| Course | NR 578 Primary Care Management of Older Adults |
|---|---|
| Week | 3 |
| Paper type | Cognitive assessment note |
| Length | About 1,110 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Primary Care NP (AGPCNP) |
| Updated | October 2026 |
Free sample paper for NR 578 Week 3
Cognitive Assessment Note for an 87-Year-Old Whose Daughter Asked About the Sunday Drive: Screens, Their Caveats, Evidence From the House and a Decision About Driving Only
Student Name
College of Nursing, Chamberlain University
NR 578: Primary Care Management of Older Adults
Instructor Name
Month Day, Year
Cognitive Assessment Note for an 87-Year-Old Whose Daughter Asked About the Sunday Drive: Screens, Their Caveats, Evidence From the House and a Decision About Driving Only
The Concern and Who Raised It
The patient's daughter, by phone to the clinic nurse and again in person today: "Dad got lost driving home from church two Sundays ago. It's one mile. Ended up on the highway ramp and had to call me." The patient, asked separately: "I took a wrong turn. The road was closed for the parade, and I went the long way." The daughter confirms there was a detour that morning. The specific question both asked was whether the patient should keep driving.
Hearing and Vision Checked Before Screening
Before the screens, I checked that the patient could hear the instructions and see the page. The patient was not yet wearing hearing aids; I sat close, faced the patient and spoke slowly in a quiet room, and the patient repeated back the first instruction correctly. For vision, the patient used the magnifier for the drawing items and was given extra time. Both conditions are recorded because they affect how the scores can be read.
Screening Results With Caveats
Mini-Cog: three-word recall 2 of 3; clock drawing abnormal, with numbers crowded on the right side and hands pointing to 11 and 2 for "ten past eleven." Total 2 of 5, which is a positive screen.
Montreal Cognitive Assessment: raw score 21, rising to 22 after the one-point adjustment for eight years of schooling. Points were lost on the cube copy, the clock, the trail-making item, delayed recall (2 of 5) and serial subtraction. The patient has macular degeneration and reads with a magnifier; the visuospatial items, which depend on sight, were scored as given but are less reliable for this patient. English is the patient's second language, after Italian; instructions were understood, but word recall may be affected. The screen was developed as a brief tool to detect mild cognitive impairment (Nasreddine et al., 2005), and it does not by itself diagnose dementia or decide driving.
Evidence From the House
From the functional assessment two weeks ago: bill paying taken over by the daughter in March after a missed electric bill; the weekly pillbox filled by the daughter since May after missed doses; meals now simpler. These changes in managing money and medicines, in that order, before physical tasks, are part of the cognitive picture.
From the daughter today: the patient has asked the same question twice in one phone call several times this month. No getting lost on foot in the neighborhood. No unsafe cooking. Still recognizes everyone and follows the news.
From the patient: "My memory isn't what it was, but I know my way around."
Driving History
For about two years, the only driving has been the Sunday-morning mile to church. No crashes, no tickets. Stopped driving at night three years ago and on the highway four years ago, by choice. The daughter rates the driving as "fine until two weeks ago." The getting-lost episode involved a detour.
Assessment: What Is and Is Not Settled
Settled: there is cognitive impairment on two screens and in the history of daily tasks, affecting memory and executive function, with changes over at least nine months.
Not settled: the cause, and whether this is mild cognitive impairment or mild dementia. The loss of independence in managing money and medicines points toward the second, but the vision and language caveats on the screen, and the absence of a workup, mean the label should wait. The note does not enter a diagnosis of dementia today.
Not asked and not decided: the patient's ability to make other decisions. Capacity is specific to the decision in question (Appelbaum, 2007). Nothing in this visit suggests the patient cannot decide about medical care, money or where to live, and none of those questions was raised.
The Driving Question
The neurology practice parameter on driving and dementia lists several features associated with unsafe driving, including a family member who now judges the driving to be borderline or unsafe, any past crashes or traffic tickets, reduced driving mileage, situational avoidance and certain screening results (Iverson et al., 2010). For this patient: driving mileage is already very low and self-limited, there are no crashes or citations, the caregiver's rating has only just changed, and the getting-lost episode involved a detour, which is a situation where people with cognitive impairment are known to struggle.
Plan for driving: a formal on-road driving evaluation by an occupational therapist, which the patient agreed to. Until then, the patient agreed to let the daughter or a neighbor drive to church for the next four Sundays. This is the patient's decision, made with the information, not an order.
Why No Dementia Label Today
The history and screens may well fit mild dementia. A label entered today, though, would rest on screens affected by vision, hearing and language, before the reversible causes have been checked. Once entered, it would travel to every future clinician. The note records cognitive impairment, cause and severity under evaluation, and sets a date to revisit once the workup and hearing test are complete.
What Was Said to the Patient and Daughter
I told the patient and daughter together that the tests showed changes in memory and in planning, that we did not yet know the cause and that some causes are treatable. On driving, I said the question was about the Sunday drive alone, not about any other decision, and that an occupational therapist could test driving on the road. The patient said, "If they say I can't, I won't. But let them say it, not my daughter." The daughter agreed to that.
Further Workup
Blood count, B12, thyroid function and a metabolic panel. Medication review for drugs that affect cognition: none found. A hearing test referral was made, since hearing loss can lower scores and isolate the patient. If hearing aids are fitted, the screen will be repeated with them in, so that the second score reflects memory rather than missed words. The same screen will be used each time, so changes can be compared over the year. The next visit, in four weeks, will cover the results and the driving evaluation; it is booked for late on a Wednesday, the one weekday the daughter can come.
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Iverson, D. J., Gronseth, G. S., Reger, M. A., Classen, S., Dubinsky, R. M., & Rizzo, M. (2010). Practice parameter update: Evaluation and management of driving risk in dementia: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 74(16), 1316-1324. https://doi.org/10.1212/WNL.0b013e3181da3b0f
Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
The Chamberlain NR 578 Week 3 instructions
The Week 3 note asks you to assess an older patient's cognition after a concern has been raised. Be careful about where information comes from: quote the concern and identify who raised it, because a worry from a daughter, a pharmacist or the patient means different things. Report the screen your section names with the raw result, any adjustments and caveats for education, language and the senses, and a line on what it does and does not settle. Add evidence from the patient's daily life. Most prompts warn against turning a score into a diagnosis and against a global verdict on decision-making when only one question was asked.
How the NR 578 Week 3 example is put together
The note quotes the daughter's account of getting lost and the patient's own account of a detour, and states the question both asked, about driving. A section checks hearing and vision before the screens. The Mini-Cog and MoCA appear with raw scores, the education point and caveats for macular degeneration and a second language, citing the MoCA's purpose. Evidence from the functional assessment and the daughter adds to the picture. The driving history is set out. The assessment separates what is settled from what is not, explains capacity as decision-specific, sets out the driving plan the patient accepted and lists the workup.
NR 578 Week 3 rubric: what full points look like
Top of the list for lost points is converting a score straight into a diagnosis; this note reports the scores with caveats and enters no dementia label. Next is a global verdict on decision-making when only one decision was asked about, so the note answers the driving question alone and cites the decision-specific nature of capacity. No identified informant leaves the history authorless. Screens reported without caveats for vision or language lose credit, as do notes that skip evidence from daily life. Recording the patient's own terms for the driving plan earns the shared decision row. A note that checks hearing and vision before screening shows the score was read with care.
Common NR 578 Week 3 mistakes, and how to avoid them
The commonest NR 578 Week 3 problem is a note that moves from a low score to a dementia diagnosis in one sentence. Another is declaring that the patient cannot make decisions in general when the question was about driving. Many notes leave out who raised the concern. Some ignore hearing, vision, education or language when reporting a screen. Evidence from bills, medicines and household tasks is often missing. If your case raises a different question, send the concern and who raised it; a note can be drafted that reports the screens with caveats and answers only the question asked. Check hearing and vision first, report every caveat beside the score, and keep the answer to the question that was asked.
Get a NR 578 Week 3 example written to your instructions
Send the Week 3 case and the note format your section publishes, along with the decision the assessment is meant to inform, and a custom example is written to all three and returned inside 24 to 48 hours, free the first time. The example keeps the score, the possible causes and the capacity question in separate paragraphs.
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NR 578 Week 3 questions, answered
Does a low screen result mean dementia goes in the note?
No. A brief test flags that something needs a proper look, it does not name a cause and it cannot rule one out. Report the number, name the tool, note what could have depressed it that morning, and put the everyday evidence beside it. Where your section wants a working impression, write it as an impression with the further assessment that would confirm or drop it.
How much can the note say about what this patient is still able to decide?
As much as was actually tested and no further. Judgment about one question does not transfer to every other question, so a note that has settled driving has not settled money and should not read as though it had. Describe what was asked, what the patient said back, and who took part in the conversation. One sweeping sentence covering all future choices is the version that gets marked down.
Where does the informant's account belong?
In its own labeled part of the history, with the relationship stated and the number of hours a week that person is genuinely in the house. An account from a son who visits at Christmas and one from a husband in the next chair are different grades of evidence, and a note presenting them identically has thrown away something the rubric was looking for.
Where can I find a free NR 578 Week 3 sample paper?
The full cognitive note on the 87-year-old, with screens, caveats and the driving decision, is published on this page.
Does the NR 578 Week 3 note diagnose dementia?
No. It records cognitive impairment under evaluation, because the screens were affected by vision, hearing and language and reversible causes had not been checked yet.