PNEU: Case Study

Ashleigh Cole (100616145)

Durham College

PNEU-3302-02

Laura Maybury
Case History
Tammy Bleusworth is a 42 year old female, born April 18th, 1975, from Oshawa, Ontario.
Tammy was diagnosed with Alzheimer’s Disease 4 months ago when she booked a doctor’s
appointment, she was worried about her increase in forgetfulness and memory problems.
When Tammy was first examined she scored a 24/30 on the MOCA exam. Tammy has a
supportive husband named Daniel Bleusworth, who is a senior partner in a law firm. Tammy
and Daniel have two teenagers, Hannah is their 15 year old daughter, and Blake, their 17 year
old son. Tammy is elementary school teacher, but after finding an increase in difficulty, Tammy
has made the difficult choice to quit her job to be at home. Tammy currently lives at home with
her family, who have all tried their best to take on more responsibility around the home. Both
of the children are very busy with sports and academics, and family time has been slowly
decreasing, Tammy has been spending more and more time alone, and that has taken a tole on
her mental health, she really wants to find ways to reconnect her family. Tammy has also
always overseen finances in the marriage, and has been finding it very hard to keep up with the
bills, but also refuses to give up that responsibility. Tammy is very motivated to help herself, in
order to be a better mom and wife, her children and husband are working hard to help her and
make sure she is always doing well.

Present Condition
Tammy Disease has continues to progress, and symptoms continue to grow in severity, Tammy
presents with a mild memory loss, which leads to frustration and anger. She has had a decline
in attention span, and can tolerate therapy for no more then 10 minutes. Tammy also is having
an increase challenge in making decisions, she often will not have supper ready when the family
comes home because she couldn’t decide what to make, and those challenges follow through
into shopping, and finances. Daniel (husband) has a concern for safety, Tammy has left the
stove on with food, and forgotten about it, and has also flooded their bathroom when she
forgot she was running herself a bath. Tammy’s recent MOCA test scored 22/30, decreasing 2
points since diagnosis. Tammy is also showing signs of depression and the OT has referred her
to a psychologist for further examination. Tammy is prescribed Razodyne, currently taking
medication (oral pill) twice a day, once with morning meal, and once with evening meal. Tammy
and her doctor have worked to find the correct dosage, since last dosage change 9 weeks ago,
she has shown no side effects (WebMD, 2017). Tammy is currently trying to eat healthy, and is
engaging in light exercise three days a week to keep a healthy body.

WHO- ICF Model

Condition: Alzheimer’s Disease (4-month post diagnoses)
Body Structures: Loss of memory, decrease in emotional regulation, and decreased attention
span, difficulty making decisions.
Activity Limitation: inability to remember day to day activities, difficulty staying focussed on
one task, difficulty in decision making.
Participation restrictions: inability to do job (elementary school teacher), personal financing,
challenge in keeping up with household responsibilities.
Environmental Factors: Great health insurance, high family income.
Personal Factors: University degree, very motivated, supportive family, but they are also busy
during the day, signs of Depression.

What is Alzheimer’s Disease?

Alzheimer’s Disease (AD) is a neurodegenerative disorder characterized by cognitive and
behavioural impairments that interfere with independence and function. Alzheimer’s can range
from mild, moderate, and severe, each increasing in symptoms and severity (Medscape, 2017).
Mild Alzheimer’s can include forgetfulness that is more then usual, slight personality changes,
and taking longer to complete regular tasks, just to name a few key symptoms (Medscape,
2017). Moderate Alzheimer’s is a progression of previous symptoms, along with anger/
irritability, repetitive statements, impulsion, loss of logical thinking, and hallucinations
(Medscape, 2017). Severe Alzheimer’s continues to progress in the severity of symptoms, in
addition to weight loss, seizures, difficulty swallowing, loss of bowel and bladder control, and
increased sleeping (Medscape, 2017). Alzheimer’s Disease is mainly caused by either plaque in
the brain, or tangles (NIH, 2017). beta-amyloid protein is formed by the breakdown of a larger
protein, called amyloid precursor protein, while this is a natural protein in the brain, in the
Alzheimer’s brain, abnormal levels of this protein clump together to form plaques that collect
between neurons and disrupt cell function (NIH, 2017). Neurofibrillary tangles are abnormal
accumulations of a protein called tau that collect inside neurons. TAU binds to, and stabilizes
microtubules, but when someone has Alzheimer’s there is an abnormal chemical change that
cause the tau protein to stick to one another, forming threads to create tangles inside of the
neuron (NIH, 2017). These plaques and tangles tend to occur within a structure of the brain,
known as Hippocampus, this structure is responsible for memory, learning, and emotions, and
when there is plaque build up or tangles in this area, these responsibilities become impaired
(NIH, 2017). Alzheimer’s will later affect areas in the cerebral cortex responsible for language,
reasoning, and social behavior (NIH, 2017). There are many different medications that patients
may be prescribed to assist in their impairments, and lessen the symptoms, but there is no
current cure for the disease. Tammy is currently prescribed Razodyne (galantamine), which is
cholinesterate inhibitor to prevent the breakdown of acetylcholine and delay the progression of
symptoms (WebMD, 2017).

Assistive Devices
The family has stated they are willing to make costly adjustments, and the OT has suggested
some adjustments to improve home safety. First, the OT recommended automatic taps, on
both the sinks and tubs, this way they will automatically turn off after a specific time and will
not overflow (Alzheimer’s Society, 2017). OT has suggested an automatic turn of stove, that
when left on for an extended amount of time will turn off, the OT has also recommended the
use of a timer with the stove, with visual reminders attached to the stove, so when she sets the
timer she will be successful in the kitchen (Alzheimer’s Society, 2017). Another assistive device
the OT has implemented into daily life is the use of a detailed weekly schedule with blocks for
everyday. Daniel and Tammy work through creating the schedule Sunday evenings, and Tammy
has been very diligent in keeping her schedule with her at all times (Alzheimer’s Society, 2017).
The OT has also suggested setting up an automatic billing system, this way the bill will
automatically take the money from the account, which relieves Tammy of the responsibility of
remembering to pay certain bills, on specific days. These new appliances and devices have been
installed successfully, but OT has instructed OTA to have in home therapy session on other
remedial strategies for memory, in hopes that these new safety precautions will not have to be
used, and continue to keep her as independent as possible.

Treatment Session
OTA has in home therapy session with patient, to play Monopoly junior. This game will work on
memory, cognition, decision making, attention span, and money management all in one
activity. OTA is using the junior version because it will be less challenging for the patient. This
game is great because it works on so many component bases skills Tammy is working towards,
but can also be overwhelming, it is crucial not to push Tammy too far, and allow her frequent
breaks. The patient enjoyed the game, and owns her own, so the patient and her family can
play the game together to reconnect and work on her therapeutic goals. The patient was able
to focus on the game for 15 minutes in last session, before getting distracted and frustrated
with her abilities. Tammy found it challenging making the decision on whether she should buy
the building she landed on, or if it wasn’t worth it, when OTA and Tammy have a discussion of
pro’s and con’s, it made the decision easier for her to make. Tammy would get confused and
frustrated when she would have to pay OTA money, because she would forget that when she
landed on the OTA’s land, she had to pay. Overall Tammy has been tolerating treatment well,
and continue same plan for next therapy session, as per OT.

Resources
Here is a list that has been provided to the patient on websites and groups that will help her
and her family gain knowledge and support.

Alzheimer’s Society of Durham Region

http://www.alzheimer.ca/en/durham
Alzheimer’s Society of Ontario
http://findingyourwayontario.ca/living-safely-with-
dementia/?gclid=Cj0KCQiAsK7RBRDzARIsAM2pTZ-qBJMqmj2H2Nb-
5kfLEtJ5bg3aU2wEzLPR70nTUVMuLjtXVt4T7LMaAuerEALw_wcB +

Ontario Shores: Centre for Mental Health Sciences

https://www.ontarioshores.ca/

Murray Alzheimer Research and Education Program (Waterloo University)

https://uwaterloo.ca/murray-alzheimer-research-and-education-program/

Alzheimer's Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
 References

Alzheimer’s Society (2017). Assistive Technology. Retrieved on 12/12/2017, from:

https://www.alzheimers.org.uk/info/20030/staying_independent/30/assistive_technology/4

Medscape (2017). Alzheimer Disease. Retrieved on 12/08/2017, from:

https://emedicine.medscape.com/article/1134817-overview

National Institute of Aging (NIH), (2017). Treatment of Alzheimer’s Disease. Retrieved on

12/11/2017, from: https://www.nia.nih.gov/health/how-alzheimers-disease-treated

WebMD (2017). Drugs and Medication: Razadyne. Retrieved on 12/13/2017, from:

https://www.webmd.com/drugs/2/drug-93285/razadyne-oral/details#side-effects