April 2024
CASE A
Mr. CD is an 81-year-old gentleman living in a long-term care facility in Portland, Oregon. His wife is his health care surrogate and has power of attorney for decisions regarding finances. Mr. and Mrs. CD have been married for 62 years.
Past medical history includes cancer of the prostate treated with radioactive seeding with a successful outcome; multiple transient ischemic attacks; osteoarthritis; mild hypertension; progressive decline in short- and long-term memory; moderate limb apraxia, tremors, and finger joint pain; skin sensitivity; and bilateral sensorineural hearing loss for which he wears hearing instruments.
He was placed in the long-term care facility when he began to exhibit signs of agitation, short temper and memory loss. His wife, son, or grandchildren would say something very insignificant and he would have an extreme reaction such as shouting at them, storming off, or throwing objects. Later, when his wife or son attempted to discuss the incident he would not remember what happened or had a different recollection of the sequence of events. His family physician completed the Mini Mental State Exam prior to the decision to place him in the long-term care facility and he scored a 20/30, indicating a mild cognitive impairment.
On a recent visit to Mr. CD, his wife noted that he seemed “moody.” The nursing staff indicated that he was refusing to eat sometimes and he had lost weight. His hearing instruments were not in his ears. He was having difficulty getting from a sitting to standing position. He currently takes Risperidone, Norvasc, multi-vitamin, and baby aspirin.
Discussion Questions
- What information is most relevant to the case from an interprofessional practice perspective?
- What other health professionals should be involved with this patient? What referrals would you make as his audiologist?
- In building your interprofessional team, how would you explain your role as the audiologist in this case?
CASE B
GH is a 14-month-old female who lives with her maternal grandparents. GH was born at 35 weeks gestation, weighing 4 lbs 8 ozs to a young mother. The mother had a history of illicit drug abuse (likely methamphetamine and heroin) and GH is currently in the permanent legal custody of her grandparents.
GH was in the NICU for 27 days after birth due to extreme difficulty breathing, requiring intubation, as well as concern for multiple craniofacial anomalies. She had a right-sided microtia/atresia, a left-sided microtia, a small unilateral cleft lip, and coloboma of the lower portion of the eye. GH was unable to breathe through her nose at all due to bilateral choanal atresia. CT imaging indicated a bony/soft tissue cover in the back of the nasal passage. In addition, the right ear middle ear was filled with tissue and ossicles were not well defined. Left ear canal was normal with “normal appearing” ossicles; however, the cochlea was noted to have an “incomplete partition” and malformation of the saccule.
Further testing indicated a large ventricular septal heart defect. Developmental Ballard assessment indicated weak muscle tone. Chromosomal microassay was completed and GH was determined to have a mutation in the CDH7 gene in 8q12.2 associated with CHARGE syndrome. Surgery at 5 days was performed to open the nasal airway to allow GH to breathe on her own.
Subsequent MRI of the head indicated a scant spiral ganglion cell population on the left side, but a normal right side. Heart surgery was being discussed as GH was not gaining weight as she should.
Discussion Questions
- What information is most relevant to the case from an interprofessional practice perspective?
- What other health professionals should be involved with this patient? What referrals would you make as the audiologist?
- In building your interprofessional team, how would you explain your role as the audiologist in this case?
