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Mount Sinai Standardized Patient Exercise

By Chris Wood,2014-06-23 08:15
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Mount Sinai Standardized Patient Exercise

Mount Sinai Standardized Patient Exercise

Sarah Datford- Background Information for Standardized Patient

Age: 73

Marital Status: Widowed for 8 years

    Social History: My husband Frank, has been dead for a long time; he just died in his sleep one night. Frank taught French at New York University up until the time he died. He was 74 when he died. He got pneumonia and just never got better. Frank’s heart wasn’t really very strong either. But Frank did not like doctors and wouldn’t talk to anyone about it. Frank and

    I couldn’t have children, so now my only family is my nephew, Mark, who lives in San

    Bernardino, California, with his wife and children. I wish I heard from them more often.

    I live by myself in a one-bedroom apartment by Washington Square. Frank and I moved into it right after he got the teaching job at NYU and liked the apartment so much we decided to stay.

I get money from Frank’s pension and, of course, I have my Social Security. I do fine if I

    pinch my pennies. My good friend, Ruth, lives close by. She arranged for my Social Security checks to go right to my bank. She’ll cash a check for me or sometimes we’ll go to the bank together. I take a little out each week for groceries. Ruth has been paying my rent and utility bills for me because once I forgot to pay my bill and the phone company disconnected my phone! Ruth says it’s easy -- she just pays hers and mine at the same time. She’s a good

    friend.

    Ruth is always dropping by. I guess to make sure that I am OK. That’s nice, isn’t it? Sometimes we have lunch together. I eat all my meals at home. I still cook and clean for myself- I do not have any problems with that yet. I do not eat anything fancy, just some cereal in the morning and some meat or chicken and potatoes for lunch. I usually just have soup and maybe half a sandwich for dinner (I like to have my big meals in the middle of the day). I like to watch TV while I have dinner. I’ve been eating the same foods for years; I have not lost any weight and I do not usually skip a meal or forget to eat.

    I also read quite a bit. I used to love to go to all the museums and the library but, you know, I don’t anymore. I am afraid I might forget where I was or how to get home.

    I worked as a monitor at IS 44 until about a year ago. They asked me to retire. I think it was because they thought the work was too much for me.

History of Present Illness: Some time ago, I found myself on a bus and couldn’t remember

    where I was going or why I was on the bus or even what bus it was. So I just got off somewhere and called Ruth. She makes me carry her phone number in my purse. She asked me to read the street signs at the corner where I was calling her from and told me to stay put. She got there in about 15 minutes and took me back home. I have not taken the bus anywhere since.

Grocery shopping and clothes shopping aren’t so much fun anymore. I get so mixed up with

    money sometimes! The nice lady who works at the grocery will help me out, but it’s hard. Sometimes, I forget what I went to the store for. I’ll stand there and think, but it doesn’t help. I just go back home without buying anything.

Family History: My dad died at 70 in a nursing home. The doctor said he’d become senile

    and that was about 3 years before he died. I mean, I guess I don’t really know what senile means, but I think it means forgetfulness and maybe being childish. My mom died in a car accident a long time ago.

Habits: Rx Medications: None

Over the counter: Occasional Milk of Magnesia

Diet: Eats three simple meals a day

Exercise: She doesn’t really go anywhere since she got lost

Caffeine: A cup of tea in the morning with her breakfast

Allergies: None

Notes for Standardized Patient: Sarah is in the early stages of Alzheimer’s. Her long-term

    memory is OK but she has difficulty with short-term memory. She knows she is at the doctor’s office, but won’t remember the specific name of the hospital. Her attention will drift

    if you don’t keep her engaged, or if there is a significant pause in the conversation.

Regarding the Mental Status Tests the students should do:

    1. Spell “world.” Sarah can spell the word forwards, but if asked, is unable to spell it

    backwards.

    2. Remember three objects: The student will give Sarah three objects to remember saying

    the word and then having Sarah repeat it immediately afterward. The student should then

    talk about something else for a few minutes and then come back to the three items. Sarah

    will not remember them.

    3. Perform a specific task: The student may ask Sarah to take a piece of paper, write her

    name on it, fold it in half and place it on the floor. Sarah can do the first step and then

    will forget the next steps and hand the paper back to the student.

    Financial Situation: The following financial information is as factual as possible given Sarah’s husband’s work history. He would most likely have been tenured and have been making between $60,000 and $70,000 a year at the time of his retirement. Since Ruth has been taking care of Sarah’s finances for some time, Sarah most likely won’t remember what her monthly income is. Since the bus episode, Sarah doesn’t feel safe going anywhere and, thus, has developed a simple lifestyle. Overtime, she began to believe it’s based on necessity.

Monthly Income:

    Combined Social Security and Pension: ……………………………………… $3,167.00

Monthly Expenses:

    Rent (rent stabilized)……………………………………………………………… $450.00 Utilities and phone………………………………………………………………… $90.00 Food…………………………………………………………………………………. $300.00

    Total Expenses………………………………………………………………………$840.00

Sarah DatfordPresenting Situation

    Sarah Datford, a 73-year-old woman, comes to The Mount Sinai Geriatrics Clinic complaining of memory problems.

Vital Signs:

     Temperature: 98.4 oral

     Pulse: 76

     Blood Pressure: 142/84

     Respiratory Rate: 16

Read the following instructions carefully:

    1. You have a maximum of 20 minutes to perform a focused history on this patient. 2. After you have finished your interview, please go to the proctor for the questionnaire

    pertaining to this patient.

    3. Take any notes you think necessary.

    4. Leave this file at the door when finished with the patient.

    5. Discuss the case with your team.

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