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
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.
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.
- Temperature: 37.1 degrees C
- BP 123/78 HR 93 RR 22 Pox 99%
- Denies pain
- Height: 69.5 inches; Weight 87 kg
- 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.
Expert Answer and Explanation
Critical Thinking Essay
Knowledge of clinical manifestations presented by a patient, treatment regimes, and pathological process of disease is vital in ensuring that nurses have accurately and correctly diagnosed and treated patients. The purpose of this paper is to identify and explain the clinical manifestations presented by a patient, treatment regimes, and pathological process of a disease presented by Mr. C in the case study provided.
Clinical Manifestations of Mr. M
Mr. M has a memory problem. He cannot remember his family members, repeated his immediate readings, and his room number. His mood is also deteriorating. He is becoming quickly aggressive and agitated. The patient is also becoming anxious. When he is aggressive, the patient often becomes fearful and afraid. The patient is also experiencing sleep problems. He has been observed wandering at night, forgets his room number, and fails to get back to his room. The patient also needs help with most of his daily activities. His white blood count is high meaning that some medications are impacting his blood production in the body. He is an overweight and mild fever. Urinalysis shows that he has cloudy urine.
Primary and Secondary Diagnoses
Based on the presented data in the case scenario, the primary diagnosis is Alzheimer’s disease. Alzheimer’s disease is a neurological disorder that causes progressive shrinking and death of brain cells (Alzheimer’s Association, n.d.a). The disease mostly causes dementia, a disorder that causes a continuous decline in behavioral, thinking, and social abilities that; hence preventing one to function independently. Alzheimer’s disease impacts various functions of the brain. For instance, it can impact one’s memory-making them completely forget conversations, what they have read, names of their family members, repeat questions or statements, forget familiar places, and misplaces things often (Alzheimer’s Association, n.d.b). The disease can also impact their thinking making them have difficulty concentrating and thinking. The disease also prevents people from making informed judgments and change their behavior and personality (Atri, 2019). The patient in the case presents most of the symptoms mentioned above. His memory, mood, and behavior have been impacted by the disease.
The first secondary disorder for this case scenario is vascular dementia. Vascular dementia also impacts the functions of the brain. Some of the symptoms of vascular dementia include temporary paralysis, muscle weakness, movement issues, and difficulty walking (Kalaria et al., 2016). The disease has been included in the diagnosis because it causes mood changes and thinking problems experienced by the patient. However, it is a secondary disorder in people it causes stroke, a symptom not in the clinical manifestations. Another secondary disorder is Parkston’s disease. This disease can cause tremors, slowness of movement, impaired coordination, and balance. The disease is part of the diagnosis because it causes cognitive impairment, such as memory problems and thinking (Das et al., 2016). The third secondary disorder is frontotemporal dementia. Frontotemporal dementia can cause personality changes, such as aggressiveness, language problems, lack of social awareness, and becoming obsessed. Cotelli et al. (2019) note that the disease can cause cognitive impairment, and that is why it has been included in the diagnosis. The fourth secondary disorder is UTI non specified. UTI often causes fever, drop in WBC, and cloudy urine (Dune et al., 2017). The author has low WBC of 1000ul, cloudy urine, and fever of 37.6, hence is likely to suffer UTI.
One of the abnormalities a nurse can find when assessing the patient is depressed mood. Alzheimer’s disease can impact one’s mood making them feel depressed (Alzheimer’s Association, n.d.b). Another abnormality is repeating interview questions. The disease of the course forgetfulness making one forget questions or statements. A study done by Yamada et al. (2020) shows that patients with anxiety repeated most of the words in daily conversation. The last abnormality is difficulty speaking because the disease can negatively impact the patient’s language. Atypical repetition prevents Alzheimer’s from communicating clearly (Yamada et al., 2020).
Physical, Psychological, and Emotional Effects
The disease can impact the patient physically by increasing his chances of falling during the night. He is always found wandering at night, and as a result, might fall. Psychologically, the patient can develop depression, considering that he has forgotten the names of his loved ones. The feeling can make him agitated and angry. The patient might feel worthless because he forgets, cannot think, and make a clear judgment. The client’s family might also undergo stress seeing their loved one suffering from Alzheimer’s disease. They can also be impacted financially, in that caring for Alzheimer’s patients is somewhat expensive.
Alzheimer’s disease has no cure. Medications available are used to manage the symptoms. The patient can be prescribed Cholinesterase Inhibitors prevent faster brain degeneration (Regenold et al., 2018). The patient should also be referred to a therapist who will help him cope with the psychological symptoms associated with the disease. His family members should also be taken to family therapy who will help them cope with the stress of seeing their kin suffer.
Problems Facing the Patient
One of the potential problems that might befall the patient is bone fractures. The patient might fracture his bone after falling. The second problem is total brain damage. The patient’s brain will be totally damaged by the disease. The third problem is the inability to conduct ADLs. After the patient’s brain is totally damaged, he will not be able to conduct any independent activity. The patient also risks suffering from depression because the disease often affects one’s mood.
The clinical manifestations presented by the patient show that he has Alzheimer’s disease. Hence, she risks suffering from depression, falls, and memory loss. He can be treated using counseling sessions and Cholinesterase Inhibitors.
Alzheimer’s Association. (n.d.a). Medications for memory loss. Retrieved from https://www.alz.org/alzheimers_disease_standard_prescriptions.asp
Alzheimer’s Association. (n.d.b). What is Alzheimer’s? Retrieved from https://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
Atri A. (2019). The Alzheimer’s Disease Clinical Spectrum: Diagnosis and Management. The Medical clinics of North America, 103(2), 263–293. https://doi.org/10.1016/j.mcna.2018.10.009
Cotelli, M., Manenti, R., Brambilla, M., Gobbi, E., Ferrari, C., Binetti, G., & Cappa, S. F. (2019). Cognitive telerehabilitation in mild cognitive impairment, Alzheimer’s disease and frontotemporal dementia: A systematic review. Journal of telemedicine and telecare, 25(2), 67–79. https://doi.org/10.1177/1357633X17740390
Das, D., Biswas, A., Roy, A., Sauerbier, A., & Bhattacharyya, K. B. (2016). Cognitive impairment in idiopathic Parkinson’s disease. Neurology India, 64(3), 419–427. https://doi.org/10.4103/0028-3886.181533
Kalaria, R. N., Akinyemi, R., & Ihara, M. (2016). Stroke injury, cognitive impairment and vascular dementia. Biochimica et biophysica acta, 1862(5), 915–925. https://doi.org/10.1016/j.bbadis.2016.01.015
Dune, T. J., Price, T. K., Hilt, E. E., Thomas-White, K. J., Kliethermes, S., Brincat, C., Brubaker, L., Schreckenberger, P., Wolfe, A. J., & Mueller, E. R. (2017). Urinary Symptoms and Their Associations With Urinary Tract Infections in Urogynecologic Patients. Obstetrics and gynecology, 130(4), 718–725. https://doi.org/10.1097/AOG.0000000000002239
Yamada, Y., Shinkawa, K., & Shimmei, K. (2020). Atypical Repetition in Daily Conversation on Different Days for Detecting Alzheimer Disease: Evaluation of Phone-Call Data From a Regular Monitoring Service. JMIR mental health, 7(1), e16790. https://doi.org/10.2196/16790
Regenold, W. T., Loreck, D. J., & Brandt, N. (2018). Prescribing Cholinesterase Inhibitors for Alzheimer Disease: Timing Matters. American family physician, 97(11), 700-700. Retrieved from https://www.semanticscholar.org/paper/Prescribing-Cholinesterase-Inhibitors-for-Alzheimer-Regenold-Loreck/d42dcbd248bf0595610e9963718617ddb3bee3c3
[ANSWERED] Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable).