NRS 410 Case Study Mr. M. Assignment

This piece of writing focuses on a case study involving Mr. M, a 60-year-old male patient dwelling in an assisted facility with a rapid deterioration over the past 2 months. Subsequently, the paper outlines clinical features and manifestations of Mr. M, the primary and secondary medical diagnoses, abnormalities during a nursing assessment, emotional, physical, and psychological effects, and finally the interventions that can be executed to support him and his family.

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Clinical Manifestations

Rooted on the health history and medical information provided in the case study, it can be said that Mr. M exhibits a wide range of symptomatology. Subjectively, Mr. M displays memory loss and dementia. For instance, he has difficulties recalling the names of his family members as well as reiterating what he has just read. Similarly, he is often confused about the location of familiar places as he often wanders at night thus requiring a hand to get back to his room. Furthermore, Mr. M demonstrates features related to mood and personality changes. For example, he speedily becomes aggressive and agitated as well as fearful. Additionally, Mr. M has difficulty ambulating secondary to an unstable gait which arguably could have led to the fracture. Finally, the subjective data reveals that he has impaired functioning as he can’t carry out activities of daily living such as feeding, dressing, and bathing. The above manifestations are typical of a neurodegenerative disorder with progressive cognitive and behavioral dysfunction (Weller & Budson, 2018). On the other hand, objective data shows that Mr. M has well-controlled hypertension, other vital signs are also normal except a slightly elevated respiratory rate, normal liver function tests, and unblemished BMI. However, his WBC data outlines leukocytosis with lymphocytosis while urinalysis show features suggestive of a urinary tract infection including cloudy urine with moderate leucocytes.

Primary and Secondary Diagnoses

The primary diagnosis based on the clinical findings in the aforementioned case study is Alzheimer’s disease (AD). AD is a progressive neurodegenerative disorder is characterized by cognitive and behavioral dysfunction (Weller & Budson, 2018). It is the commonest cause of dementia which is explicated by Mr. M. Similarly, several risk factors such as advanced age, hypertension, hypercholesterolemia, and potential trauma are apparent in his case (Weller & Budson, 2018). However, further diagnostic studies are required to exclude other causes of dementia such as frontotemporal dementia, thiamine deficiency, and thyroid disorders despite the symptomatology favoring AD. Pseudodementia and vascular dementia can be considered other primary diagnoses. Mr. M possesses memory loss in conjunction with mood changes which points towards pseudodementia although a scrupulous clinical evaluation is required to exclude depression. Vascular dementia may also be considered although this has a more sudden onset.

Secondary diagnoses include hypertension from the health history. Nevertheless, this is well controlled by ACE inhibitors. Likewise, hypercholesterolemia can be considered a secondary diagnosis as the patient is currently on atorvastatin. Hypertension and hyperlipidemia significantly increase the risk of cardiovascular events such as cerebrovascular accidents that can manifest with behavioral, sensory, motor, and cognitive impairment (Rennert et al., 2019). Additionally, urinary tract infection is another possible diagnosis supported by the presence of leucocytes and cloudy urine on urinalysis.

Abnormalities During Nursing Assessment

Nursing assessment is a comprehensive and elaborate process that involves a detailed collection of patient information about a patient’s sociological, physiological, psychological, and spiritual needs to enable an individualized and patient-centered treatment plan (Kumar et al., 2021). The assessment would likely reveal a lack of insight into cognitive and behavioral impairment, a common phenomenon in AD (Kumar et al., 2021). Similarly, confusion, poor memory, inattention, and bladder and bowel function loss would be highly feasible since the disease is advanced. Language abnormalities, altered behavior, personality change, and inability to perform daily living activities may be readily apparent. CSF analysis would disclose a decreased beta-amyloid 42 with an increased tau protein (Kumar et al., 2021). On the other hand, volumetric MRI of the brain will typically show shrinkage in the temporal lobe of the brain. The nursing assessment should also comprise thyroid function tests, thiamine assay, and the Patient Health Questionnaire-9 to rule out thyroid disorders, thiamine deficiency, and depression respectively.

Physical, Psychological, and Emotional Effects

Mr. M as well as his family will experience a spectrum of effects related to the diagnosis of AD. First and foremost, emotional effects affect both parties and include feelings of anger, sadness, depression, apathy, and aggression after the establishment of the diagnosis due to its associated poor prognosis, morbidity, and ultimately death (Grabher, 2018).The most commonly reported psychological complication of this condition is stress. Time-related, work-related, demographic, physical, and emotional stress have all been described. For instance, the caregivers are demanded to establish an equilibrium between looking after the dependents and the aging which affects their work, time, and their health (Grabher, 2018).Furthermore, the financial burden correlated with the management of this chronic condition can also be a source of stress to the family and the patient. Physical effects include the inability to conduct activities of daily living, loss of bladder and bowel function, ataxia, pathological fractures, and falls are consequences of advanced AD that detrimentally diminishes the quality of life of the patient.

Interventions to Support Mr. M and the Family

Currently, the disease is incurable. However, a variety of pharmacological and nonpharmacological interventions can be implemented to slow the progression of the disease and manage the symptoms. Pharmacological support includes cholinesterase inhibitors such as donepezil which decelerate the progression of the condition and decrease the ferocity of the symptoms. Nonpharmacological interventions include cognitive behavioral therapy as well as family therapy which helps the family as well as Mr. M to cope with stress as well as emotional effects associated with this condition. Additionally, patient education in matters such as advance medical directives, end-of-life issues, and decision-making must be enforced. The families should also be guided on selecting a qualified caregiver to respectfully take care of the patient on a day-to-day basis. Lastly, the family should be linked to a support group.

Potential Problems

Mr. M is at risk of a complicated UTI if the current infection is not treated. Similarly, he is at risk of a cerebrovascular event given the limited physical activity, immobility, hypertension, and hypercholesterolemia that he has. In addition, he is at risk of patient falls and subsequent fractures given his advanced age (Weller & Budson, 2018). Seizures, skin infections, and dysphagia are other potential problems associated with severe AD.

Conclusion

Patient assessment encompassing a thorough health history and medical evaluation plays a crucial role in healthcare. Patient assessment forms the principal basis of diagnosis and directs other investigations as well as treatment. AD can be diagnosed clinically after the elimination of other causes of dementia. AD is a progressive neurodegenerative disease that is currently incurable. Management of the condition involves supportive measures that target both the patient and the affected family.

References

Grabher, B. J. (2018). Effects of Alzheimer’s disease on patients and their families. Journal of Nuclear Medicine Technology, 46(4), 335–340. https://doi.org/10.2967/jnmt.118.218057

Kumar, A., Sidhu, J., Goyal, A., Tsao, J. W., & Svercauski, J. (2021). Alzheimer Disease (Nursing). In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568805/

Rennert, R. C., Wali, A. R., Steinberg, J. A., Santiago-Dieppa, D. R., Olson, S. E., Pannell, J. S., & Khalessi, A. A. (2019). Epidemiology, natural history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 85(suppl_1), S4–S8. https://doi.org/10.1093/neuros/nyz042

Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Research, 7. https://doi.org/10.12688/f1000research.14506.1

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Case Study: Mr. M.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

Temperature: 37.1 degrees C
BP 123/78 HR 93 RR 22 Pox 99%
Denies pain
Height: 69.5 inches; Weight 87 kg
Laboratory Results

WBC: 19.2 (1,000/uL)
Lymphocytes 6700 (cells/uL)
CT Head shows no changes since previous scan
Urinalysis positive for moderate amount of leukocytes and cloudy
Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.\’s situation. Include the following:

Describe the clinical manifestations present in Mr. M.
Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
Describe the physical, psychological, and emotional effects Mr. M.\’s current health status may have on him. Discuss the impact it can have on his family.
Discuss what interventions can be put into place to support Mr. M. and his family.
Given Mr. M.\’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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