NRS-410V Case Study: Mr. M. Solved

NRS 410V Case Study Mr M Solved


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.

Case Study: Mr. M

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.

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.


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.


Grabher, B. J. (2018). Effects of Alzheimer’s disease on patients and their families. Journal of Nuclear Medicine Technology46(4), 335–340.

Kumar, A., Sidhu, J., Goyal, A., Tsao, J. W., & Svercauski, J. (2021). Alzheimer Disease (Nursing). In StatPearls. StatPearls Publishing.

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. Neurosurgery85(suppl_1), S4–S8.

Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Research7.

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.


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.





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

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 health16(3), 303–320.

Tahami Monfared, A. A., Byrnes, M. J., White, L. A., & Zhang, Q. (2022). Alzheimer’s Disease: Epidemiology and Clinical Progression. Neurology and therapy11(2), 553–569.

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 open1(6), 1291–1296.


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