NRS 410 Case Study: Mr. M.

NRS 410 Case Study: Mr. M.

NRS 410 Case Study Mr. M.

Case Study: Mr. M.

            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.

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.

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            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.

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