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 su
bjective 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
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
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NRS-410V Case Study: Mr. M. Solved
Lopes Write Policy
For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.
Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource