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Delirium Diagnosis in Geriatric Patient
Case study 1
Delirium, dementia and depression are serious health complication common among geriatric population. The clinical manifestation of these healthcare complications is mainly impaired cognitive function, which makes it difficult to differentiate. This is usually a challenge because most of geriatric patients often present with multiple medical comorbidities which contribute to the affective and cognitive changes. Advanced nurse practitioners are expected to understand the key differences between these diseases as it is the first step to effective treatment (Holt, Young & Heseltine, 2013).
In this case study, the list of differential diagnosis would include dementia, depression and delirium. However, the fact that the patient is very confused, agitated, mental status fluctuates and rambles in an incoherent and disorganized manner, then, the most likely definitive diagnosis is the patient is derelict. Delirium is differentiated from the other two mental disorders by a) onset, b) Attention, c) and d) fluctuation of the symptoms.
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The onset of delirium in geriatric population occurs rapidly as compared to other two diseases where symptoms onset is mainly gradual and worsens progressively. In patients that are derelict, the patient is unable to remain focused. In early stages of dementia and depression, the patient is generally able to remain alert. In delirium patients, the signs and symptoms fluctuation is predominant throughout the day (Flaherty & Resnick, 2011).
To further confirm the diagnosis, the cognitive assessment should be done using comprehensive geriatric assessment tool. The physical exams, neurological exam, blood test and urine test should be conducted to check indicators of underlying health complications. I would not request from brain imaging test unless the aforementioned diagnostic tests fails to confirm delirium or underlying health complications (Featherstone, Hopton & Siddiqi, 2010).
The first step in treatment of the patient is to address underlying triggers. This includes terminating medication identified as underlying cause. With regard to pharmacological management of delirium, the patient should be give antipsychotics of choice, administered at lowest dosage.
Therefore, the patient should be administered Haloperidol and benzodiazepines. The healthcare provider must ensure that the patient gets an individualized care plan to treat and prevent further complications. This includes devising environmental interventions to address the disorientation and cognitive impairments (Holroyd-Leduc & Reddy, 2012).
Flaherty, E., & Resnick, B. (2011). GNRS. New York, NY: American Geriatrics Society.
Holroyd-Leduc, J., & Reddy, M. (2012). Evidence-based geriatric medicine. Chichester, West Sussex, UK: Blackwell Pub.
Holt, R., Young, J., & Heseltine, D. (2013). Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age and Ageing, 42(6), 721-727. http://dx.doi.org/10.1093/ageing/aft120
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Milgram Experiment reveals that the majority of people are willing to obey an authority figure by following instructions to perform acts that conflict with their coincidence. Besides , the Lord of Flies is a real example of obeying authority. This is because the Lord of Flies shows that boys are willing to follow any chain of command. The connections show that there are less evil people than good. However, society acts as the foundation of a person’s wrongdoing or evil.
Milgram Experiment assessed people’s reaction told to give a painful electric shock, while in the Lord of Flies by William Golding readers are introduced to actors of evil and good. The study shows that despite many individuals being useful in the world, only a few are great.
The purpose of this study is to show how William Golding in the Lord of Flies connects with Milgram Experiment themes to demonstrate how people are willing to obey orders from an authority figure. The paper provides a clear analysis of the link between the Lord of Flies and Milgram Experiment and the implications it has on the modern day leadership style and how people are willing to obey a chain of command from an authority figure.
Milgram’s Experimet Theoretical Framework
Milgram Experiment was carried out to show how people obey authorities under all circumstances, especially people who instructed them to perform acts that conflict the coincidence of purposes. The purpose of Milgram Experiment was to give students electric shocks by separating them from the subject and establishing a tape recorder, which was integrated with electronic shocks. Therefore, if the answers were inaccurate, the teacher would administer a shock to the learner by an increasing voltage for each wrong answer, while for the correct answer, the teacher would go to the next word pair.
Milgram Experiment was in a controlled setting such that the learner could not attempt to quit the experiment, which led to the establishment of status and authority (Batson and Daniel, 2016,10). Milgram Experiment showed factors that affect obedience. For instance, the status of location showed that prestige of location increase obedience, while less personal responsibility increases obedience. Besides, individuals tend to obey others if they acknowledge their authority as legally based or/and morally right.
Thus, the uniformity of the authority figure can provide people with status as well as peer support or presence of others disobeying the authority figure decreases the obedience level. Milgram Experiment showed that proximity to authority plays a significant role in obedience as people can easily resist orders from authority if they are not nearby (Haslam and Stephen, 2017, 63).
In Milgram Experiment, the teacher does not know that the shocks are not real, and the student behind the participation is in the experiment working with Milgram. Besides, the learner is getting words pairs incorrect on purpose, making the experiment fake despite showing the importance of obeying authority. Therefore, the actual experiment is on the teacher.
Despite the increased yelling by participants, they continue to finish the experiment. As much as many participants wished to stop, Milgram used four phrases to entice them to finish the exercise. The motivating phrases were, “please continue, the experiment requires you to continue, it is necessary for you to continue and you have no other choice, you must go on (Haslam, Nick, Loughnan, and Perry, 2014).”
The Lord of Flies by William Golding introduced characters of evil and good. The study shows that despite many individuals being useful in the world, only a few are great. This is because people control how their environment influences their actions and behaviors. During the feast, Jack sat like a leader and idol as he issued commands such as who was going to join his tribe. [ (pg #?). ] Through his command and leadership authority, most of the boys accepted because they wanted meat and protection from Jack.
Besides, despite Jack punishing Wilfred for no particular or apparent reason, Roger and the rest of the boys of the tribe felt nothing wrong about it. This is because none of the boys had the courage or confidence to stand up for Wilfred. Therefore, the Lord of Flies by William Golding showed that people have a fear of authority and quickly give up justice. Moreover, Jack and Roger tortured Eric and Sam, forcing them to submit to Jack’s command and join his tribe. This shows that authority forces the weak people to follow them using violent action and false use of authority.
The failure of Jack to admit that he took too much power and authority shows that influential leaders are not willing and lack the courage to admit mistakes such as enslaving others. The analysis of the Lord of Flies shows that civilized officers are part of an adult world in which violence and war are associated with social order and civilization. People are expected to obey authority as influential leaders do things to destroy the peaceful world, similar to what Jack did to the boys and vice versa.
The comparison of Milgram Experiment and the novel of the Lord of Flies show that the boys feared the beast referred as the electronic shocks, while they allowed Jack to gain power and authority through obedience to his command. The review shows that it is easier to control people and persuade them to be savagery by obeying the experiments. This is because the boys followed the authority or command to get protection or avoid the electric shock.
The connection between Milgram Experiment and the novel of the Lord of Flies is evident in that both boys follow the order to obtain protection or avoid electronic shocks. For instance, the boys are stranded and end up following the commands from Jack without comprehending the reasons for doing it. Besides, from both sets of experiments, it is evident that people follow orders without questioning the consequences or impacts on the other party.
William Golding in the Lord of Flies presents the obedience idea in Milgram Experiment through the connections of actors take as a leader, Jack, and Ralph, and the other actors who ideally obey the leader’s command or orders without questioning. This connection shows how people or kids are ready and willing to obey the authority figure that has leadership skills. Besides, both Lord of Flies and Milgram Experiment present the obedience idea through leaders and the ones who unthinkingly follow commands and believe that they should be led.
People who want to be led wait for commands and orders to follow and they believe they need to be directed by a leader as Jack demonstrated by allowing characters to follow him without question. This undeniably connects with Milgram Experiment on obedience. This is because according to the Milgram Experiment, persons are possibly to obey commands by authority figures. Therefore, the robust scenarios of obedience on the Lord of Flies are indicators of Milgram Experiment.
The novel on the Lord of Flies presents the obedience theme, which is accurately connected, to Milgram Experiment on obedience. This is because many instances demonstrate the obedience theme. For instance, Jack is the leader of a group of hunters in a jungle who target to kill a pig, and the group follows him to the jungle without questioning and obediently. The boys have drifted away with the words of command such as “kill the pig,” “cut her throat. Spill her blood”(Laurent et al., 2015, 300).
It is evident that the kids are carried away with the obedience feeling as hunters and Jack manipulate the boys’ fear of the beast, making them obey him even further for protection and safety. The boys not only see Jack as a powerful leader but also obey him without question. Besides, there are other particular moments during the hunting game where Jack uses is authority and command to instill fear in the boys as they obey him unquestioningly. These instances in the novel of the Lord of Flies present how far the obedience feeling can take people.
The kids lose their morality and rational thinking by following commands. Despite the increased use of command, which instills fear and obedience to the boys, the sense of obedience goes off-limits, which signals that things can easily go out of control. Jack who is their leader for the sake of security and food because the boys do everything tells this. Thus, the novel by William Golding in the Lord of Flies presents the idea obedience in Milgram Experiment as it shows that without no doubt individuals will obey commands from others if they perceive them as leaders or authorities (Branson and Buckroyd, 2017, 20).
William Golding presents the obedience idea in Milgram Experiment in the final chapter of the Lord of Flies. In the last chapter of the Lord of Flies, there are clear instances where the boys obey authority figure as well as carrying them to higher levels. It is evident when Jack acts as a leader and as an idol giving commands during the feast where the boys obey the orders without question. Jack commands the boys to join his tribe, and all except Ralph agree to the idea. However, the reason behind Ralph objection is because he is supposedly the chief.
The sense of obedience manifested in Milgram Experiment is present in this scenario as all hunters obey Jack and fail to either object or to question the idea of being a tribe. Despite Wilfred getting punished for no apparent reasons, Roger and the rest of the boys of the tribe do not feel it or question for a reason for the punishment. This shows that they lacked courage and confidence to stand up for Wilfred because their submission and loyalty to their authority blocks them.
Even though Ralph wants to call for an assembly to question Jack, the boys once again prove their obedience and loyalty to their authority figure. Instances of obedience in the novel of the Lord of Flies stem from the idea of obedience from Milgram Experiment. In both groups of boys, they accept the command or authority figure by carrying out the orders issued to them by the leader or teacher.
For instance, if the boys are told to eat, they eat, and if told to fetch something for the leader, they do so. Also, they sit down when told to do so and even if the leader says they should be punished, they accept it without question. This result significantly connects with obedience from Milgram Experiment (Gridley and Jenkins, 2017, 25).
Milgran experiment Critical and Relevance
William Golding successfully puts the obedience idea in the Lord of the Flies novel by installing Jack as the leader. Jack is obeyed, and his subjects follow his commands or orders without questioning. The connections of two scenarios show that philosophic and legal aspects of obedience are of enormous importance. The excessive willingness of people to go to any level in the order of authorities constitutes the main findings of research and the idea that most directly demands full justification.
The study shows that people with authority tend to control the outcome and actions of others. The experiments reveal that a more significant part of people are just willing to comply with authority figures who directs merely them to execute acts that may vary or conflict with their individual coincidence, while the Lord of Flies by William Golding is a real example of obedience to authorities because the people are willing to obey any chain of authority (Hollander, 2017, 430). \
We live in a world where people demand obedience from the authority for them to function well for a society. However, obedience can have significant impacts on a society because authority figures have little to justify actions. Thus, conformity is an impact that influences people to do things they may not have otherwise done. Evidence shows that both obedience and conformity lead to atrocious actions. Therefore, horrendous crimes against humanity have happened and yet people fail to question the actions of authority figures.
The experiment shows that discipline and obedience are learned through social conventions. Thus, individuals are able of substantial evil and great good according to the circumstances they are positioned in. in addition, acts of both resistance and obedience have the power to motivate and inspire people to obey commands of an authority figure.
From the connection between Milgram’s Experiment and Lord of Flies, several factors force people to carry obedience to the extreme, even without questioning the command. People justify their behavior be assigning responsibility to authorities rather than themselves, and they define their behavior which is expected of them as a routine. Besides, evidence from the experiment shows that people do not want to offend or be rude to authority and they obey orders. Therefore, it is essential for people to question orders and reasons behind their issue.
This will ensure that obedience is acknowledged and is not adhered out of fear. The results show how people follow orders and obey leaders without question. This is a disappointing aspect of leadership style as the leaders directly threatened people in order to guarantee the protection and security.
Batson, Charles Daniel. What’s wrong with morality?: A social-psychological perspective . Oxford University Press, 2016: 2-25
Bègue, Laurent, et al. “Personality Predicts Obedience in a Milgram Paradigm.” Journal of Personality 83.3 (2015): 299-306.
Branson, Jane, and Peter Buckroyd. Lord of the Flies, William Golding: Workbook. Oxford University Press, 2017: 10-30
Gridley, Mark, and William J. Jenkins. Obedience to Authority. Macat Library, 2017: 20-27
Haslam, Nick, Steve Loughnan, and Gina Perry. “Meta-Milgram: An empirical synthesis of the obedience experiments .” PloS one 9.4 (2014): e93927.
Haslam, S. Alexander, and Stephen D. Reicher. “50 Years of “Obedience to Authority”: From Blind Conformity to Engaged Followership.” Annual Review of Law and Social Science 13 (2017): 59-78.
Hollander, Matthew M. “The repertoire of resistance: Non‐compliance with directives in Milgram’s ‘obedience’experiments.” British Journal of Social Psychology54.3 (2015): 425-444.
The case has to establish the compensation for traumatic stress as a result of death caused by negligence of a careless driver. The rules are very clear pertaining to this case. The question is whether the driver of the car is answerable to problem of traumatic stress that is being experienced by the three individuals. The other issue is whether the driver owed the victims the duty of care. The tort principles of negligence can therefore be applied in this case since the drivers conduct was that of negligence hence generated traumatic stress and that the illness was not farfetched when we apply the Wagon Mound test.
The rules therefore requires the complainants to have suffered traumatic stress that is easily recognized and if the victim is a secondary complainant, then should have suffered from shock, the traumatic stress should have been foreseen that the complainant would eventually suffer from traumatic stress as a result of the negligence and that the stress can heal if it was as a result of fear of physical injury to himself. The victim ought to prove that the suffering is as a result of traumatic stress. Very minor stresses like grief are not accepted in the court. In most cases the cases that have been listened to include reactive stresses and also stresses after a trauma. The evidence from the expert is also important in order to prove that the complainant has really been affected.
Damages are in general only recoverable where the recognized psychiatric illness was shock-induced. What is required is “a sudden assault on the nervous system or “the sudden appreciation of a horrifying event, which violently agitates the mind .The law does not in general provide recovery for psychiatric illness brought about by an accumulation of more gradual assaults upon the nervous system. A person who has had to cope with the deprivation consequent upon a bereavement,20 a spouse who has been worn down by caring for an injured husband or wife, and a parent made distraught by the wayward conduct of a brain-damaged child are not able to claim for psychiatric illness suffered as a result.
In the case of Hinz and Berry, the court of appeal entertained a case in the award of 40000 Euros as a compensation for psychiatric stresses. Lord Pearson came up with five reasons why he thought the victim was stressed up. One is sorrow and mourning the loss of the husband, worry about the well being of the children, stresses about money due to the death of the sole bread winner, adjusting to a new way of life and also shock as a result of watching the accident happen. Lord stated that only the issue of witnessing the accident take place qualifies to be compensated since the stresses could not have taken place if the victim did not witness the accident happen.
Those who come to rescue the individuals involved in an accident are also protected under the law in case of any injury as a result of drivers negligence. As with the case of Cardozo J in Wagner v International Railway Co. It is stated that when an accident occurs, automatically rescuers have to come. The law therefore protects this type of reaction which is natural. The law states that this form of reaction is very normal. The law therefore protects them so as not to discourage their actions.
In the case of Chadwick v British railway’s the principle equally applied to the traumatic stresses that came after. This application was eventually approved by Lord Wilberforce in Mcloughlin. The extent to which this law applies is illustrated in Rapley V P 6.10 European Ferries.
The victims therefore ought to receive compensation since their lives have completely changed as a result of the traumatic stress/psychiatric stress. The rescues is well protected under the law. Further, the family member is also considered as a beneficiary since they witnessed the accident taking place hence traumatic stress/psychiatric stress.
Psychiatric stress Case Study 2a
The moment one agrees to offer advice to another party, a special relationship is established since he is relied upon for special guidance. The person therefore assumes the responsibility of advice. When a court is determining special relationship, the court will look at whether the complainant relied on the experts opinion, whether the professional knew that the complainant was relying on him for the advice In the case of Hedley Byrne & Co. Ltd. –v- Heller & Partners Ltd  AC465 2 it was okay for the victim to rely on the professional for advice. Under the proximity test the Supreme Court ruled that it is reasonable for the party affected to get compensation
Psychiatric stress on Case Study 2b
In the case of Berg v. General Motors Corp.,57 which was a case touching on the changes in the a pre-tort reform case, the supreme court in the US the Washington Supreme accepted the payment of damages as a result of negligence. In this case, Berg purchased a vessel which eventually did not give him the service. He sued the company thus general motors for selling him a machine which did not work and caused him a lot of economic losses. Berg sued the company for negligence. The court ruled that the manufacturer was not exposed to further law suits since he was protected by the warranty.
The other case on psychiatric stress involves Stuart v. Coldwell Banker Commercial Group who sued builder of Condominium units so as to compensate for the economic losses for causing economic losses. The builder was accused of negligence. The damages were therefore direct thus the cost of repairing the machine. The judges ruled that when negligence results into risky conditions, the purchaser of the product should be compensated in tort even though the buyer only lost money. The decision in Stuart case does not concur with the Tort changes of 1981. However, it goes against the previous court’s decision in Berg v General Motors Corp. thus the court allowed the victim to be paid the profits as a result of the manufacturer’s negligence.
Psychiatric Stress Case Study 2c
The case of voluntarily accepting responsibility outside a formal contract was first heard in the courts in the UK when there was claim for the compensation of an economic loss and also in the decision of the House of Lords in Hedley Byrne v Heller. In this case of psychiatric stress, a court decided that a bank can be found responsible for the information it provided without bearing in mind its usual clients.where it was decided that a Bank can be liable for a negligent information supplied without consideration to a regular client. In the more recent case of Henderson v Merrett Syndicate Ltd12, Lord Goff, in looking for the principle which underlay the decision in Hedley Byrne, referred to passages in the speeches of Lord Morris and Lord Devlin in that case including a passage in the speech of Lord Devlin where he considered the sort of relationship which gave rise to a responsibility towards those who act upon information or advice, and thus created a Duty of Care towards the person so acting. Lord Devlin had said: “From these statements, and from their application in Hedley Byrne, we can derive some understanding of the breadth of the principle underlying the case. We can see that it rests upon a relationship between the parties, which may be general or specific to the particular transaction, and which may or may not be contractual in nature. All of their Lordships spoke in terms of one party having assumed or undertaken a responsibility towards the other.”
In White v Jones13 (see infra) Lord Goff stated again that the Hedley Byrne principle was “founded upon an assumption of responsibility.” In Galoo Ltd (In liq) & Others v Bright Grahame Murray (a firm) and another14 the Court of Appeal set out to identify the difference between the facts there and those in its previous decision in Morgan Crucible Co Plc v Hill Samuel Bank Ltd15, that allowed the recovery of an economic loss. The question was when is an adviser, e.g. in this case, an auditor, in close proximity with a person suffering loss by relying on his negligently false advice or information? The answer given by the Court of Appeal in Galoo was, when the auditor ‘intends’ that the third party, a particular identified person, will rely on it16. Thus the bidder relying on the auditor’s accounts of the target company in Galoo had his claim dismissed, because, although he was personally known to the auditor, it was not ‘intended’ by the latter that he should rely on his accounts. The leading judgment of Glidewell L. J. relied on Lord Denning’s so-called ‘classic statement’ in Chandler v Crane Christmas & Co. 17. The auditor’s ‘intention’ was meant as referring to his knowledge, and willingness, of the reliance of the plaintiff, not any willingness to inflict on him financial injury through such false information. It must be noted here that a professional making a false statement in the course of doing his every day job, on the subject-matter of his expertise, will find it hard to shift a presumption of negligence in the error. The idea of a ‘voluntary assumption of responsibility’ was used to explain the importance of ‘intended reliance’, and in Galoo it was turned into a new concept of a ‘voluntary inter-personal’ relationship, said to fall short of being a contract only because of lack of consideration proceeding from the plaintiff to the defendant in return for the advice or information18. In Coulthard and others v Neville Russell (a firm)19 , the Court of Appeal, in another case concerning the civil liability
Psychiatric stress Case Study 3:
Lena, Rasmus and Martin have a case against Apollon which led to their injuries. The employer’s duty of care law focuses on the responsibility of the employer to protect the employees. The employer has to ensure the working area is safe. The enterprise and Regulatory act 2013 also comes into play. So as to succeed with this case under the common law, the three employees will have to show that the injury was foreseeable and that the common laws which provides for standard care were neglected.
The employers liability and public liability claims covers all cases below 25,000 euros. The law applies to cases involving accidents that occurred before or on July 2013. Section 69 of the enterprise and regulatory changes 2013. According to this act, all accidents which happen from 1 October 2013, the civil liability is not about breach of guidelines at the workplace even the criminal proceedings can be launched.
Psychiatric stress Case Study 4 a
The judge will calculate the lump sum award for the damage based on the type of damage and also based on the opinion of the expert on the side of the victim. The age of the victim, extent of the damage and also the ability of the claimant to recover quickly in case of an injury. The damage can be compensatory where a person is compensated for breach of agreement, special damages where a victim is paid the money lost, quantum damages where the victim is compensated after proving that the defendant actions caused him to lose money and also the general damages where someone is compensated money for an injury that does not involve money.
The proximate cause involves a case where compensation as a result of damages to the victim is governed by the principles of law. The damages have to be as a result of the accused bad behavior. This principles applies to the recovery of all damages thus contract or tort.
Psychiatric stress Case Study 4b
The common law requires the victim to be paid all the damages at once. This implies that analysis of the losses ought to be done before and during the prosecution of the case. However, this can be challenging since the victim has no room for appeal if the condition of damage worsens. The award can also be too low or too high since so many factors are considered during the determination process. Furthermore, there is the issue of delay since the compensation can only take place after the whole process of prognosis is finalized. The victim should therefore present the case in a timely manner lest he faces challenges of lateness in court. This has to be done once for both the past and future damages. The victim cannot in any case split the case to present it on separate occasions. The best scenario could therefore be for the victim to be paid periodically.
Psychiatric stress Case Study 4c
In order to realize a reasonable award of damages as a result of negligence, the court ought to consider several factors. The most obvious thing is that Tort law is not the same as criminal law. Torts can be caused by negligence or criminal behavior and also cases revolving around tort have very low threshold of prove. The complainant will always get compensation even if the accused person was acquitted in an earlier criminal case. For instance, O.J Simpson was released in a case where he was accused of murder but found to be guilty of tort due to causing death wrongfully.
Punitive damages as a result of psychiatric stress are never given in order to compensate the victim but rather to send a warning to the accused and any other person from repeating the same mistake. Punitive compensation is therefore given to people who were reckless in their actions. In the case of Liebeck v McDonald’s restaurant (1994) an old woman was burnt with tea which led to very serious burns. Lie back tried to plead with McDonald to pay fo the hospital bills but Mc refused. Through scrutiny, it was discovered that McDonald’s coffee caused very severe damages to other clients. The court asked the hotel to pay for the damages. The court gave Lie Back $2.7 as a punitive damage compensation.
The duty of care on psychiatric stress revolves around the case of Mrs Donoghue who was bought ice cream and ginger beer. The ginger however, had some dead snail which had started decomposing. The case was successful and led to the development of the modern law on negligence.
The court also need to look at the damage. The case of Hughes v Lord Advocate  AC 837. The boys went to play in the manhole that had been left after works of excavation. The hole had been closed and covered with some paraffin with a lamp. The boys went with the lamp inside the hole and led to a very serious explosion. The court decided that since the burns were seeable, and the explosion was not foreseeable, the boys ought to be compensated.
Vicarious Liability as pertain psychiatric stress in the case of Mohamud v WM Morrison Supermarkets Plc  UKSC 11. A supermarket employee who worked at the fuel station attacked a customer due to provocation. The customer had insulted the employee using racist terms. The Supreme Court ruled that the supermarket was responsible for the employee’s violent behavior to the client and ruled out the defense argument on psychiatric stress.