Case Study: Mr. M. NRS 410

Case Study Mr. M. NRS 410

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The case scenario discussed in this week’s assignment is about 70-year-old Mr. M a resident of the assisted living facility who presents with difficulty in recalling, agitation, aggression, and difficulty in ambulation. The conditions have rendered him dependent on others. He is being managed for hypertension which is well controlled and hypercholesterolemia. His assessment reveals that he is obese and the laboratory results show leukocytosis and feature suggestive of urinary tract infections. The purpose of this assignment is to describe Mr. M’s clinical manifestations, discuss his primary and secondary diagnoses, then highlight the physical, psychological, and emotional impact of his diagnoses on him and the family including the nursing interventions that could be employed in addressing these effects.

The 32year old Mr. C who has had the challenge of being overweight since childhood presents to the clinic inquiring about the possibility of undergoing bariatric surgery. He has been experiencing leg swelling, shortness of breath during physical activity, and pruritus. He is employed at the catalog telephone center and reports to have both high blood pressure and sleep apnea that he has been managing by restriction of sodium intake. His laboratory assessment reveals deranged kidney functions, hyperglycemia, and dyslipidemia whereas his physical assessment shows morbid obesity and high blood pressure. The purpose of this assignment is to explain Mr. C’s clinical manifestation and the risks he faces due to obesity, then discuss the functional health patterns identified in the case study, describe the staging of end-stage renal disease (ESRD) and ESRD prevention strategies that could be employed for Mr. C.

Clinical Manifestations

Mr. M is an elderly male who presents with memory problems for the past 2months with reports of trouble in recalling names of people and even objects such as things he read or his room number. This is associated with aggressive behaviors and has rendered him dependent on others to help with activities of daily living. The urinalysis done on the patient showed that his urine was cloudy in appearance with a considerable amount of leukocytes detected. The patient’s forgetfulness may be diagnosed as dementia which accounts for most of these cases, especially in old patients (Arvanitakis et al., 2019). Due to the forgetfulness in dementia, the patient may be frustrated at his inability to remember information thus the agitation and aggression that is reported by Mr. M. The agitation and aggression may also relate to deterioration in personality that usually results from dementia (Gale et al., 2018).

The urinalysis results obtained are consistent with a diagnosis of urinary tract infections (UTI). This condition has an interesting relationship with dementia as more cases are reported in dementia due to reduced hygiene levels and neglected personal care (Yourman et al., 2020). Further, dementia may be worsened by UTI due to increased inflammatory response in UTI with most patients experiencing delirium and disorientation despite the previously stable dementia (Arvanitakis et al., 2019). UTIs should therefore be properly diagnosed and promptly managed in dementia to prevent deterioration.

Primary and Secondary Diagnoses

The patient’s primary diagnosis is dementia and UTI. Dementia that manifests with memory problems and personality changes is probably due to Alzheimer’s disease (AD) which accounts for 80% of dementia and is characterized by gradual onset and deterioration in memory (Parnetti et al., 2019). On the other hand, UTIs have been diagnosed based on urinalysis results. His primary diagnoses are therefore AD and UTI.

Mr. M’s secondary diagnoses as derived from his past medical history include hypercholesterolemia and hypertension. He had reported that he had been diagnosed with hypercholesterolemia and hypertension that was managed with 40mg Lipitor and 20mg of lisinopril daily respectively. Given they are still on these medications during the current presentation, it can be assumed that he is still suffering from hypercholesterolemia and hypertension (Gale et al., 2018). However, the normal blood pressure of 123/78mmHg that was obtained confirms that hypertension is well controlled at the current doses of antihypertensive drugs. Hypercholesterolemia should however be controlled aggressively to minimize the risk of cardiovascular events.

Abnormalities during Nursing Assessment

When the nurse analyzes the health information provided about Mr. M, some abnormalities can easily be identified. Such abnormalities include abnormal urinalysis results consistent with UTI, a history of progressive memory loss suggestive of dementia, as well as elevated lymphocyte levels. Leukocytosis and lymphocytosis may be induced by the body’s response to an infectious pathogen such as the one implicated in UTI (Yourman et al., 2020). In addition to these abnormalities and laboratory reports, some abnormalities that are anticipated during patient examination include cognitive disturbance, poor memory, and low intelligence during mini-mental status examination due to dementia (Parnetti et al., 2019).

Psychological, Emotional, and Physical Effects of the Disease on Mr. M and the Family

Dementia results in a decline in physical and psychological function. The neglect of physical hygiene and personal care predisposes the patients to infections such as UTIs and even pressure sores that develop when the patients assume the same sitting or lying posture for a long time without shifting (Gale et al., 2018). The forgetfulness may also affect the eating schedule with patients going without meals for long especially when they live alone. As such, their physical well-being including body mass as well as physique thus the increased risk of infections (Parnetti et al., 2019). The loss of muscles and dementia itself may affect the patient’s ability to control bowels and thus further deteriorates personal hygiene.

In addition to the physical effects, the condition also poses psychological impacts on the patients including anger, depression, and anxiety. The depression results from the increased dependence on other family members to help with activities that the patient could initially able to achieve (Gale et al., 2018). Further, forgetfulness is also frustrating and may contribute to depression (Arvanitakis et al., 2019). The family members are equally affected by the AD especially due to the required financial support, the need to play a physical caregiving role, as well as the depression that results when they witness their loved ones being affected by the illness (Parnetti et al., 2019).

Nursing Interventions to Assist Mr. M and the Family

The nursing interventions will seek to address the physical and psychological needs resulting from the patient’s diagnosis. Timely administration of antibiotic medications would be appropriate for the management of the suspected UTI, cognitive behavioral therapy (CBT) would be indicated for improving the cognitive status of the patient, as well as family education that would improve family involvement in patient care (Arvanitakis et al., 2019). Further, the nurse can refer the patient to other healthcare workers such as nutritionists and occupational therapists whose services would be needed (Yourman et al., 2020). They can also link the patient to the support groups in the society where they would be assisted with physical resources as well as pieces of advice that improve their wellbeing.

Actual or Potential Problems

Mr. M has the risk of developing pressure ulcers, deep venous thrombosis (DVT), sepsis, and depressive illness. The pressure ulcers would develop due to neglect of physical care and prolonged sitting or sleeping in the same posture whereas DVT would result from stasis due to being bedridden (Kassahun, 2018). On the other hand, sepsis results from untreated UTI, and depression would be a consequence of the chronic illness, DVT, that reduces the health status (Yourman et al., 2020). These problems should be prevented or screened for and promptly treated.

Conclusion

Chronic conditions such as dementia that present with memory loss may result from degenerative illnesses or may be triggered by acute illnesses such as UTIs to progress to delirium. The conditions have physical and psychological impacts on the patients and their families thus the need for nurses’ involvement in supporting the affected individuals. Some of the assistance strategies include drug administration, linking with support groups, as well as provision of family education. These measures help in prevention of complications including DVT and sepsis.

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References

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia: Review. JAMA: The Journal of the American Medical Association, 322(16), 1589–1599. https://doi.org/10.1001/jama.2019.4782

Gale, S. A., Acar, D., & Daffner, K. R. (2018). Dementia. The American Journal of Medicine, 131(10), 1161–1169. https://doi.org/10.1016/j.amjmed.2018.01.022

Kassahun, W. T. (2018). The effects of pre-existing dementia on surgical outcomes in emergent and nonemergent general surgical procedures: assessing differences in surgical risk with dementia. BMC Geriatrics, 18(1). https://doi.org/10.1186/s12877-018-0844-x

Parnetti, L., Chipi, E., Salvadori, N., D’Andrea, K., & Eusebi, P. (2019). Prevalence and risk of progression of preclinical Alzheimer’s disease stages: a systematic review and meta-analysis. Alzheimer’s Research & Therapy, 11(1), 7. https://doi.org/10.1186/s13195-018-0459-7

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

Nursing Assessment and Possible Abnormalities

When doing a nursing assessment, various abnormalities are expected. For instance, for the case of dementia, a PET scan would show tau protein abnormal accumulation in the nerve cells. In addition, some other abnormalities would include changes in the patient’s vital signs, such as changes in respiratory rate, blood pressure, and temperature, all of which can be higher than the expected range. In practice, older individuals with various conditions are usually assessed to evaluate cognitive impairment since they have many risks of mental impairment (Weller & Budson, 2018). During such assessments, various scales can be used. In the case of Alzheimer’s dementia, abnormal findings may include cognitive impairment and impaired function.

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Possible Emotional, Psychological and Physical Effects on the Patient and The Family

The Case Study: Mr. M. NRS 410 patient’s current health condition may have various impacts on the patient and the family members. Among the physical impacts are impairments in physiological and physical functioning. For instance, the patient may have a diminishing ability to carry out his daily activities, which may proceed to muscle loss (Weller & Budson, 2018). The muscle loss eventually makes the patient incapable of withholding urine and bowel movement. The patient may also experience various psychological and emotional impacts. For instance, the patient may experience apathy, aggression, anxiety, fear, anger, depression, and loneliness.

Apart from the patient, the current condition may impact the family members in various ways. One of the major impacts is the burden associated with caregiving. Such burdens may make the family members have feelings of fear, frustration, anger, and sadness (Weller & Budson, 2018). In some cases, the family members may be called upon to make crucial decisions surrounding the patient’s conditions, such as making adjustments to the patient’s and the family’s living conditions, end-of-life care decisions, treatment options, and financial decisions. Such decisions may lead to family feuds resulting in more psychological and emotional misery.

Possible Interventions to Support the Patient and the Family: Case Study: Mr. M. NRS 410

Patients living with various conditions or illnesses need various interventions to help them have better life quality by relieving the symptoms. As such, Mr. M and the family need various interventions. This case requires offering medications and life coping skills that would help in alleviating the signs and symptoms like depression and emotional effects. The patient needs to use medications that help him to manage hypertension, diabetes, and hyperlipidemia better. Alzheimer’s dementia is a long-time condition. Therefore, one of the long-term care plans and interventions would be to administering the patient and the family home-based care and support (Weller & Budson, 2018). Such caregiving efforts would also focus on offering home health programs and social support to both the patient and the family members.

Case Study: Mr. M. NRS 410

The long-term care plan would require that the caregiver performs a detailed assessment on the home setting and the prevailing living conditions within the care home environment and formulate a patient-centered care plan. Such a plan would be instrumental in helping the caregiver to conduct a frequent assessment of the family and the patient as the need arises (Weller & Budson, 2018). Mr. M also needs various medications to help in the management of Alzheimer’s dementia to foster the patient’s mental abilities. These medications can help slow the disease progression and relieve symptoms even though they cannot reverse the damage done or stop the disease. Community support groups would also greatly help Mr. M and the family since sharing experiences with other individuals and families affected by the same problem would help them better manage the symptoms.

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 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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Case Study Mr. M

Neurological, perceptual, and cognitive complexities are common among elderly patients from the age of 55 years. They are associated with aging and chronic illnesses that affect the elderly. Neurocognitive complexities have been linked to poor health outcomes among patients and are a major cause of morbidity, prolonged hospital stays, and mortality rates among geriatric patients. The most prevalent neurocognitive disorder is dementia, which could be secondary to Alzheimer’s, Vascular, or Lewy Body. The purpose of this paper is to analyze the case of Mr. M, a patient with neurocognitive complexities. I will discuss the patient’s clinical manifestations, medical diagnoses, and support interventions.

Clinical Manifestations Present in Mr. M

Mr. M presents with a decline in memory with a history of having trouble recalling familiar names and places, repeating what he has just read, getting lost, and wandering at night. He is also easily agitated with aggression and cannot perform most ADLs. He has a history of hypertension and hypercholesterolemia. Positive objective data include a height of 69.5 inches and a weight of 87 kg, which calculates to a BMI of 27.9 categorized as overweight. Lab results reveal a WBC count of 19,200/uL and lymphocyte count of 6700 cells/uL, which indicates leukocytosis and lymphocytosis, respectively, with a systemic infection. In addition, urinalysis results show cloudy urine and moderate amounts of leukocytes, which point to a urinary tract infection. The patient’s protein, AST, and ALT levels are within the normal range.

Medical Diagnoses

Primary Diagnosis

Alzheimer’s disease (AD) Dementia. This is a neurodegenerative condition marked by impairment in cognitive and behavioral processes, which interferes with individuals’ occupational and social functioning (Rodríguez et al., 2016). Mr. M has Moderate AD based on positive symptoms of increasing memory loss, difficulties recalling familiar names and places, and the presence of agitation, aggression, and anxiety (Rodríguez et al., 2016). Moreover, Mr. M has confusion that causes wandering at night, difficulties in reading, and limitations in performing ADLs.

Secondary Diagnosis

Asymptomatic Bacteriuria (ABU): ABU is characterized by an infection in the urine but with no subjective data of a urinary tract infection such as dysuria or urinary frequency and urgency (Biggel et al., 2019). ABU refers to the isolation of bacteria in an appropriately collected urine specimen from a person without symptoms of urinary tract infection. ABU’s pertinent positive findings include urinalysis results revealing cloudy urine and a moderate amount of leukocytes with negative patient’s urinary symptoms. Besides, the patient has leukocytosis and lymphocytosis, which indicate presence of infection.

Expected Abnormalities in the Nursing Assessment

Patients with moderate AD are expected to portray abnormal findings in the neurologic and mental status exam. Expected findings on general examination include anxiety and restlessness, with the patient getting aggressive during the interview (Mukherjee et al., 2017). Cognitive impairment is expected with the patient portraying difficulties in reading, writing, and simple calculations secondary to cognitive difficulties.

Expected findings on neurologic exam include decreased attention and concentration levels, poor recent and remote memory, language difficulties, and declined executive function (Rodríguez et al., 2016). Expected finding in the mental status exam include an angry mood as a result of anxiety and confusion. Thought process is expected to be characterized by disorganizes thought and illogical thinking due to an altered thought process (Mukherjee et al., 2017). Thought content is likely to be marked by paranoia, visual or auditory hallucinations, and delusions. Mr. M might be disoriented to both place and time with a declined immediate, short, and long-term memory due to confusion (Rodríguez et al., 2016). Furthermore, the patient is expected to portray an impaired judgment marked by making poor decisions as well as lack of insight evidenced by denial of symptoms or decline in functioning.

Physical, Psychological, And Emotional Effects of Mr. M.’S Current Health Status

Mr. M’s current health status may result in physical injuries such as bruises and fractures secondary to falls. The patient has an unsteady gait with difficulties in ambulation as well as increased confusion levels that put him at a high risk of falls (Brooke, 2016). Besides, the ABU may result in complications in the upper urinary tract, causing urinary stones and prostatic hyperplasia (Biggel et al., 2019). Limitations in performing ADLs, such as inability to feed himself, may result in decreased intake, causing symptoms of nutritional deficiency such as muscle wasting, drastic weight loss (Brooke, 2016). The patient may also develop dehydration marked by loss of skin turgor. Besides, the patient’s existing may worsen, such as hypertension, causing frequent cases of hypertensive urgencies and emergencies.

A decline in the ability to perform ADLs may cause psychological distress to both the patient and his family. Dementia patients often lose confidence in themselves and their abilities due to limitations in performing ADLs, and they also feel insecure (Mukherjee et al., 2017). Mr. M may lose control over his life and health and may develop distrust in his judgment, which can have adverse effects on his psychological wellbeing. The family members are at risk of developing psychological distress such as depression seeing their loved ones lose the ability to perform ADLs. Besides, they will be forced to help the patient perform ADLs, which can result in exhaustion and psychological distress (Mukherjee et al., 2017). Caring for AD patients is often challenging and demanding. It results in physical and mental exhaustion leading to social isolation and increased stress anxiety and depression levels.

Mr. M and his family may encounter social stigma due to the AD, which will negatively impact the patient’s self-esteem and significantly contribute to psychological distress (Mukherjee et al., 2017). Furthermore, the patient will be required to undergo frequent medical follow-ups, resulting in financial strains in the family. Financial strains have a negative impact on the psychological and emotional wellbeing of patients and their families.

Interventions That Can Be Put Into Place to Support Mr. M. And His Family

Interventions that can support Mr. M include Cognitive Stimulation Therapy (CST), which is designed to engage and stimulate patients with dementia. CST is strengthened by key principles of person-centeredness, involvement, respect, inclusion, choice, fun, reminiscence, and maximizing potential and strengthening relationships (Johnston & Narayanasamy, 2016). Reminiscence therapy can also be used to help the patient tap into his long-term memory and recall past pleasurable experiences. It is one of the most popular interventions which can be enjoyed by both patients, their families, and health providers (Johnston & Narayanasamy, 2016). Furthermore, the patient can be encouraged to engage in physical activities, and the provider can design exercise programs for the patient. The exercise programs should be tailored to meet the patient’s interests, abilities, preferences, and safety needs (Johnston & Narayanasamy, 2016). There is evidence validating how physical activity can lessen depressive symptoms and behavioral disturbances such as agitation, noisiness, and aggression in patients with dementia (Brooke, 2016).

Interventions to support the family who are the informal caregivers include providing information on how to dementia and care of the patient. The family can be linked to online support groups where they can learn from others on how to interact and care for a family member with AD (Brooke, 2016). Additionally, the family can be provided psychological counseling interventions to lower the perceived burden and levels of depression and delay admissions to nursing homes.

Actual or Potential Problems Mr. M Faces

The patient faces self-care deficit, as evidenced by the patient’s inability to perform ADLs independently such as feeding, dressing, and bathing. Self-care deficit is as a result of declined memory loss, limited physical activity, confusion, and impaired cognitive functioning. Moreover, he also faces disturbed thought process related to cognitive dysfunction, as evidenced by memory loss. Other findings that indicate a disturbed thought process include wandering, disorientation, and decreased attention span.

Mr. M similarly faces risk for injury related to the patient having difficulties in ambulation and unsteady gait. Confusion further puts the patient at risk of injury since he may fail to recognize environmental hazards and may result in Mr. M making decisions that put him in danger (Brooke, 2016). Further the patient faces risk for social isolation related to alteration in mental status. Mr. M is at risk of facing social isolation due to the progression of AD as well as confusion, memory loss, agitation, and unacceptable social behavior (Mukherjee et al., 2017). He may face social isolation from his family, friends, and the community that may result in further progression of SD symptoms.

References

Biggel, M., Heytens, S., Latour, K., Bruyndonckx, R., Goossens, H., & Moons, P. (2019). Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization. BMC geriatrics, 19(1), 170.https://doi.org/10.1186/s12877-019-1181-4

Brooke, J. (2016). Caring for patients with dementia. Nursing in Practice, 89, 68-71.

Johnston, B., & Narayanasamy, M. (2016). Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy-an integrative review. BMC geriatrics, 16(1), 77.https://doi.org/10.1186/s12877-016-0250-1

Mukherjee, A., Biswas, A., Roy, A., Biswas, S., Gangopadhyay, G., & Das, S. K. (2017). Behavioral and psychological symptoms of dementia: correlates and impact on caregiver distress. Dementia and geriatric cognitive disorders extra, 7(3), 354-365. https://doi.org/10.1159/000481568

Rodríguez, T. M., Galán, A. S., Flores, R. R., Jordán, M. T., & Montes, J. B. (2016). Behavior and emotion in dementia. Update on Dementia, 449. https://doi.org/10.5772/64681

The case study concerns Mr. M 70-year-old male living at an assisted living facility. The patient’s health status has rapidly deteriorated in the past two months. He struggles to remember his family members’ names and room number and repeats things he has read. Mr. M quickly becomes agitated and aggressive. The purpose of this assignment is to analyze Mr. M’s health condition and interventions to support him and the family.

Clinical Manifestations of Mr. M.

Mr. M exhibits clinical manifestation of cognitive decline in memory as seen by forgetting family members’ names and room number and getting lost. He has mood symptoms, as evidenced by getting quickly agitated and aggressive. In addition, the patient has difficulties performing ADLs independently. The patient is overweight, with a BMI of 27.9. Diagnostic results show that the patient has leukocytosis and lymphocytosis. Urinalysis results reveal cloudy urine and leukocytes, indicating a possible urinary tract infection (UTI).

Diagnoses and Secondary Diagnoses

The primary diagnosis is Alzheimer’s dementia (AD). The patient demonstrates positive AD symptoms like a gradual decline in memory, difficulties remembering familiar names and places, confusion with wandering at night, aggression and agitation, reading difficulties, and inability to perform ADLs independently (Tahami Monfared et al., 2022).

The secondary diagnosis is Asymptomatic Bacteriuria (ABU). ABU is characterized by leukocytes on urinalysis but with no reported clinical symptoms of UTI. Persons living with dementia often have atypical clinical manifestations and high ABU rates (Yourman et al., 2020). The patient has not expressed any symptoms consistent with UTI, but urinalysis results of cloudy urine and leukocytes indicate UTI, making ABU the secondary diagnosis. The nursing diagnosis derived from AD is Impaired memory related to chemical imbalances in the brain as evidenced by memory loss. The nurse should consider this diagnosis by evaluating the patient’s cognitive function and memory.

Expected Abnormalities during Nursing Assessment

Abnormal findings are expected in nursing assessment in the general, neurological, and mental status assessment based on the AD medical diagnosis. On general assessment, the nurse can expect to find a nervous, restless, and disoriented patient with explosive behavior when asked about his cognitive decline symptoms (Tahami Monfared et al., 2022). The patient may also exhibit paranoia and inappropriate social behavior. The likely neurological exam findings include short-term memory loss, reduced attention span, dysarthria, and impaired executive functioning.

The expected abnormal mental status exam (MSE) findings include disorganization, disorientation to time, place, and person, impaired reasoning, abstract thought and judgment, problems with calculation, and decreased attention span. In addition, the patient may demonstrate deterioration in personal care and appearance and have poor cooperation (Tahami Monfared et al., 2022). The nurse may not identify any abnormal findings with ABU because it is asymptomatic. However, a thorough genitourinary exam is crucial to identify if the patient has costovertebral angle tenderness, penile ulcers or lesions, scrotal tenderness, meatal discharge, or prostatic tenderness.

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

AD has a significant physical, psychological, and emotional impact on patient and their families. The patient is at risk of developing perceptual-motor problems which cause disturbances in ambulation, gait, balance, and motor coordination. This increases the risk of falls and fractures (Grabher, 2018). Besides, the difficulties in performing ADLs cause self-care deficits in bathing, dressing, and toileting. If the skin is not properly cleaned or dried, it can cause skin conditions due to impaired skin integrity. Self-care deficit in feeding can also cause nutrition deficiency and dehydration because of inadequate dietary intake (Grabher, 2018). The limited ability to perform ADLs and cognitive decline in AD patients cause psychological distress, which increases the risk of developing depression and anxiety disorders. Therefore, Mr. M’s aggression and agitation can be linked to cognitive decline.

The family of Mr. M may be required to help him with ADLs, which causes physical exhaustion and burnout, especially if they have not been trained to care for an AD patient. Besides, they may develop psychological distress that progresses to depression or anxiety when they see their loved one lose his independence (Grabher, 2018). Exhaustion and burnout also increase psychological distress. Furthermore, Mr. M’s care will require financial resources if the family hires a caregiver or takes him to a nursing home. The financial drain caused by the care of AD patients adversely affects the patient’s and family’s emotional well-being.

Interventions for Support

Mr. M can be supported through supportive psychotherapy, where he gets a platform to talk about how his thoughts and feelings affect his mood and behavior. For instance, he can be started on group psychotherapy for persons with dementia, which improves depression and anxiety symptoms and interpersonal functioning. Supportive psychotherapy can also help Mr. M understand his life situation’s reality, including his limitations and what he can and cannot achieve. Mr. M’s family can be supported through caregiver training to educate them on how to provide care to their loved ones at home and avoid burnout (Simpson et al., 2018). Besides, the family can be introduced to social support groups for AD caregivers, where they interact with other families and learn how to cope.

Actual/Potential Problems

Mr. M’s actual problems include impaired memory caused by the AD disease process and chemical imbalances in the brain. He also has self-care deficits in bathing, dressing, and feeding caused by impairment in neuromuscular and cognitive functioning (Breijyeh & Karaman, 2020). In addition, the patient has confusion with a reduced ability to interpret his environment caused by the AD disease process. The patient has a risk for injury due to confusion, disorientation, and impaired decision-making.

Conclusion

Mr. M has clinical features of memory loss, confusion, disorientation, and aggression, which are consistent with Alzheimer’s disease making it the primary diagnosis. The secondary diagnosis is ABU since urinalysis results suggest a UTI, but the patient has no symptoms. AD affects the patient’s and family’s physical, psychological, and emotional well-being, increasing the risk of depression and anxiety disorders. The patient and family can be supported through psychotherapy, training on caregiving, 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.

Simpson, G. M., Stansbury, K., Wilks, S. E., Pressley, T., Parker, M., & McDougall, G. J., Jr (2018). Support groups for Alzheimer’s caregivers: Creating our own space in uncertain times. Social work in mental health, 16(3), 303–320. https://doi.org/10.1080/15332985.2017.1395780

Tahami Monfared, A. A., Byrnes, M. J., White, L. A., & Zhang, Q. (2022). Alzheimer’s Disease: Epidemiology and Clinical Progression. Neurology and therapy, 11(2), 553–569. https://doi.org/10.1007/s40120-022-00338-8

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