Final answer:
Initially, determining the patient's baseline mental status (option a) is important to understand the deviation from her normal cognitive function. Subsequently, obtaining a complete list of medications and accessing medical records provide context for the patient's health and guide further assessment. These steps will enable a more accurate preliminary diagnosis before pursuing specialized tests.
Step-by-step explanation:
When dispatched to a skilled nursing care facility for an 80-year-old female with abnormal behavior, who is clearly confused and asks if you are her husband, a few steps must be taken. First, it is imperative to determine the patient's baseline mental status. This involves understanding her usual level of cognitive function to assess how the current state deviates from her norm. You can gather this information by inquiring staff members familiar with the patient, reviewing any available medical history, and conducting a brief mental status examination. A simple test like the three-word recall can offer immediate insights into her memory capabilities.
Secondly, it is often helpful to obtain a complete list of the patient's medications, as changes in medication or drug interactions can lead to confusion and altered mental status. Additionally, you could inquire about a history of Alzheimer's disease or any other known cognitive impairments, which can help contextualize the patient's current status. However, you should also consider acute medical problems such as infections or electrolyte imbalances that can precipitate confusion, especially in the elderly. Therefore, narrowing down to Alzheimer's should not be an initial step without a comprehensive approach.
Lastly, asking an attendant for the patient's medical records can provide crucial background information about her health, past medical conditions, and any recent events that might have triggered the change in behavior. Furthermore, witnessing activities such as the patient's ability to state her name or follow simple commands can also give insight into her cognitive function, indicating whether she is aware, oriented, and capable of interaction. These approaches can help formulate a preliminary diagnosis before conducting further specialized tests and assessments.