Case Study Assignment: RN-BSN-prepared Nurse

Case Study Assignment: RN-BSN-prepared Nurse

Case Study Assignment: RN-BSN-prepared Nurse

Cognitive decline causes an impaired mental function that causes cognitive and behavioral changes and lower individuals’ quality of life. The case study depicts Mr. M, a 70-year-old man whose health status has rapidly worsened in the past two months. The purpose of this paper is to examine the patient’s condition and discuss diagnoses, disease impact, and support measures.

Clinical Manifestations of Mr. M.

Clinical manifestations in Mr. M include cognitive and motor function decline, as seen with memory loss, wandering, and increased dependency on ADLs. He has psychological symptoms like agitation and aggression. The patient is also overweight. He has an elevated WBC and lymphocyte count, suggesting an underlying infection. In addition, he has cloudy urine and leukocytes in the urine, indicating a urinary tract infection (UTI).

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Primary and Secondary Diagnoses

The primary diagnosis is Alzheimer’s disease (AD). Patients in the moderate AD stage present with features of cognitive decline such as worsening memory loss, increased confusion, poor attention span, difficulties recognizing familiar faces, including friends and relatives, and wandering (Breijyeh & Karaman, 2020). Moderate AD also manifests with psychological features like agitation, restlessness, anxiety, tearfulness, and loss of impulse control. Mr.M. has symptoms consistent with moderate AD, like memory loss, difficulties remembering familiar names and places, aggression, agitation, wandering at night, and difficulties performing ADLs.

Asymptomatic Bacteriuria (ABU) is the secondary diagnosis based on findings of cloudy urine and leukocytes on urinalysis. Yourman et al. (2020) explain that persons with dementia may present with atypical clinical manifestations of UTI. AD patients have higher rates of ABU, especially if they stay in long‐term care facilities, like Mr. M.

Expected Abnormalities during Nursing Assessment

The expected abnormalities on nursing assessment include an anxious and restless patient who often becomes aggressive during examination. Abnormal findings in the neurological system include impaired recent and remote memory, reduced attention and concentration span, impaired executive functioning, language difficulties, and difficulties in reading, writing, and simple arithmetic tasks (Breijyeh & Karaman, 2020). Expected mental status exam (MSE) findings include disorganized thought process, irrational thinking, likely delusions and hallucinations, disorientation to place, event, and time, impaired judgment, and lack of insight (Breijyeh & Karaman, 2020). Furthermore, the nurse will likely find signs of malnourishment and dehydration due to inadequate nutrition.

Health Status Effect on Physical, Psychological, and Emotional Aspects of Patient and Family

AD impacts the physical, psychological, and emotional well-being of patients and their families. AD may physically affect the patient by impacting their ability to perform ADLs independently. Consequently, they must rely on their family members or caregivers to carry out self-care ADLs like grooming, dressing, eating, and toileting. AD patients are at risk of injury due to the associated confusion. Furthermore, AD is associated with eating and swallowing problems, which affect patients’ nutritional status increasing their risk of malnutrition (Grabher, 2018). The loss of independence in performing ADLs affects patients psychologically, contributing to psychological symptoms like apathy, aggression, depression, agitation, sleep disturbances, and psychosis. Besides, patients with dementia often experience emotional changes and may have less control over their feelings and how to convey them.

The family is usually affected physically, especially those caring for the AD patient at home. Family members help the patient in carrying out ADLs, which causes physical strain resulting in fatigue and burnout. The caregivers experience challenges caring for AD patients, like limited energy, time, and financial resources. This significantly contributes to psychological and emotional distress. Grabher (2018) explain that caregiver of AD patients often experience anxiety and depression and have a low quality of life caused of these challenges. Furthermore, families incur out-of-pocket expenses for the care of AD patients creating a financial burden that worsens their mental wellbeing.

Interventions for Support

Interventions to support Mr. M include mental and social stimulation, memory training, and physical exercises, which improve the patient’s cognitive performance and independence. Memory training slows cognitive decline in AD patients (Breijyeh & Karaman, 2020). The patient’s family can be supported through caregiver training programs where they are trained to assist patients with AD. The program enables caregivers to understand AD better and address problems related to the care of their family members (Hinton et al., 2019). Besides, the family can be referred to social support groups where they share their experiences with other families and encourage each other, which improves their mental wellbeing.

Actual/Potential Problems

Mr. M’s actual problems include a disturbed thought process caused by cognitive decline, which is demonstrated by confusion and memory loss. He also has a self-care deficit caused by impaired cognitive function and limitation in physical activity, making him dependent on ADLs. The patient is at risk of confusion due to difficulties in interpreting his environment and confusion. Besides, his altered mental state puts him at risk of social isolation from relatives, peers, and the community.

Conclusion

Mr.M’s primary diagnosis is moderate AD, and the secondary diagnosis is ABU. AD impact a patient’s ability to perform ADLs and increase the risk of malnutrition and psychological distress. It also causes fatigue, burnout, financial burden, and psychological stress on families. The patient can be supported through mental and social stimulation, memory training, and physical exercises, and the family through caregiver training and social support groups.

References

Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease: Causes and Treatment. Molecules (Basel, Switzerland), 25(24), 5789. https://doi.org/10.3390/molecules25245789

Grabher, B. J. (2018). Alzheimer’s Disease and the Effects it has on the Patient and their Family. Journal of Nuclear Medicine Technology, jnmt.118.218057. doi:10.2967/jnmt.118.218057

Hinton, L., Tran, D., Nguyen, T. N., Ho, J., & Gitlin, L. (2019). Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: a scoping review. BMJ Global Health, 4(6), e001830. http://dx.doi.org/10.1136/bmjgh-2019-001830

Yourman, L. C., Kent, T. J., Israni, J. S., Ko, K. J., & Lesser, A. (2020). Association of dementia diagnosis with urinary tract infection in the emergency department. Journal of the American College of Emergency Physicians open, 1(6), 1291–1296. https://doi.org/10.1002/emp2.12268

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Assessment Description

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 known 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 subjective and objective clinical manifestations present in Mr. M.

Based on the information presented in the case scenario, state what primary and secondary medical diagnoses should be considered for Mr. M. Formulate a nursing diagnosis from the medical diagnosis and explain why these should be considered and what data is provided for support.

What abnormalities would you expect to find and why when performing your nursing assessment using the identified primary and secondary medical diagnoses.

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 a rationale for each.

You are required to cite a minimum of three 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.

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

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Rubric Criteria

Total

120 points

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Evidence

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

4.5 points

Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.

4.74 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

5.34 points

Relevant evidence that includes other perspectives is used.

6 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

0 points

Appropriate format is not used. No documentation of sources is provided.

1.8 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

1.9 points

Appropriate format and documentation are used, although there are some obvious errors.

2.14 points

Appropriate format and documentation are used with only minor errors.

2.4 points

No errors in formatting or documentation are present.

Diagnoses and Secondary Diagnoses

Diagnoses and Secondary Diagnoses

0 points

Discussion on what primary and secondary medical diagnoses should be considered, and/or nursing diagnosis formulated from the medical diagnosis, and/or rationale and evidence used to support the medical and nursing diagnosis is omitted.

9 points

Discussion on what primary and secondary medical diagnoses should be considered, and/or nursing diagnosis formulated from the medical diagnosis, and/or rationale and evidence used to support the medical and nursing diagnosis are present, but lack detail or are incomplete. .

9.48 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and evidence used to support the medical and nursing diagnosis are present.

10.68 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are detailed.

12 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are thorough.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

2.7 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

2.84 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

3.2 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

3.6 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Health Status Effect on Physical, Psychological, and Emotional Aspects of Patient and Family

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family.

0 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and/or the impact the health status has on the family.is omitted.

13.5 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and/or the impact the health status has on the family are present, but lack detail or are incomplete.

14.22 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is present.

16.02 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is detailed.

18 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is thorough.

Clinical Manifestations of Mr. M.

Clinical Manifestations of Mr. M.

0 points

Subjective and objective clinical manifestations are omitted.

9 points

Subjective and objective clinical manifestations are present, but lack detail or are incomplete.

9.48 points

Subjective and objective clinical manifestations are present.

10.68 points

Subjective and objective clinical manifestations are detailed.

12 points

Subjective and objective clinical manifestations are thorough.

Thesis, Position, or Purpose

Communicates reason for writing and demonstrates awareness of audience.

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

4.5 points

The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.

4.74 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

5.34 points

The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.

6 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

Explanation of Expected Abnormalities During Nursing Assessment

Explanation of Expected Abnormalities During Nursing Assessment

0 points

A discussion of what abnormalities a nurse would expect to find during a nursing assessment is omitted; or, the expected findings are not relevant for the patient or his health status.

13.5 points

An incomplete summary of some abnormalities a nurse would expect to find during a nursing assessment is presented. There are inaccuracies. No rationale or evidence is provided for support.

14.22 points

A general discussion on the abnormalities a nurse would expect to find during a nursing assessment is presented. There are minor inaccuracies. Some rationale or evidence is provided for support.

16.02 points

A discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. General rationale and evidence are provided for support.

18 points

A thorough discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. Strong rationale and evidence are provided for support.

Interventions for Support

Discussion of interventions that can be put into place to support patient and his family

0 points

Discussion of interventions that can be put into place to support the patient and his family is omitted.

13.5 points

Discussion of interventions that can be put into place to support the patient and his family are present, but lack detail or are incomplete.

14.22 points

Discussion of interventions that can be put into place to support the patient and his family is present.

16.02 points

Discussion of interventions that can be put into place to support the patient and his family is detailed.

18 points

Discussion of interventions that can be put into place to support the patient and his family is thorough.

Actual or Potential Problems Based on Condition

Discussion and rationale of four or more actual or potential problems faced by the patient

0 points

Discussion and rationale of four or more actual or potential problems faced by the patient are omitted.

13.5 points

Discussion and rationale of four or more actual or potential problems faced by the patient are present but lack detail or are incomplete.

14.22 points

Discussion and rationale of four or more actual or potential problems faced by the patient are present.

16.02 points

Discussion and rationale of four or more actual or potential problems faced by the patient are detailed.

18 points

Discussion and rationale of four or more actual or potential problems faced by the patient are thorough.

Development, Structure, and Conclusion

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

4.5 points

Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.

4.74 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

5.34 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

6 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.