MODULE 14:
ANATOMY & PHYSIOLOGY
CASE STUDY #4
Nervous System
INSTRUCTOR’S GUIDE Case Study
PLANNING NOTES: (1) Teams: 4 students; (2) Length: Approx. 3 classes (Day 1: Subjec>ve, Objec>ve, & Pre-­‐Assess ques>ons: Day 2: Research & Assessment; Day 3: Plan & WriKen Report (3) Resources Needed: Computers for research; Copies of student workbook
Professor Daniels’ Case: Misplaced Memories
DIAGNOSIS: Alzeheimer’s Disease (stage 3 -­‐ mild cogni1ve decline)
OVERVIEW:
Professor Daniels is experiencing some troubling changes in his personality and
memory. His wife, Mrs. Daniels, is quite distraught. When he runs a stop sign near
their home and nearly hits a person walking a dog, his wife realizes it is time to
take him to get evaluated by the doctor.
SOAP Note: If students have NOT done modules/case studies using the SOAP method, GOALS: some prep is required (sugges>on: 2-­‐3 class periods. See SOAP resource lessons).
1. Determine a diagnosis from subjective & objective information.
2. Create an aligned, thoughtful, and evidence-based plan.
ROLE:
You are Professor Daniels’ family doctor;
he has been your patient for 15 years.
OBJECTIVE:
Obj. 14.4: Identify the structures,
functions, and pathophysiology of the
nervous system.
DELIVERABLE:
1) SOAP Note
2) Pre-Assessment Questions
3) Written Statement of Health
Standards: WHST.11-­‐12.2: Provide a concluding statement or sec>on that follows from or supports the argument presented.
WHST.11-­‐12.7: Conduct short as well as more sustained research projects to answer a ques>on (including a self-­‐generated ques>on) or solve a problem; narrow or broaden the inquiry when appropriate; synthesize mul>ple sources on the subject, demonstra>ng understanding of the subject under inves>ga>on.
WHST.11-­‐12.9: Draw evidence from informa>onal texts to support analysis, reflec>on, and research.
ASSESSMENT CRITERIA:
Assessment: 1) clear, accurate, and
precise diagnosis (claim); 2) supporting
subjective and objective data
(evidence); 3) logical reasoning and
explanation (warrant)
Plan: 1) comprehensive (includes physical, social & mental health); 2) aligned to
facts of the case; 3) evidence-based; 4) addresses short- & long-term
Note on use of case studies: These case studies are designed to be used as an introduc>on to a body system in an A&P course OR as a supplement &/or authen>c assessment tool to the middle or end of unit. The case studies are compa>ble with any other A&P curricula & reference online resources so that no formal text or other curricular source is required. They can also be used in a shorter “survey”/case-­‐based course of A&P to give students a preview of applica>ons for A&P, while engaging & ”hooking” them on A&P! :)
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MODULE
UNIT 1: MENTAL
14: ANATOMY
HEALTH & PHYSIOLOGY
Case Study Steps:
CASE STUDY #4: NERVOUS
LESSON
SYSTEM
1.1
Steps: The independence students have in proceeding through the case study should be determined based on a variety of factors, including experience doing similar case studies in the past, grade level, etc. This case study could be completely independent, except for providing students with required lab tests & vitals in step #6. Students won’t have a chance to ask addi>onal ques>ons in this case study, so they will have to solve with the informa>on given. _____ 1. Review the coversheet. Assign team roles. Discuss what how
you will carry out these roles to make an effective team.
_____ 2. Review Mrs. Daniels’ phone call explaining Professor Daniels’
symptoms. Add information to SOAP note.
_____ 3. Review Mr. Daniels’ narrative account in the physicians’
office. Add information to SOAP note.
_____ 4. Review Mrs. Daniels’ notes. Add information to SOAP note.
_____ 5. Complete the Pre-Assessment Guiding Questions Write out
your SOAP.
_____ 6. Research information on a diagnosis and treatment plan.
Request vital signs & 1-2 tests/labs. Be sure you can provide evidence
& rationale for needing tests or labs!
_____ 7. Formulate diagnosis & treatment plan in SOAP note.
_____ 8. Write a Statement of Health
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MODULE
UNIT 1: MENTAL
14: ANATOMY
HEALTH & PHYSIOLOGY
CASE STUDY #4: NERVOUS
LESSON
SYSTEM
1.1
Mrs. Daniels’ Phone Call:
Transcript:
IDEA: Consider having an actor (student, teacher, fellow colleague, administra>on, parent, alum, act as Mrs. Daniels & Professor Daniels & read their por>ons of the script.
“My husband is a patient, and he retired from his work as a
professor a few years ago. Since then, I’ve notice that he just
doesn’t seem as sharp as he used to. But recently, in the past 3-4
months it has gotten much worse. He forgets things I just told him
a few moments ago, he gets angry at nice people when we go
out to eat or go shopping, and he is starting to become a very
awful driver. Yesterday, he blew through a stop sign that is two
blocks away from our home. He knows that stop sign like the
back of his hand. He almost hit a poor dog that was walking
ahead of one of our neighbors. I’m afraid that someone is going
to report his driving. And I certainly won’t let him drive our
grandkids anymore. I keep making excuses because I’m afraid
to tell him the truth about his driving--he won’t understand and
will just get angry at me. One last thing: he has stopped doing
his crossword puzzles and no longer wants to play Scrabble with
me. He has been getting worse at these games lately, but now
he has just given up out of frustration, and, I think,
embarrassment. I just don’t know what to do. I want the doctor
to put into writing what he thinks is happening to my poor
husband. I just can’t hide what is going on anymore.”
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MODULE 14: ANATOMY & PHYSIOLOGY
CASE STUDY #4: NERVOUS SYSTEM
Mr. Daniels’ Narrative Account:
Transcript:
Doctor: “Your wife seems concerned by your behavior lately.
Can you explain what has been going on?”
Professor Daniels: “My wife is becoming an old worry wart. She is
always reading the Reader’s Digest and a few years ago she
read this article on Alzheimer’s Disease. She has been talking
about it non-stop ever since. And she over-analyzes every little
thing I do. I can’t forget or misplace a single thing without her
giving me a huge lecture about watching for signs of
Alzheimer’s. It’s true I’ve become a bit more forgetful over time.
I seem to have trouble listening to my wife these days...but I
think that’s what 56 years of marriage does to anyone. She’s just
an old worry wart, that’s all.”
Doctor: “How has driving been for you lately?”
Professor Daniels: “Well, I’m sure she told you about the stop
sign I ran. I was totally distracted by her, and just messed up. She
was rambling on about how we need to start thinking about
selling the house because it’s just too large and most of our
children and grandkids have moved away. But we’ve lived in
that house for... 17... no, 23...whatever, lots of years anyway. I’m
not ready to just up and sell it. Anyway, she shouldn’t get all
argumentative when I’m driving. Anyone would have gotten
distracted.”
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MODULE 14: ANATOMY & PHYSIOLOGY
CASE STUDY #4: NERVOUS SYSTEM
Mrs. Daniels’ Notes:
Mrs. Daniels recorded notes over the past few weeks to
document examples of changes she has noticed in Professor
Daniels.
8/24: I suggested we play a short game of Scrabble. He replied:
“Darn it, you are always trying to get me to play that game. You
just want to test my math don’t you. Your stupid theories about
that Old Timers Disease have got to end, HEAR ME!?
9/4: He spent 45 minutes looking for the lawnmower. He tore up
the shed and garage and then swore that someone stole it. He
even tried to make me call the police to report the theft. The
next day, I found it behind the shed. For some reason he left it
there last time he mowed the lawn.
9/5: When I suggested we finally hire someone to do the lawn,
he said, “What? Pay $3 a week for something I can do myself!?”
I said, “$3!? What is this--1960? We would have to pay at least
$20.” He replied, “$20... you are out of your mind?” He has been
forgetting how much things cost lately.
9/12: I asked him if he remembered whose birthday it was. (It
was our youngest granddaughter’s 2nd birthday. He said, “Why
are you always testing me? I don’t keep track of these kinds of
things.” When I told him it was Evie’s birthday he gave me a
blank stare as if he couldn’t figure out who I was talking about.
Then he thought I meant our church friend, Eve. I eventually
showed him a picture on our refrigerator and that helped him
remember.
9/18: We were talking about the house and I was trying to
explain all the reasons we should think about selling it. He started
yelling at me, so I stopped. A few minutes later, he ran a stop
sign right near our house. He almost ran over a dog! I’m sure I
distracted him, but it was like he totally never realized there was
a stop sign there. Afterward he even said, “since when did they
decide that is a place for a stop sign!?” It’s been there for over
20 years!
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SOAP K
EY:ANATOMY & PHYSIOLOGY
MODULE
14:
PURPLE = Info given in case
GREEN = vital signs
ORANGE = possible lab/test results
CASE STUDY #4: NERVOUS SYSTEM
THOROUGHNESS: Remind students to be thorough when documen>ng the details in the SOAP note. Even if a detail seems irrelevant, it may be important later. Simultaneously, encourage them to be Forge_ulness; emo>onal personality changes (anger); isplacing bjects succinct & M
concise in otheir notes.
with difficulty re-­‐tracing steps; forget occasional names
Professor; re>red 3 years ago; married 56 yrs; changes in habits (e.g., crosswords & Scrabble); driving has become dangerous; resis>ng change (e.g., selling house); irritable & argumenta>ve; mispercep>on of current norms (e.g. money-­‐-­‐cost of lawn care); forge_ulness about longer-­‐term details (e.g., stop sign); seems defensive & possibly embarrassed
Symptoms began at mild level a few years ago; began to worsen 3-­‐4 months ago
79 years old; 5’11”; 166 lbs
HR: 92; RR: 16; BP: 140/90; Temp: 98.7 deg F -­‐-­‐Brain scan (MRI, fMRI, etc.) shows no bleeding in the brain or evidence of stroke)
-­‐-­‐Folstein mini mental state exam (30 pt test to screen for cogni>ve impairment): Score = 22 (See wikipedia.org/wiki/Mini–mental_state_examina>on for scale)
-­‐-­‐Reflexes, eye movements, coordina>on, speech and sensa>on all normal for a person his age
-­‐-­‐Other tests: instructor can determine appropriate results with simple online research
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PURPOSE: These ques>ons will help learners connect the case study pa>ent scenario with the structure, func>on & pathophysiology of the skin system. MODULE 14: ANATOMY & PHYSIOLOGY
CASE STUDY #4: NERVOUS SYSTEM
USE OF THESE QUESTIONS: The amount of >me students need to research answers to these ques>ons will depend on the concurrent or previous level of instruc>on/pre-­‐reading about the skin system.
Pre-Assessment Questions:
1. What is a neuron? Describe it’s parts and draw a simple picture labeling them.
Suggested sources:
hKp://kidshealth.org/kid/htbw/brain.html
hKp://en.wikipedia.org/wiki/Neuron
2. What might be occurring in Professor Daniels’ brain?
Suggested sources:
hKp://www.nia.nih.gov/alzheimers/publica>on/part-­‐1-­‐basics-­‐healthy-­‐brain/
changing-­‐brain-­‐healthy-­‐aging
hKp://www.psychologytoday.com/blog/memory-­‐medic/201211/what-­‐
happens-­‐the-­‐aging-­‐brain
3. What are the main functions of the nervous system? Which functions are causing
Professor Daniels problems?
“As the most complex system, the nervous system serves as the body control center and communica>ons electrical-­‐chemical wiring network. As a key homeosta>c regulatory and coordina>ng system, it detects, interprets, and responds to changes in internal and external condi>ons. The nervous system integrates countless bits of informa>on and generates appropriate reac>ons by sending electrochemical impulses through nerves to effector organs such as muscles and glands. The brain and spinal cord are the central nervous system (CNS); the connec>ng nerve processes to effectors and receptors serve as the peripheral nervous system (PNS). Special sense receptors provide for taste, smell, sight, hearing, and balance. Nerves carry all messages exchanged between the CNS and the rest of the body.” (Source: hKp://www.pennmedicine.org/health_info/body_guide/recext/html/
4. What is the difference between the central and peripheral nervous system?
Autonomic & somatic? Sympathetic & parasympathetic?
Suggested source:
hKps://faculty.washington.edu/chudler/nsdivide.html
5. How is a nerve impulse conducted? Describe the process? Might there be any
problem in the conduction of Professor Daniels nerve impulses?
Suggested source:
hKps://highered.mcgraw-­‐hill.com/sites/0072495855/student_view0/chapter14/
anima>on__the_nerve_impulse.html
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MODULE 14: ANATOMY & PHYSIOLOGY
CASE STUDY #4: NERVOUS SYSTEM
Research:
Team Member
Research
Focus
Notes from Team Member
Labs/Tests Requested (explain reasoning, expected results, & actual results for each!)
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MODULE 14: ANATOMY & PHYSIOLOGY
CASE STUDY #4: NERVOUS SYSTEM
Professor Daniels’, age 79, is experiencing mild cogni>ve impairment, including forgehulness, confusion, and emo>onal changes, along with changes in ability to perform daily tasks including driving.
1) Stroke
2) Brain aneurysm
3) Concussion
4) Vascular demen>a
5) Parkinson’s disease
6) Hun>ngton’s Disease
7) Alzheimer’s Disease
Alzheimer’s Disease (Stage 3 -­‐ Mild Cogni>ve Decline)
-­‐Folstein Mini-­‐Mental State Exam: score:22
-­‐Comprehensive evalua>on of symptoms
-­‐Absence of other explana>ons (no bleeding or blood clot in brain)
See source: hKp://www.alz.org/alzheimers_disease_treatments.asp
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MODULE 14: ANATOMY & PHYSIOLOGY
CASE STUDY #4: NERVOUS SYSTEM
STATEMENT OF HEALTH: Written Presentation of Patient
Often, physicians are asked to provide a written statement of health for patients
for various reasons. In this case, Professor Daniels’ wife is requesting it as a formal
way to understand what her husband is going through, as well as a document to
use if she should need to try to have his drivers’ license legally revoked or
eventually get help in the home or an assisted living facility for him.
Draft a professional letter that includes the following information:
• Diagnosis and explanation
• Treatment plan
• Prognosis and expected outcomes
• Recommendations for future care
• Restrictions, if any
Outline of Statement of Health:
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