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Symptom Analysis

Discuss about the Treatment Plan for Medical Directors Association.

The patient is 69 years old and is presented by Korsakoff Syndrome. It is said that she has a history of Hepatic Encephalopathy, Epilepsy, Osteoarthritis and urine incontinent. The nurse should proceed with her investigation to confirm the presence of the syndrome and then provide a treatment plan for her. The following essay would describe the diagnostic tools, assessment of the disorder and treatment plan for the same.

The patient is affected by the Korsakoff syndrome. Before proceeding with the diagnostic tools and describing the procedure of the treatment approach. Under the normal conditions, thiamin plays a very important role especially in the metabolism of glucose and thereby providing energy in the brain. When thiamin gets reduced in amount, it results in an inadequate supply of thiamin to the brain more particularly in the hypothalamus. Hypothalamus mainly regulates the body temperature, growth, appetite and also controls emotional response. Besides, it also controls the pituitary functions like metabolism and also different release of hormones (Oudman et al. 2014). It also harms the neural pathways that mainly take part in the different memory function in the mammalian brain. Therefore, when thiamine deficiency occurs in the brain, energy is not produced and the above mentioned side effects are observed.

The patient was a sufferer form Hepatic Encephalopathy which is an acute disorder that remains intricately associated with liver dysfunction. As the patient had a habit of drinking alcohol much more than the normal rate, it had affected her previous disorders. Chronic alcoholism mainly affects the thiamine uptake and also hampers the utilization of the thiamine. Thereby, the disorder has been the result of alcohol uptake and thereby had caused the patient to suffer a lot (Gerridzen et al., 2016).

In order to explain the correct diagnostic tools, it must be mentioned that diagnosis of the disease is very difficult. I the acute cases, the patient may be noted to develop skin changes with a beefy tongue (Miguel et al., 2016). However this are just symptoms and do not confirm the disorder. Blood count, electrolytes and also liver function tests need to be conducted as diagnostic tools.

In order to explain the various diagnostic tools that may help the identification of the syndrome in the patient would be the serum albumin level. This will help to measure the level of albumin in the blood and will portray whether any sort of protein deficiency is present in the blood or not, that will help to identify her nutritional deficiency. Followed by that, serum albumin test will be conducted that will help to understand the level of B1 vitamin in blood. This can be further confirmed with the enzyme activity test if the patient responds in a low enzyme activity tests, one can understand that the patient has Korsakoff syndrome (Horton et al., 2015).

Diagnostic Tools for Korsakoff Syndrome


As the patient already have history of the hepatic encephalopathy, therefore the concerned person for the diagnosis can easily take chances with the above mentioned diagnostic tools as it is a neurological disorder in the brain occurring to persons with liver damage. Moreover the patient also has history of epilepsy that mainly occurs when the the electrical impulses in the brain are not following the usual rhythm and thereby result in seizures. Therefore alcohol uptake and the associated history of disorders already give us a clue that nutritional deficiency is mainly affecting the brain’s work (Atkins et al., 2015).

The nurse can thereby apply another type of diagnostic tool that will mainly contain the conductance of an electrocardiogram in the absence of vitamin B1 and gain in the presence of the Vitamin B1. While she is conducting this diagnostic test for the patient, the nurse should also ensure that whether the patient had developed any brain lesions due to hepatic encephalopathy. The nurse can also undertake an MRI test that will show shrunken mammaliary bodies as well as other associated changes in the brain if the patient really has Korsakoff syndrome (Steinmetz et al., 2016).

Basically, the diagnosis of the diseases is very difficult because there is no specific test that helps in identification of the diseases individually. These is mainly because the syndrome often gets masked by the  symptoms of other condition common among different patient like those who misuse alcohol both involving intoxication as well as withdrawal and infection and also head injury (Risko et al., 2015). One can see here also that the patient was alcoholic and so her chances to be affected increases.

Often the symptoms that the patient shows can be misunderstood with the symptoms of Alzheimer’s’ dementia. However this dementia is very different from the dementia that occur die to Korsakoff syndrome. Therefore diagnosis of the diseases has often been very difficult and is reported mainly after the death of individual after post mortem. The symptoms that the patient shows like confusion, hallucinations, apathy, communication issues, problems in learning new information and memory impairment. These are also the symptoms of many other types of mental disorders as well which make it very difficult for health care professionals to denote them. Many healthcare professionals utilize different medications for Alzheimer’s and when they are not recovering the patient, then only the professionals can guess about the occurrence of the diseases through the tools that are mentioned above (Svanberg & Evans, 2014).

Therapy for Korsakoff Syndrome


When a nurse suspects the occurrence of the Korsakoff syndrome, she can further confirm her diagnosis by the incorporation of the high dose parenteral thiamin. Parenteral thiamine can itself be associated with a very small risk of anaphylactic reactions but the nurse should only provide this thiamine to the patient where proper resuscitation program would be present. If the patient really has the syndrome then she would inevitably show response of recovery. The ocular abnormality of the patient will recover at a much faster rate like within days to within a week. Ataxia will also respond within a few days only but may take about a month or so to resolve. Improvements will also be observed in the cases of the patient as the acute confusion or delirium that the patient is experiencing may also be resolved within only 1 to two days. The global confusion of the patient will also be seen to resolve and also improve within two to three weeks but may also take about one to three months for complete recovery (Marin – Khan et al., 2015). Therefore, when the patient responses well to the nurse’s intervention of parenteral thiamine, it becomes clear that the patient is indeed responding and the vulnerability of the patient towards.

Once the acute state of confusion that the patient is suffering from has been resolved, the nurse may carry out a particular type of clinical examination in order to be sure that whether any core deficits including physical examination is present or not that will help to ascertain the presence or absence of Symptoms of the disorder. The Mini- Mental State Examination (MMSE) can also help to screen whether any global confusion is present in the Korsakoff patient (Oudman et al., 2014). However researchers have stated that it is an inadequate assessment reading the memory functions. Therefore nurses nowadays also ask various types of supplementary questions in order to ensure and judge the condition of the patients (O’Regan et al., 2016).

As discussed above, the nurse have to thoroughly analyze the history of the the patient before doing any physical examination in order to understand the presence of the Korsakoff syndrome. She should also conduct a number of differential diagnoses in order to confirm her suspected disorder. Red cell transketolase activity usually gets decreased when thiamine deficiency takes place which can bear a signal for the syndrome (Beerens et al., 2014). Pyruvate also can get elevated and the serum thiamine levels will be low. Moreover the patient is already suffering from liver dysfunction and therefore has the hepatic encephalopathy. Therefore the nurse can easily have an idea that the alcohol consumption have been mainly the sole reason for the occurrences and can thereby claim that the patient is suffering from the Korsakoff syndrome.

After the nurse had conducted various diagnoses with the different diagnostic tools mentioned above and made a thorough assessment of the symptoms that the patient is facing along with the complete documental d evaluation of the history of the patient, she may prepare a treatment plan that would help to treat the patient. She should first make sure that the patient is completely avoiding alcohol. If the patient has significant alcohol dependency, she should be given thiamine supplementation. Besides, the nurse should also be sure that she should conduct adequate discharge and follow- up arrangements which are also as much important as the thiamine replacement (Rao, 2014). Proper maintenance of food and diet with adequate presence of all the important vitamins and minerals should also be ensured by the nurses so that she can provide an overall care for the patient.

From the above discussion, one can come to the conclusion that the confirmation of the patient suffering from Korsakoff syndrome is very difficult. The nurse has to go through the history of the patient to make an idea of the occurrence of the diseases. From making an idea about the disorder the nurse should then try to confirm it with different medical tests that will help her to understand whether her assumptions are right. Once she is confirmed after differential diagnosis, she may proceed further and thereby implement her interventions through a detailed treatment plan which will help to cure the patient from her syndromes.

Reference:

Atkins, S., Rackham, K., Acevedo, J., Dowman, J. K., Fowell, A. J., & Aspinall, R. J. (2015). PWE-138 Increasing burden of alcohol related brain injury is disproportionate to hospital admissions with liver disease. Gut, 64(Suppl 1), A273-A273.

Beerens, H. C., Sutcliffe, C., Renom-Guiteras, A., Soto, M. E., Suhonen, R., Zabalegui, A., ... & RightTimePlaceCare Consortium. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. Journal of the American Medical Directors Association, 15(1), 54-61.

Gerridzen, I. J., Moerman?van den Brink, W. G., Depla, M. F., Verschuur, E. M., Veenhuizen, R. B., Wouden, J. C., ... & Joling, K. J. (2016). Prevalence and severity of behavioural symptoms in patients with Korsakoff syndrome and other alcohol?related cognitive disorders: a systematic review. International Journal of Geriatric Psychiatry.

Horton, L., Duffy, T., Hollins Martin, C., & Martin, C. R. (2015). Comprehensive assessment of alcohol?related brain damage (ARBD): gap or chasm in the evidence?. Journal of psychiatric and mental health nursing, 22(1), 3-14.

Martin-Khan, M., Salih, S. A., Rowland, J., Wootton, R., & Gray, L. C. (2015). General practitioners, patients, and care givers support the use of a telegeriatric memory disorder consultation for older adults. Advances in Alzheimer's Disease, 4(01), 1.

Miguel, S., Alvira, M., Farré, M., Risco, E., Cabrera, E., & Zabalegui, A. (2016). Quality of life and associated factors in older people with dementia living in long-term institutional care and home care. European Geriatric Medicine, 7(4), 346-351.

O'Regan, N. A., Maughan, K., Liddy, N., Fitzgerald, J., Adamis, D., Molloy, D. W., ... & Timmons, S. (2016). Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups. International Journal of Geriatric Psychiatry.

Oudman, E., Postma, A., Van der Stigchel, S., Appelhof, B., Wijnia, J. W., & Nijboer, T. C. (2014). The montreal cognitive assessment (MoCA) is superior to the mini mental state examination (MMSE) in detection of Korsakoff’s syndrome. The Clinical Neuropsychologist, 28(7), 1123-1132.

Rao, T. (2014). The role of community nursing in providing integrated care for older people with alcohol misuse. British journal of community nursing, 19(2).

Risco, E., Cabrera, E., Jolley, D., Stephan, A., Karlsson, S., Verbeek, H., ... & RightTimePlaceCare Consortium. (2015). The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: a prospective observational cohort study. International journal of nursing studies, 52(5), 980-987.

Steinmetz, J. P., Theisen-Flies, C., & Federspiel, C. (2016). Views on quality of life differ between alcohol related brain damaged individuals and their healthcare professionals. Applied Research in Quality of Life, 11(1), 239-251.

Svanberg, J., & Evans, J. J. (2014). Impact of SenseCam on memory, identity and mood in Korsakoff's syndrome: A single case experimental design study. Neuropsychological rehabilitation, 24(3-4), 400-418.

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