keith rn dementia case study

Are your students developing clinical judgment to prepare for practice?

Research shows most new graduate nurses are not practice-ready.¹

Case studies are an effective teaching strategy² and used most often³ to practice clinical judgment skills in nursing education, but not all case studies are created equal.

Request Demo

Why KeithRN® Case Studies?

KeithRN Clinical Reasoning Case Studies integrate educational best-practices with scenarios derived from real life that develop clinical judgment skills needed for safe practice and NextGen NCLEX®.

10 Reasons Your Program Should Use KeithRN Case Studies

KeithRN Clinical Reasoning Case Studies

Other Case Studies

New KeithRN Clinical Judgment Rubric

Score students' performance on KeithRN Clinical Reasoning Case Studies with the KeithRN Clinical Judgment Rubric, a powerful tool that quantitatively measures and assesses students’ clinical judgment skills. By using the rubric throughout the program, you can gain valuable insights into students' progress over time.

Case Study Levels

Access three different levels of KeithRN Clinical Reasoning Case Studies: NextGen, Skinny, and Unfolding.

See All Case Study Topics

KeithRN’s Think Like a Nurse Membership

Access exclusive active learning resources for faculty and students, including KeithRN Case Studies, making it your go-to resource.

Faculty and Student Outcomes

Make learning active

Transform teaching

Apply knowledge to practice

Practice clinical judgment skills

Prepare to transition to practice

EXCLUSIVE FACULTY MEMBER BENEFITS

Access time saving tools to make learning active.

• More than 100 clinical reasoning case study topics derived from practice.
• Cases evolve from simple to complex, and can be used by traditional or concept-based curriculum.
• Classroom worksheets emphasize problem solving and active learning.

Improve Practice Readiness

• Teaching tools develop clinical judgment to prepare students for real-world practice.
• Open-ended questions in NextGen NCLEX format enhance clinical reasoning and deepen learning.
• Resources authored and reviewed by educational and clinical judgment experts.

Prepare for NextGen NCLEX

• Updated case studies, based on Tanner’s Clinical Judgment Model, align with NextGen NCLEX®.
• Prepare students for NextGen NCLEX® using educational best practices that include case-based active learning emphasizing clinical reasoning.

Strengthen Faculty Development

• Time-saving, evidence-based teaching resources.
• Webinars and courses with CEUs to help transform your teaching.
• Exceptional support and rapid responses to your questions.

Additional Benefits

• Student access to case study links and tools chosen by faculty.
• Content is secure. Only faculty members have access to answer keys and case studies are not downloadable.
• A user-friendly experience with enhanced search functionality to easily find relevant resources.

Updates Make Membership an Even Better Value

• Research and Evidence-Based Content Cases have been reviewed by top educators across the country to ensure current best-practices and patient diversity with relevant social determinants of health, so the most important information is presented in each case.
• Handouts Faculty and student handouts apply learning in classroom and clinical settings to improve the ease of use and strengthen student learning.
• Regular Updates New case study topics, handouts, faculty development webinars, and tools that can be shared with students will be added monthly. The membership will grow over time at no additional cost, making it an even better value.

Try Member Resources for Free

Access a KeithRN Clinical Reasoning Case Study, the KeithRN Clinical Judgment Rubric (with scoring sheet and instructions), and popular worksheets to use with your students before you join Think Like a Nurse.

Become a Member!

• Pay Monthly

Individual All-Access Bundle

Billed monthly.

As an individual member, get access to all active learning resources.

Membership auto-renews.

Departmental All-Access Bundle

Best Value – Save 33% with a group of 5 or more!

Get access to active learning resources for faculty in your department at a low annual price.

Great Value – Save 15% when you pay annually!

Questions? Need more information? Contact us!

Reviews from Nurse Educators

“ The integration of medications, labs, diagnostics, assessment findings with images and sounds, as well as psychosocial and other contextual factors, results in a revolutionary teaching resource to use in the classroom or clinical setting. Tiffany Condren, MSN, RNC, Assistant Professor of Nursing, Simulation Coordinator William Jewell College

“ Keith RN's updated case studies are phenomenal! The case studies do an excellent job of creating a sense of realism and are a valuable tool for the nurse educator. Daniel Eaton DNP, RN, Assistant Teaching Professor of Nursing Penn State Ross and Carol Nese College of Nursing

“ As a nurse educator, I am constantly looking for resources that I can adapt for my senior level students. The progressive case studies are perfect for this! The case studies can be used in the simulation lab, classroom or an online course. The diverse patient scenarios require students to adapt care and recognize social determinants of health. Raven D. Wentworth, DNP, RN, APRN, AGPCNP-BC, FNP-BC, CNE, Associate Professor Freed-Hardeman University

“ The updated case studies allow students to implement clinical judgment and critical thinking in NextGen-like scenarios. The activities are saturated with realism and usher the student through all aspects of the client's life, including psychosocial, reflection, and family dynamics. Marielle Combs, DNP, RN, CNE, Nursing Faculty Wayne Community College

“ Clinical judgment is at the top of my list in all of my teaching practices. With my busy schedule, I don’t always have time to create something new to use with my students. The Think Like a Nurse Membership was the first site that gave me access to tools, case studies, handouts, webinars, and more that I could immediately use. My students are challenged and learning with every resource. Keith’s resources go perfectly with class, lab and clinical and covers a wide range of topics. I can’t wait to see his next resource. Christie Cavallo, MSN, RN, EdD (c), CNE, CNEcl University of Tennesee Health Science Center College of Nursing

Recommended by Nursing Programs

Hundreds of programs are successfully using the Think Like a Nurse membership including:

Concordia University

St. Paul, MN

Mid Michigan College

Harrison, Michigan

Cuyahoga Community College

Cleveland, Ohio

Morton College

Cicero, Illinois

Lone Star College

Kingwood, Texas

Pennsylvania Institute of Technology

Media, Pennsylvania

East Central University

Ada, Oklahoma

Upper Cape Cod Regional Technical School

Bourne, Massachusetts

Chamberlain University

Jacksonville, Florida

Central Carolina Community College

Pittsboro, North Carolina

Southern Maine Community College

Portland, Maine

Southeast Community College

Lincoln, Nebraska

Frequently Asked Questions

Who will benefit from this membership.

If you are a new full-time educator or part-time clinical adjunct, this membership site is perfect for you. It will provide essential teaching that will lay a solid foundation to help you successfully transition to your new role. Experienced educators who recognize the need to do things differently have also found this content helpful and appreciate the innovative case studies and time-saving tools. Students benefit by learning from the case studies, tools, and videos at no extra cost!

Is the content inside the updated membership still the same?

All content will be carried over into the updated platform but will be better than ever! Every case study topic has been revised with current references and all worksheets have been edited to strengthen and improve student learning.

How often will you be adding additional content?

Each month, at least one resource will be added that may include a new case study topic, student and faculty webinar, or tools that faculty can share with students.

How are case studies accessed inside the membership?

Faculty answer keys and PowerPoint files are embedded as PDF docs that cannot be downloaded. The PowerPoint can be shared in class. The student version of each topic is also an embedded PDF that can be viewed by students through a link that faculty can share. Students can then download a template of the case study questions to print or fill in as a writeable document. Using this process ensures security of case studies to prevent unauthorized use.

Classroom and clinical learning worksheets can be shared with students as downloadable PDFs to make it easy to integrate into your content as supplemental learning activities.

Is the content inside the membership secure?

Because all case studies have been completely updated with new scenarios, patient data, and case study structure, the prior versions of KeithRN case studies that are avilable on the internet will have no value to students who may be tempted to take shortcuts. And because all updated content is now embedded into the site, there is nothing from the case study to download except a generic template for students to answer questions as they view an embedded PDF.

Can I share the content inside the membership with other faculty?

According to the terms of the membership, sharing content with other faculty who do not have a membership is strictly prohibited. Members have the license to use all resources with the students they teach.

I have an individual membership and love it. How can I get my department access to the membership?

To get departmental access, share this link with a decision maker in your program so they can register the number of faculty seats that are needed. If a decision is made to purchase, the decision maker can use the program credit card for payment, receive an invoice and detailed instructions to send to faculty to obtain approved access.

As an individual member, you will no longer be responsible for payment and will access the content through the department.

Why do faculty pay for this resource and not students?

Because the vision of KeithRN is to transform how nursing is taught by providing the best possible resources for faculty, it was decided to implement a completely different model that is faculty centric, not student centric. For less than the price of a typical conference, faculty can access innovative teaching with CEUs as well as all the time-saving tools to transform how nursing is taught.

Because students get access to all resources that faculty decide to make available to them, the true cost of the membership can be determined by how many students benefit divided by the individual or departmental cost. Compared to what other companies charge to access simulation based products, the true value of this membership becomes evident. Plus, students are already paying so much in student fees, an increase in student fees is the last thing they need!

If my membership is no longer active, can I still use any of the downloadable resources?

According to the terms of the membership, if an individual or departmental membership is no longer active, the license to use any of the downloadable resources ceases and they cannot be used. Most faculty who are members renew every year unless they experience a life change. Currently the membership has a 99% departmental retention rate.

How soon will I be able to access the membership after registration?

For the security of content and to ensure that students are not receiving access to faculty resources, all new members must be approved before accessing the Think Like a Nurse Membership. Approval will be completed within 24 hours of sign-up. Weekend registrations will be approved on Mondays. If you need immediate assistance, please reach out to Member Support .

What if this membership doesn’t meet my needs?

No problem. We offer a full 30-day money-back guarantee. First you will need to submit your cancellation from inside your Membership Account Overview area. Then you may Contact Membership Support , and we will promptly refund the cost of your membership if you signed up within 30 days of cancelling.

I have had a life change and need to cancel my individual membership.

Individual memberships can be canceled at any time from inside your Membership Account Overview area.

What if I have an additional question or need support?

Contact Us with questions and you will receive a prompt reply.

• Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “Crisis in Competency: A Defining Moment in Nursing Education” OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 1, Manuscript 2.
• Nielsen, A., Gonzalez, L., Jessee, M. A., Monagle, J., Dickison, P., & Lasater, K. (2022). Current Practices for Teaching Clinical Judgment: Results From a National Survey. Nurse educator , 10.1097/NNE.0000000000001268. Advance online publication. https://doi.org/10.1097/NNE.0000000000001268
• McLean, S. (2016). Case-based learning and its application in medical and health-care fields: A review of worldwide literature. Journal of Medical Education and Curricular Development , 39. doi: 10.4137/JMECD.S20377

KeithRN for Good

It’s estimated that each year, 30,000 women and girls are trafficked across the border of Nepal to India. When you become a Think Like a Nurse member, you become part of the solution.

Together, KeithRN and nurse educators are creating a safer world for women and children. We are proud to partner with Venture, a nonprofit providing anti-trafficking and women empowerment programs. A portion of the cost of your membership directly supports their life-changing work.

Learn More →

• Helpdesk & Support
• Privacy Policy

© 2024 Think Like a Nurse®. A registered brand of KeithRN LLC®. All rights reserved.

• Advanced Life Support
• Endocrinology
• Gastroenterology
• Infectious disease
• Intensive care
• Palliative Care
• Respiratory
• Rheumatology
• Haematology
• Endocrine surgery
• General surgery
• Neurosurgery
• Ophthalmology
• Plastic surgery
• Vascular surgery
• Abdo examination
• Cardio examination
• Neurolo examination
• Resp examination
• Rheum examination
• Vasc exacmination
• Other examinations
• Clinical Cases
• Communication skills
• Prescribing

Dementia case study with questions and answers

Dementia case study with questions and answers

Common dementia exam questions for medical finals, OSCEs and MRCP PACES

The case below illustrates the key features in the assessment of a patient with dementia or undiagnosed memory decline. It works through history, examination and investigations – click on the plus symbols to see the answers to each question

Part 1: Mavis

• Mavis is an 84-year old lady, referred to you in the memory clinic for assessment of memory impairment. She attends in the company of her son and daughter-in-law.
• On the pre-clinic questionnaire her son has reported a severe deterioration in all aspects of her cognition over the past 12 months.
• The patient herself acknowledges that there have been memory problems, but feels it is just her short term memory that is an issue.

Question 1.

• To begin the history, start broadly. Build rapport and establish both the patient’s view on memory impairment (if any) and the family’s (or other collateral history).
• Patient’s (and collateral) view of memory decline
• Biographical history
• Objective view of memory decline (e.g. knowledge of current affairs)
• Impact of memory decline on day-to-day living and hobbies
• Social history, including safety and driving
• General medical history (especially medications)
• See below for details on these…

Question 2.

• Is it for everything or are specific details missed out/glossed over?
• Try to pin down specific details (e.g. names of people/places).
• At what time in chronological order do things start to get hazy?

Question 3.

• If under 12 years this will lead to additional point being awarded on some cognitive tests
• Ask about long term memories, e.g. wedding day or different jobs
• Then move on to more recent memories, e.g. last holiday

Question 4.

• If your patient watches the news/read newspapers on a regular basis, ask them to recount the headlines from the past few days.
• Be sure to look for specifics to prevent your patient masking memory deficiencies with broad statements. For example: “The government are incompetent, aren’t they?!” should be clarified by pinning down exactly why they are incompetent, for example: “Jeremy Hunt”.
• If they like to read, can they recall plotlines from current books or items from magazines?
• If they watch TV, can they recount recent plot lines from soaps, or formats of quiz shows?

Question 5.

• Ask about hobbies and other daily activities, and whether or not these have declined recently.
• If your patient no longer participates in a particular hobby, find out why: is it as a result of a physical impairment (e.g. arthritis making cooking difficult), or as the result of a loss of interest/ability to complete tasks (e.g. no longer able to complete crosswords/puzzles).
• Once you have a good idea of the memory decline itself, begin to ask about other features. Including a social and general medical history.

Question 6.

• Review their social history and current set-up, and also subjective assessments from both patient and family over whether or not the current arrangements are safe and sustainable as they are.
• Previous and ongoing alcohol intake
• Smoking history
• Still driving (and if so, how safe that is considered to be from collateral history)
• Who else is at home
• Any package of care
• Upstairs/downstairs living
• Meal arrangements (and whether weight is being sustained).
• Of all these issues, that of driving is perhaps one of the most important, as any ultimate diagnosis of dementia must be informed (by law) to both the DVLA and also the patient’s insurers. If you feel they are still safe to drive despite the diagnosis, you may be asked to provide a report to the DVLA to support this viewpoint.

Now perform a more generalised history, to include past medical history and – more importantly – a drug history.

Question 7.

• Oxybutynin, commonly used in primary care for overactive bladder (anticholinergic side effects)
• Also see how the medications are given (e.g. Dossett box)
• Are lots of full packets found around the house?

Part 2: The History

On taking a history you have found:

• Mavis was able to give a moderately detailed biographical history, but struggled with details extending as far back as the location of her wedding, and also her main jobs throughout her life.
• After prompting from her family, she was able to supply more information, but it was not always entirely accurate.
• Her main hobby was knitting, and it was noted that she had been able to successfully knit a bobble hat for her great-grand child as recently as last month, although it had taken her considerably longer to complete than it might have done a few years previously, and it was a comparatively basic design compared to what she has been able to create previously.
• She has a few children living in the area, who would frequently pop in with shopping, but there had been times when they arrived to find that she was packed and in her coat, stating that she was “just getting ready to go home again”.
• She had been helping occasionally with the school run, but then a couple of weekends ago she had called up one of her sons – just before she was due to drive over for Sunday lunch – and said that she could not remember how to drive to his house.
• Ever since then, they had confiscated her keys to make sure she couldn’t drive. Although she liked to read the paper every day, she could not recall any recent major news events.  Before proceeding to examine her, you note that the GP referral letter has stated that her dementia screen investigations have been completed.

Question 8.

• Raised WCC suggests infection as a cause of acute confusion
• Uraemia and other electrolyte disturbances can cause a persistent confusion.
• Again, to help rule out acute infection/inflammatory conditions
• Liver failure can cause hyperammonaemia, which can cause a persistent confusion.
• Hyper- or hypothyroidism can cause confusion.
• B12 deficiency is an easily missed and reversible cause of dementia.
• This looks for space occupying lesions/hydrocephalus which may cause confusion.
• This can also help to determine the degree of any vascular component of an ultimately diagnosed dementia.

Part 3: Examination

• With the exception of age-related involutional changes on the CT head (noted to have minimal white matter changes/small vessel disease), all the dementia screen bloods are reassuring.
• You next decide to perform a physical examination of Mavis.

Question 9.

• Important physical findings that are of particular relevance to dementia, are looking for other diseases that may have an effect on cognition.
• To look for evidence of stroke – unlikely in this case given the CT head
• Gait (shuffling) and limb movements (tremor, rigidity, bradykinesia)
• Affect is also important here and may also point to underlying depression
• Pay attention to vertical gaze palsy, as in the context of Parkinsonism this may represent a Parkinson plus condition (e.g. progressive supranuclear palsy).
• It is also useful to look at observations including blood pressure (may be overmedicated and at risk of falls from syncope) and postural blood pressure (again, may indicate overmedication but is also associated with Parkinson plus syndromes e.g. MSA)

Part 4: Cognitive Testing

• On examination she is alert and well, mobilising independently around the clinic waiting room area.  A neurological examination was normal throughout, and there were no other major pathologies found on a general examination.
• You now proceed to cognitive testing:

Question 10.

• Click here for details on the MOCA
• Click here for details on the MMSE
• Click here for details on the CLOX test

Part 5: Diagnosis

• Mavis scores 14/30 on a MOCA, losing marks throughout multiple domains of cognition.

Question 11.

• Given the progressive nature of symptoms described by the family, the impairment over multiple domains on cognitive testing, and the impact on daily living that this is starting to have (e.g. packing and getting ready to leave her own home, mistakenly believing she is somewhere else), coupled with the results from her dementia screen, this is most likely an Alzheimer’s type dementia .

Question 12.

• You should proceed by establishing whether or not Mavis would like to be given a formal diagnosis, and if so, explain the above.
• You should review her lying and standing BP and ECG, and – if these give no contraindications – suggest a trial of treatment with an acetylcholinesterase inhibitor, such as donepezil.
• It is important to note the potential side effects – the most distressing of which are related to issues of incontinence.
• If available, put her in touch with support groups
• Given the history of forgetting routes before even getting into the care, advise the patient that she should stop driving and that they need to inform the DVLA of this (for now, we will skip over the depravation of liberty issues that the premature confiscation of keys performed by the family has caused…)
• The GP should be informed of the new diagnosis, and if there are concerns over safety, review by social services for potential support should be arranged.
• Follow-up is advisable over the next few months to see whether the trial of treatment has been beneficial, and whether side effects have been well-tolerated.

Now click here to learn more about dementia

Perfect revision for medical students, finals, osces and mrcp paces, …or  click here to learn about the diagnosis and management of delirium.