Clinical Vignette Discussion Questions
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School
University of Illinois, Urbana Champaign *
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Course
100
Subject
Medicine
Date
Dec 6, 2023
Type
Pages
2
Uploaded by KidBisonMaster413
As this was written by a physician, there may be more of a medicine taste in your mouth after this case
study. But don't get bogged down with the medicine. The intention is to focus on an older patient
residing on the "edge of independence" and how the care team and the caregivers assess, treat, and
respond to the patient. This could easily become a huge discussion involving ethical, medical, and
psychosocial issues, systems of care delivery, payer and insurance concerns, and so on. I hope that we
can fold these broader issues into a focused discussion about this particular case and practical
approaches to it.
This is a true clinical vignette closely resembling a patient this physician has known for several years. I
think that the case raises a number of questions, and I encourage you to ask your own questions, reflect
on those below, and respond as a group.
As you read through the clinical vignette, consider the following questions:
Riya Patel, Nilima Patel, Jashanti Scott, Jordan Smith
1. What are basic activities of daily living? Instrumental activities?
Basic activities of daily living are self-care activities that Marianne is able to do by herself. These
activities include bathing, using the bathroom, washing her hands, etc. Instrumental activities are
activities that Marianna might need some assistance with. Instrumental activities could include cleaning,
cooking, booking doctor’s appointments.
2. Do you think Marianne (the patient) is in a safe environment? Why or why not?
I do not believe Marianne is an unsafe environment because it was mentioned that Carrie leaves
Marianne home for long periods of time. The hospice nurse has explained that Marianna should not be
left home alone for any amount of time. When Carrie had left Marianne alone, the nurse noticed her
breath smelled of alcohol as well, implying that Carrie goes out to drink while her mother is left home
alone. Although Marianne may be in a comfortable environment, I do not believe that it is safe.
3. How would you assess Marianne's safety and her functional abilities? Are there tools that could help
you? What disciplines might you involve in her evaluation and care?
One way I would assess Marianne’s safety and her functional abilities is by monitoring her weight
regularly. Marianna had lost a significant amount of weight in a short amount of time, and it would be
unsafe for her to lose any more weight than she already has. Her weight loss could continue to be
evaluated by tools like blood tests, CT scans, and swallowing studies as mentioned in the clinical
vignette. The amount of time she is left alone in the house without Carrie should also be monitored
because it was mentioned that the amount of time, she was left alone was unknown. The disciplines I
would involve in her evolution and care would include clinical psychology, physical therapy, medicine,
and nutrition because those are the primary areas concerning her health at the moment. Some sort of
cognitive test should also be given to Marianne to assess her cognitive abilities.
4. Specifically- from the field you plan to go into – what would you be addressing in the care of
Marianne AND her daughter.
What resources would you use?
The field I plan to go into is Medicine, so I would be addressing the diagnosis and development of
Marianne’s Alzheimer’s disease and dementia. I would also address Marianne’s diagnosis of multiple
sclerosis and her functional abilities. It would be important to take into consideration both of their
medical histories and how they impact their current conditions. Marianne has a variety of medical
problems including osteoporosis, anemia, hyperextension, etc. that could be affecting her abilities and
health as well. I would use resources like the aid of other healthcare workers in different disciplines that
could analyze both Marianne and Carrie’s cognitive abilities. This could give a better idea about what
type of care and supervision would be best for Marianne.
5. Is Marianne able to function independently? What evidence leads you to your conclusion?
Marianne is not able to function independently. One thing that makes me believe she is unable to
function independently is when Carrie was sick, the hospice nurse mentioned that Marianne should not
be left alone for any amount of time. Additionally, when Marianne was hospitalized, she had been going
into other patient’s rooms and yelling, which is a clear sign she is not in the condition to be left alone.
Marianne has also been losing an extreme amount of weight, meaning she likely doesn’t know or care to
properly take care of herself.
6. How would you differentiate the terms elderly, frail, disabled, and aging successfully? How do these
terms apply to Marianne?
I believe the term elderly typically refers to induvial that are over the age of 65. Frail would describe a
person who is weak or vulnerable. Disabled refers to an induvial who has a limited ability to use their
senses or participate in activities. Aging is the process of growing old. Marianne is 86 years old, meaning
she would be considered an elder. Because she is growing older, she would be considered to be aging as
well. She is also frail due to her large number of medical conditions and weight loss. She is also disabled
because she has lost a lot of the abilities that she used to have.
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