Darron is a 68-year-old white widower and retired accountant. He was referred for psychosocial evaluation at the diabetes clinic after an emergency room (ER) visit to a local hospital
Darron is a 68-year-old white widower and retired accountant
Case Study: Complex Psychiatric/Medical Adult/Geriatric Patient
Use the template to complete a Psychiatric Initial Assessment on the patient based on the Case Study information. Then complete a plan of care. Lastly, include answers to the questions listed at the bottom of your completed psychiatric initial assessment template.
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Darron is a 68-year-old white widower and retired accountant. He was referred for psychosocial evaluation at the diabetes clinic after an emergency room (ER) visit to a local hospital. He arrived at the ER with confusion and a severe hypoglycemic episode after taking an overdose of insulin. He denied suicidal intent or alcohol abuse and claimed to have mistakenly taken insulin lispro rather than his insulin glargine dose. The ER staff was suspicious about his claim because there had been eight similar ER visits for severe hypoglycemia within the last two years. He explained these previous events as a result of mixing up the types of insulin he injected.
After psychiatric assessment he was not judged to be a suicidal risk. He was discharged after his blood glucose levels stabilized, and he promised to pursue outpatient mental health treatment. His hemoglobin A1c (A1C) at the time was 7.9% – his lowest on record for several years. Generally, his blood glucose levels displayed wide swings. He explained that high blood glucose levels made him feel more apathetic about eating and depressed about his diabetes self-management.
As a child, Darron attained developmental milestones at expected times. His father was in the Army, and as a result, Darron had moved 32 times before he graduated from high school. He was an excellent student throughout high school but only managed mediocre grades in college because of family conflict. He dropped out of college in his junior year and moved to a South Pacific island for one year.
After returning to the United States, he earned an undergraduate degree in English and then a second degree in accounting. After graduation, he married and worked for 20 years as an accountant in a group practice. Later, Darron started his own accounting firm, but he had difficulty keeping organized and recalls being constantly late for business meetings and failing to complete projects on time. In hindsight, Darron believes that he has struggled with depression on and off for > 30 years.
He first recalls feeling depressed after his diagnosis with diabetes 36 years ago. He felt more depressed after he lost his 47-year-old sister to colon cancer in 1988, and then his 74-year-old father died from heart disease in 1991. But, he says his life “really fell apart” when his 54-year-old wife died from lung cancer in 1995. He contemplated suicide for three months but never acted. During this desperate period, he marginally functioned, lost many business clients, and was forced to close his company.
Overwhelmed by depression, he moved to the West Coast to live with his mother and worked at unskilled jobs. Diabetes complicated his emotional struggles, with blood glucose control fluctuating wildly and ranging from episodes of ketoacidosis that required hospitalization to severe hypoglycemic events that resulted in car crashes. Depression complicated his diabetes management, and after a hypoglycemia-related auto accident in which he ran over several pedestrians, he decided to stop working and was approved for social security because of psychiatric disability.
He came to the East Coast in 1998 to briefly visit his younger brother and decided to stay. Although he still lives near his brother, he says they have had only sporadic contact since a falling out after Darron “passed out” during a severe hypoglycemic episode. In 2010, Darron got engaged, but his fiancée left him to marry the father of her child.
He says he felt devastated by the loss of yet another woman who had “become everything” to him. Since then, he has withdrawn socially and does not leave his apartment unless it is necessary. He has trouble managing his money, keeping his apartment neat and orderly, taking medications on time, and maintaining any structure in his day.
Darron punctually arrives at the correct hour but often on the wrong day for his medical appointments. He grapples with neuropathy, retinopathy, and unpredictable blood glucose levels. He monitors his blood glucose levels 8–12 times/day and tries to be careful about what he eats. He also has sleep apnea, and his sleep patterns are highly erratic. He frequently does not fall asleep until 4:00 a.m. and then may only be able to sleep for 2 hours.
Often, he will then nap for several hours in the afternoon. He began continuous positive airway pressure treatment for his sleep problems in 2003 but did not tolerate treatment. He has switched to bilevel positive airway pressure (biPAP) within the last 18 months but only tolerates it for up to 3 hours each night. Additional diagnoses include hyperlipidemia, hypertension, atrial fibrillation, Meniere’s disease, tinnitus, and arthritis. His medication list includes atorvastatin, lisinopril, hydrochlorothiazide, warfarin, meclizine, and folic acid. He does not smoke and only rarely drinks alcohol. Only his paternal grandmother had diabetes.
Depression has plagued Darron since his diagnosis with diabetes. As noted earlier, his depression intensified after the deaths of his sister and father, but he did not descend into a suicidal mood until his wife died 10 years ago. Four years ago, he underwent electroconvulsive therapy (ECT), and although he continues to have occasional suicidal ideation, he has not made an attempt and has had no further psychiatric admissions.
Both of his parents, his brother, and his sister suffered from depression. A maternal aunt suffered from dementia. His mother also struggled with alcohol abuse until her death from emphysema in 2004 at the age of 89. At the time of referral, he was taking fluoxetine, 40 mg, and venlafaxine, 37.5 mg, prescribed by a PMHNP.
- Was Darron’s insulin overdose accidental or a suicide attempt based on clinical decision making you would invoke as a PMHNP?
- What are the causes for his cognitive impairment?
- How does his depression and cognitive problems affect his diabetes self-management?
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Intellectual Milestones for 2-Month-Old Babies
Babies grow and develop at an astonishing pace, and the first few months of their lives are filled with numerous milestones. Among these, intellectual development plays a crucial role in shaping a child’s future abilities. As a parent, it’s essential to understand the intellectual milestones your baby should achieve at each stage. In this article, we’ll explore the intellectual milestones for two-month-old infants, offering insights into their cognitive, motor, emotional, and social development. Let’s dive in!
Welcoming a newborn into your life brings immense joy, and witnessing their growth and development is a remarkable experience. Intellectual milestones, specifically, encompass the cognitive abilities and skills your baby should display at different ages. By understanding these milestones, you can actively support your child’s intellectual growth and create a nurturing environment for their development.
Cognitive Development at Two Months
At two months old, your baby’s sensory abilities continue to expand. They can visually track moving objects and focus on faces with increasing precision. Bright and contrasting colors catch their attention, stimulating their visual senses. Moreover, infants become more responsive to sounds, turning their heads toward voices and becoming alert to various auditory stimuli.
Two-month-old babies start to demonstrate a growing interest in people and their surroundings. They enjoy observing faces and may respond with smiles or coos when engaged in social interactions. Your baby’s brain is actively processing information and making connections with their surroundings, setting the foundation for future social and emotional development.
Early Communication Skills
During this stage, your baby begins to make meaningful vocalizations. They might coo, gurgle, or even respond to your voice by attempting to mimic sounds. While their babbling may not yet resemble words, these early vocalizations are essential building blocks for language development.
Motor Development at Two Months
Gross Motor Skills
At two months, your baby’s motor skills progress steadily. They can hold their head up for brief periods when supported and may display increased control over neck muscles. During tummy time, they can lift their head and chest, building strength in their upper body.
Fine Motor Skills
Though still in the early stages, your baby’s fine motor skills begin to emerge. They may start to swipe at objects within their reach and briefly grasp onto toys or your fingers. Encouraging your baby to explore objects of various shapes and textures helps develop their hand-eye coordination and dexterity.
Emotional and Social Development at Two Months
Attachment and Bonding
Two-month-old babies thrive on the emotional connection they develop with their caregivers. They show an increased preference for familiar faces and enjoy being held, cuddled, and comforted. Your baby may also respond positively to soothing sounds or gentle rocking motions.
As your baby’s emotional awareness expands, they may exhibit a wider range of expressions. They can display happiness, contentment, or frustration, and you may notice them seeking comfort or reassurance when upset. Responding to your baby’s emotional cues helps establish trust and security.
Stimulating Intellectual Development in Two-Month-Olds
Engaging with the Senses
To support your baby’s intellectual development, provide them with a rich sensory environment. Surround them with visually stimulating toys, mobiles, or picture books with high-contrast images. Soft music or soothing sounds can further engage their auditory senses.
Talking and Singing to the Baby
Engage your baby in conversations, even if they don’t understand the words yet. Narrate your daily activities, describe objects you encounter, and sing songs to stimulate language acquisition. The rhythm and melody of your voice captivate their attention and contribute to their cognitive growth.
Playing Interactive Games
Simple games like peek-a-boo or gentle tickling sessions promote your baby’s cognitive development and facilitate bonding. These activities help them understand cause and effect, practice visual tracking, and enhance their motor skills.
Common Concerns and FAQs
What if my baby is not meeting these milestones?
Every baby develops at their own pace, and minor variations in reaching milestones are common. However, if you have concerns about your baby’s intellectual milestones, it’s advisable to consult your pediatrician. They can provide guidance and address any potential developmental issues.
How can I support my baby’s development?
Interacting with your baby, providing a stimulating environment, and offering plenty of love and attention are crucial in supporting their overall development. Talk, play, and engage with them regularly to foster intellectual growth.
Are there any warning signs to look out for?
While variations in development are normal, certain warning signs may indicate potential concerns. These include a lack of eye contact, limited response to sounds or voices, or persistent difficulty with motor skills. If you notice any such signs, consult your healthcare provider for a professional evaluation.
How do I know if my baby is progressing well?
Monitoring your baby’s progress against general milestones is a good starting point. However, remember that each baby develops at their own pace. If your baby demonstrates curiosity, engagement, and responsiveness to their environment, they are likely progressing well.
Should I consult a healthcare professional if I have concerns?
If you have any concerns or questions about your baby’s intellectual milestones, it’s always recommended to consult a healthcare professional. They can provide personalized guidance based on your baby’s unique needs and help address any specific concerns you may have.
The intellectual milestones achieved during the first few months of a baby’s life lay the foundation for their cognitive, emotional, and social growth. By understanding these milestones, you can actively support your baby’s development and create a nurturing environment that stimulates their intellectual potential. Engage with your baby through interactive play, provide sensory stimulation, and foster emotional connections to help them reach their full potential.
- Can I start reading to my two-month-old baby?
- Yes! Reading aloud to your baby, even at this early stage, helps foster a love for language, enhances bonding, and introduces them to new sounds and vocabulary.
- How often should I interact with my baby to promote intellectual development?
- Regular interactions throughout the day, such as talking, singing, and playing, are essential for promoting intellectual development. Aim for frequent engagement while being responsive to your baby’s cues.
- Is it normal for a two-month-old baby to have preferences?
- Yes, it’s normal for babies to have preferences at this stage. They may show preferences for certain toys, sounds, or people. Pay attention to their cues and adapt to their preferences while encouraging exploration.
- What are some signs of an intellectually stimulated baby?
- An intellectually stimulated baby may demonstrate curiosity, engage in their surroundings, exhibit increased alertness and responsiveness, and show interest in exploring their environment through sight, sound, and touch.
- What other activities can I do to enhance my baby’s cognitive growth?
- Activities such as tummy time, offering age-appropriate toys, encouraging reaching and grasping, and providing opportunities for sensory exploration can enhance your baby’s cognitive growth and motor skills.