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Does Paul demonstrate other clinically significant symptoms?
DSM Diagnosis 294.11 (F02.81) Major Neurocognitive disorder due to Alzheimer’s disease, Without Behavioral Disturbances, Severe 319.F71 Intellectual Disability- moderate 331.0 Alzheimer’s disease 758.0 Down syndrome V61.8 Sibling relational problem 704.0 Alopecia 562.13 Diverticulosis of colon, unspecified Recent seizure activity V60.0 (Z59.0) Homelessness V61.8 (Z62.891) Rationale Paul qualifies for the diagnosis of Alzheimer’s disease. He has been experiencing memory impairment for more than two years. He has experienced apraxia (difficulty walking and maintaining balance), agnosia (not recognizing objects such as utensils, clothing articles), and disturbances in executive functioning (no longer recalling how to dress self or bathe himself). These cognitive deficits have caused significant decline from his previous level of functioning. There was a gradual onset of these characteristics, and he has experienced continuing cognitive decline. The cognitive deficits are not due to a central nervous system condition, any other known medical condition, or a substance induced condition. They do not occur during the course of delirium or are not better accounted for by another diagnosis. The particular specifiers were chosen because there have been no significant behavior disturbances and the age of onset of the cognitive symptoms was approximately age fifty-four. The diagnosis of an intellectual disability was given prior to entering the current agency system. The agency has no record of his IQ score, but the diagnosis was deemed appropriate during a psychological evaluation performed 13 years ago. Paul had impairments in several adaptive functioning areas prior to onset of dementia, including his home living, use of community resources, academic skills, and work. Paul was further diagnosed with two V codes: homelessness, because his living situation is uncertain once he is discharged; and sibling relational problem because his brother is not in contact with him. Additional Information Required To validate the diagnosis of an intellectual disability the social worker needs to find records that indicate Paul’s tested levels of cognitive functioning. At this time new testing would not be practical because of the dementia. To validate the diagnosis of a Neurocognitive Disorder, Alzheimer’s type, additional medical testing may be necessary. While his onset was slow, he had a few periods of rapid decline in cognitive functioning. The social worker should also talk more with the staff at the nursing home in which he currently lives for additional details about his functioning level. Additional information about Paul’s childhood and his parents’ health would provide clues about what risk and protective influences he was exposed to pertaining to all his current diagnoses. One particular fact that would be helpful to know about is whether his parents smoked or if he was ever exposed to some environmental toxins, since these are risk influences for Alzheimer’s disease. Risk and Resilience Assessment Onset Biological risk influences for the onset of Paul’s dementia include his having Down’s syndrome and a probable small stroke in adulthood. Psychological risk influences include his history of depression. Socially, he has come from a background of low socio-economic and educational status. Protective influences for Paul's dementia include his male gender, European-American cultural background, lack of history of smoking, steady pattern of exercise, and his generally low-fat, high-vitamin diet. Alzheimer’s disease has an unremitting downward course, although the speed of Paul’s decline is likely influenced by its early onset (before age 60). Protective mechanisms include his regular exercise, use of medications to combat the cognitive decline, good communication skills, and positive attitudes. Regarding the course of his intellectual disability, Paul has developed adequate coping skills, lived in an environment for most of his life that concentrated on the principles of empowerment, normalization, and independence, and received skills training in independent living and employment. Treatment The primary treatment strategy for Paul should be to focus on promoting his safety, comfort, and productivity for as long as possible. As previously stated, many measures have already been put in place to assure this, particularly in regards to ensuring his safety. To keep him comfortable, the staff should surround him with items that are familiar to him. Recently, they were able to move some of the furniture from his old room, as well as some photographs and paintings, into his room at the nursing home. Paul should also be helped to live as enriching a life as possible. Keeping him involved in physical and cognition-stimulating activities can help toward that end (Bharani & Snowden, 2005). The nursing home does have group outings twice a week, many times to places that Paul enjoys, and he should be encouraged to join in on such activities. Visits from friends who get him engaged in conversation will also be beneficial. To keep him productive, Paul should return to some type of structured day program. His guardian has been looking into job or day program placements that might fit his needs for constructive and pleasurable activities. Paul should be encouraged to do as much for himself as he can. Since he has shown evidence of forgetting how to perform many self-care tasks, his caretakers can work on skills training with him. Even if such skills reviews work only on a short-term basis, staff can jog his memory by using them again the next day. Paul should also be encouraged to participate in recreational and art therapies since these provide both cognitive stimulation and leisure opportunities to him. Another essential part of Paul’s treatment is to ensure that he is linked with appropriate doctors and other medical personnel. He needs to be on anti-seizure medication, but this should be routinely monitored to ensure he does not build up toxic levels again. He should also be in contact with a dietician to ensure he is getting enough nutrients since he no longer eats solid food. His caretakers also need to remain aware of available sources of support. They should continue looking into the least restrictive living environment possible. They should also contact his insurance companies to see what services they cover. The guardian might be able to hire a home health aide to work with him a few hours a day. Lastly, Paul's caretakers need to be educated on how to work with a person who has both mental retardation and Alzheimer’s disease, so that they can preserve their own well-being and be appropriately supportive of him (Burns, Nichols, Martindale-Adams, Graney, & Lumus, 2003). Since people are unsure what abilities he has developed throughout his life, Paul is often treated differently than other Alzheimer’s patients. Since he has no family members involved in his life, his friends can be helped to advocate for him when necessary. Since Alzheimer’s is a progressive disease, Paul’s needs will most likely change over time and he will become less able to speak up for himself. Critical Perspective While it seems clear that Paul has dementia, there are some current issues related to the course of his disorder. Since he has an intellectual disability, many of his early symptoms might have been overlooked; he may have been suffering from this disease longer than the people around him thought. This might be why the medication Aricept did not seem to stabilize his condition, even temporarily. Paul actually began to decline rapidly after its introduction and some staff are concerned that it was actually the trigger to his rapid decline. This process may be a coincidence, but having such a sudden and extreme loss of cognition and abilities could be a sign of a different form of dementia, since Alzheimer’s disease features a gradual process. Some tests were done, like checking for a stroke, but there are numerous conditions mentioned in the DSM that can trigger Vascular Dementia. Since he had Down’s syndrome, which is considered a considerable risk mechanism for Alzheimer’s disease, the assumption was made that he had Alzheimer’s.
Even if you have already revised your research report and are satisfied with it, you should ask your colleagues to read it and criticize it - and then, based on their criticism, you should revise it yet again
Indicate whether the statement is true or false
In general, as sample size increases A) sampling error increases
B)sampling error decreases.? C)sampling error will remain the same regardless of changes in sample size.? D) measurement error decreases.
The term __________________refers to any situation in which a board member (or staff) is influenced in an organizational decision by personal or financial concerns unrelated to the organization’s best interests.
A) unduly influenced B) persuasion C) conflict of interest D) private inurement