SWK5013CaseStudy

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Capella University *

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5013

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Sociology

Date

Feb 20, 2024

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pdf

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SWK5013 Case Study Identifying Information: David Jones is a 68-year-old married Caucasian male. Lives on a Ranch with his wife Referral Source: David has been referred to the Veterans Administration by Sarah. Presenting Problem: Sarah has requested residential care for David. During the initial interview, David presents himself as agitated and not knowing why they are at the intake appointment. He states that his wife is "worried about nothing" and that she is "overreacting." Mrs. Jones reported that she noticed his personality changing and that he was easily agitated and increasingly isolated and refusing to attend any social events that used to be important to both of them. Mrs. Jones reports that he constantly repeats himself and can't sit still. She reports that their favorite thing to do would be sit and watch Jeopardy and Wheel of Fortune every night and now they can't because he won't still and becomes angry when he doesn't remember the questions on the TV or how to put together simple words. When asked what he does for fun, Mr. Jones reports that he drinks two to three beers a day, that it has always been routine after a hard day on the ranch to relax with a beer and stated: "What else am I supposed to do, it seems to be the only thing I can do right anymore." Sarah smiled and stated it seems to be the only thing he remembers to do every day. His records indicate that during this initial visit for memory loss, Mr. Jones admitted to being aware of increasing memory problems. He would do things such as lose keys, forget the day of the week, and was creating problems on the ranch by overfeeding the smaller animals or forgetting to feed them overall. Mrs. Jones reported that she noticed his personality changing and that he was easily agitated and increasingly isolated and refusing to attend any social events that used to be important to both of them. Mrs. Jones reports that he constantly repeats himself and can't sit still. John his son doesn't want him on the ranch anymore because he is creating problems, in the way, and is going to hurt himself or the animals. History of Problem: Records at the Veterans Administration report that Mrs. Jones had brought David into the clinic 4 years ago with reports of agitation and memory loss. The previous report indicated that there was an incidence where he forgot to close gates and the livestock was getting out and in danger due to his actions. Previous Counseling Experience: There is no significant family history for family psychiatric or cognitive disorders. Family Background: David lives with his wife, Sarah who he has been married to for 42 years, Sarah is a 65 year old female. David and Sarah have three grown children: John who is 40, Elizabeth, 38, and Pamela, 34.

Personal History: David graduated high school and states that he never felt the need to go to school but wanted to get off of the ranch so he joined the military where he served 4 years in the Army. He spent two of those years in the Vietnam War. When he returned to Rawlins after the war his father was sick and needed help on the ranch. David states "he never left." David and Sarah went to high school together. Sarah attended nursing school out of high school and kept in touch with David while he was overseas. Sarah was able to obtain her RN during this time and when David returned from the war they were married. Sarah reports she was never able to be a nurse as she became a rancher's wife and mother. Sarah reports that they have had a "beautiful life with perfect children." Medical History: He has a healthy gait, is alert, and able to engage in discussion, and answer direct questions. The medical records also report that David is an otherwise healthy individual, he has maintained his annual checkups. He has high cholesterol and is on medication. Educational History: David graduated high school and states that he never felt the need to go to school but he wanted to get off the ranch so he joined the military where he served 4 years in the Army. He spent two of those years in the Vietnam War. Social Class: David is a rancher. David is a retired active war veteran. Cultural History: No information is presented by David and his family. Spirituality: No information is presented by David and his family. Mental Status/Current Functioning: Mr. Jones is Alert and Oriented x 3, able to make his needs/wants known. Mr. Jones presents as agitated. The agitation is a symptom of his reported cognitive memory loss. Mr. Jones can not be left alone and need assistance with his health planning and daily living. Mr. Jones's family reports poor safety awareness. Mr. Jones's assessment on the PHQ-15 is severe with a scoring of 20. References:

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