NRS 410 Case Study Mr. M. Assignment

NRS 410 Case Study: Mr. M.

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

NRS 410 Case Study Mr. M. Assignment

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.

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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:

1. Describe the clinical manifestations present in Mr. M.

Case Study: Mr. M

In the given case study, Mr. M, a 70-year-old patient, is shown to have become worse during the previous two months. The patient’s memory loss is growing worse since he sometimes forgets to return to his room after being outdoors. His aggression and agitation are rising swiftly. When he becomes aggressive, he conveys dread and apprehension. Due to his inability to continue independent living, he needs assistance with the majority of his daily tasks. The purpose of this paper is to evaluate the patient’s clinical symptoms under other circumstances, establish the main and secondary diagnoses, and provide a suitable solution.

Clinical Manifestations Present In Mr. M.

There might be several reasons for the patient’s declining health. The patient is unable to carry out daily life tasks on his own. He periodically forgets where he is, which is another sign of his deteriorating memory loss. As a result, he has trouble recalling information he has read. These signs may indicate that the patient is having cognitive issues (Filshtein et al., 2019). Additionally, he exhibits shifts in hostility and irritability, both of which are indicators of emotional issues. The patient seems to be disoriented and then wanders off, which is a sign of behavioral issues. For the best course of action, the patient must undergo a comprehensive medical examination.

• 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.

The most appropriate main diagnosis for Mr. M is dementia or Alzheimer’s disease based on the facts presented. In addition to deteriorating memory loss, the patient also exhibits increased anger and bewilderment. According to Ansai et al. (2019), the early stages of Alzheimer’s disease are often marked by changes in the patient’s mood, confusion about time or place, language issues, attention problems, challenges with everyday chores, memory impairment, and retreat from social involvement.

For the majority of these symptoms, the patient tests positive. The patient seems to have a secondary diagnosis of urinary tract infection based on the results of the lab tests. His leukocyte and white blood cell counts are increased. As a consequence, traces of leukocytes were detected in the urine findings. Additionally, research indicates that UTIs are frequent among people with cognitive decline, which makes them more confused (Hardy et al., 2022). For instance, sleepiness, agitation, incontinence, impaired mobility, and falls are a few of the non-classic symptoms of UTI.

• When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
• Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
• Discuss what interventions can be put into place to support Mr. M. and his family.
• Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

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

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

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

NRS-410 Topic 2 DQ 1

Cognitive impairment affects memory and other functions of the conscious brain. A sudden or slow onset can occur, whether brief or long-term. As a result, the progression varies depending on the cause. In addition to medication side effects, such as sedatives, tranquilizers, and anticholinergic medications, cognitive impairment is often caused by medication side effects. It is possible for metabolic imbalances, such as elevated sodium, calcium, or glucose levels in the blood, and deficiencies in vitamins and other vital nutrients, such as vitamin B12, B vitamins, and folate, to affect brain function. In addition to delirium, cognitive impairment can occur due to infections or hospitalizations in older adults. Cognitive impairments are also influenced by mental illnesses such as depression and anxiety (Kernisan et al., 2023).

Keeping blood pressure, cholesterol, and blood glucose levels regular can reduce cognitive impairment, but no precise preventive methods exist. In addition to practicing a healthy diet, it is vital to maintain an appropriate weight. The importance of stopping smoking and avoiding excessive drinking cannot be overstated. You must engage in physical activities and get adequate sleep to keep a healthy brain and memory. A regular doctor’s consultation is crucial for a healthy mind and body, and engaging in social activities is also beneficial. (n.d.).

Taking care of one’s mental and physical health is essential for those with early dementia. It is recommended that the patient and the family interact with the support group, counselor, or social worker regarding any anxiety, frustration, anger, loneliness, or depression they may be feeling. In the case of a diagnosis, the patient’s family members can assist with medications, cooking, transportation, and daily activities. To prevent arguments with patients, family members should speak slowly and calmly to them. The caregiver must be patient when answering repetitive questions and responding to other behaviors. In addition to memory aids, writing down daily activities, medications, phone numbers, and other instructions will be necessary (Larson, 2021).

Cleveland Clinic. (n.d.). Mild cognitive impairment: Symptoms, causes, treatments & tests. Cleveland Clinic. Retrieved January 25, 2023, from https://my.clevelandclinic.org/health/diseases/17990-mild-cognitive-impairment/prevention

Larson, E. B. (2021, July 27). Patient education: Dementia (including Alzheimer disease) (Beyond the Basics). UpToDate. Retrieved January 25, 2023, from https://www.uptodate.com/contents/dementia-including-alzheimer-disease-beyond-the-basics

Kernisan, L., says, M. M. K., says, L. J., says, N. S., Didyk, N., says, R. T., PhD, A. E. N., says, A., says, T., says, S. D., says, L. E., Says, M., says, A. B. E., says, J. A. G., says, J. M., Says, J. T., says, J. L. A., says, S. S., says, T., … says, S. L. T. (2023, January 25). Cognitive impairment in aging: 10 causes & what the doctor should check. Better Health While Aging. Retrieved January 25, 2023, from https://betterhealthwhileaging.net/cognitive-impairment-causes-and-how-to-evaluate

Course Code Class Code Assignment Title Total Points
NRS-410V NRS-410V-O500 Case Study: Mr. M. 120.0

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%)
Content 80.0%

Clinical Manifestations of Mr. M. 10.0% Clinical manifestations are omitted. Clinical manifestations are partially presented. There are major omissions and inaccuracies. Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

NRS 410 Case Study Mr. M. Assignment

Diagnoses and Secondary Diagnoses 10.0% A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is omitted; or, medical diagnoses presented are inaccurate. A partial discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. There are major inaccuracies. Rationale and evidence for the diagnoses are lacking. A general discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. There are some inaccuracies. A summary provides some rationale and evidence to explain why the diagnoses are relevant. A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. General rationale and relevant data are used to explain why the diagnoses should be considered. There are minor inaccuracies. A detailed discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. Strong rationale and reliable data are used to explain why the diagnoses are relevant and should be considered.

Explanation of Expected Abnormalities During Nursing Assessment 15.0% 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. 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. 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. A discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. General rationale and evidence are provided for support. 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.

Effects of Health Status on Physical, Psychological, and Emotional Aspects of Patient and Family 15.0% The effects of the health status on the physical, psychological, and emotional aspects of the patent, and the impact the health status has on the family, are omitted. The effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, are partially summarized. The effects presented are questionable, and support for the discussion is not provided. The effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, are summarized. Overall, the described effects on the patient and impact to the family are relevant. Some support for the discussion is provided. A discussion of the effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, is presented. Support for the discussion is provided. A thorough discussion of the effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, is presented. Strong support for the discussion is provided. NRS 410 Case Study Mr. M. Assignment

Interventions for Support 15.0% Interventions that can be put into place to support Mr. M. and his family are omitted. Some interventions that can be put into place to support Mr. M. and his family are partially presented. More information is required. Some interventions that can be put into place to support Mr. M. and his family are summarized. There are minor inaccuracies. Key interventions that can be put into place to support Mr. M. and his family are discussed. Some detail is needed for clarity. All relevant interventions that can be put into place to support Mr. M. and his family are thoroughly discussed.

Actual or Potential Problems Based on Condition 15.0% Fewer than three actual or potential problems faced by the patient are presented. The problems posed are not relevant to his condition. Three actual or potential problems faced by the patient are partially presented. It is unclear how some of the posed problems are relevant to his condition. There are inaccuracies. At least four actual or potential problems faced by the patient are summarized. The posed problems are generally relevant to his condition. There are minor inaccuracies. Some information or rationale is needed. Four or more actual or potential problems faced by the patient are discussed. The posed problems are relevant to his condition. Rationale provided generally supports the discussion. Four or more actual or potential problems faced by the patient are thoroughly discussed. The posed problems are clearly related to his condition. Strong rationale is provided and supports the discussion.

Organization, Effectiveness, and Format 20.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 3.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Cognitive impairment affects memory and other functions of the conscious brain. A sudden or slow onset can occur, whether brief or long-term. As a result, the progression varies depending on the cause. In addition to medication side effects, such as sedatives, tranquilizers, and anticholinergic medications, cognitive impairment is often caused by medication side effects. It is possible for metabolic imbalances, such as elevated sodium, calcium, or glucose levels in the blood, and deficiencies in vitamins and other vital nutrients, such as vitamin B12, B vitamins, and folate, to affect brain function. In addition to delirium, cognitive impairment can occur due to infections or hospitalizations in older adults. Cognitive impairments are also influenced by mental illnesses such as depression and anxiety (Kernisan et al., 2023).

Keeping blood pressure, cholesterol, and blood glucose levels regular can reduce cognitive impairment, but no precise preventive methods exist. In addition to practicing a healthy diet, it is vital to maintain an appropriate weight. The importance of stopping smoking and avoiding excessive drinking cannot be overstated. You must engage in physical activities and get adequate sleep to keep a healthy brain and memory. A regular doctor’s consultation is crucial for a healthy mind and body, and engaging in social activities is also beneficial. (n.d.).

Taking care of one’s mental and physical health is essential for those with early dementia. It is recommended that the patient and the family interact with the support group, counselor, or social worker regarding any anxiety, frustration, anger, loneliness, or depression they may be feeling. In the case of a diagnosis, the patient’s family members can assist with medications, cooking, transportation, and daily activities. To prevent arguments with patients, family members should speak slowly and calmly to them. The caregiver must be patient when answering repetitive questions and responding to other behaviors. In addition to memory aids, writing down daily activities, medications, phone numbers, and other instructions will be necessary (Larson, 2021).

Cleveland Clinic. (n.d.). Mild cognitive impairment: Symptoms, causes, treatments & tests. Cleveland Clinic. Retrieved January 25, 2023, from https://my.clevelandclinic.org/health/diseases/17990-mild-cognitive-impairment/prevention

Larson, E. B. (2021, July 27). Patient education: Dementia (including Alzheimer disease) (Beyond the Basics). UpToDate. Retrieved January 25, 2023, from https://www.uptodate.com/contents/dementia-including-alzheimer-disease-beyond-the-basics

Kernisan, L., says, M. M. K., says, L. J., says, N. S., Didyk, N., says, R. T., PhD, A. E. N., says, A., says, T., says, S. D., says, L. E., Says, M., says, A. B. E., says, J. A. G., says, J. M., Says, J. T., says, J. L. A., says, S. S., says, T., … says, S. L. T. (2023, January 25). Cognitive impairment in aging: 10 causes & what the doctor should check. Better Health While Aging. Retrieved January 25, 2023, from https://betterhealthwhileaging.net/cognitive-impairment-causes-and-how-to-evaluate