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
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.
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:
- 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.
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.
Expert Answer and Explanation
Patient Assessment
Based on the presenting clinical manifestations, it is likely that Mr. M suffers from Alzheimer considering that he has memory issues. According to the presenting symptoms, he shows symptoms of dementia, and he is unable to recall his family members’ names, which suggest that he could have contracted an Alzheimer. Besides, the patient shows signs of agitation as well as aggressiveness with fear every time he becomes aggressive.
Besides, the fact that he wanders at night, and he gets lost to the extent that it becomes difficult for him to trace his room, further demonstrates his loss of memory. Because Alzheimer’s patients tend to experience difficulty making correct judgment and carrying out activities of daily living (ADLs), the fact that he becomes dependent carrying out these tasks demonstrates how his memory lapse has worsened (Budson & Solomon, 2015). As a 70-year-old, it is probable that old age could be a factor that exacerbates the patient’s dementia.
Primary and Secondary Diagnosis
The diagnosis of the Alzheimer follows the standard primary as well as secondary diagnostic procedures. When determining whether the Alzheimer is present, it is imperative to conduct an assessment of the memory problems with specific focus on carrying out tests on the patient’s mental status. Interviewing the patient’s family, guardian or even a friend is important because it could provide details concerning the patient’s behaviors.
Considering the essence of the biological tests on the diagnostics process, it is recommended that the diagnostic process include an analysis of the lab tests. In addition, it is important to perform an imaging of the brain (Budson & Solomon, 2015). Given that conditions such hypothyroidism as well as the deficiency of the vitamin B12 are known to cause memory loss, the blood tests have to be part of the diagnostics.
The body’s normal white blood cells (WBC) count ranges from 4,000/uL to 10,000/uL , and at WBC count of 1,000/uL, it is probable that the patient has deficiency of the vitamin B12. A blood protein reading of 7.1 g/dL; AST: 32 U/L; ALT 29 U/L shows a low blood protein level. The fact that the lymphocyte level in the patient’s blood reads below 6700 cells/ uL rules out the presence of the thyroid disease.
Possible Abnormalities
One would expect to find some abnormalities in the event that they perform assessment. One of the sources of these abnormalities is the classification of the condition as a disease that affects the thyroid because of the lab test results. This is because of the fact that the low WBC count is both an indication of the presence of the Alzheimer as well as a thyroid disease. Thus, one needs to take these issues to perspective when conducting the assessment of the disease to prevent error in diagnosis of the disease.
The Physiological and Psychological Impact of the Disease
Alzheimer comes with serious issues which may psychologically and physiologically affect the patient as well as their family members. Reflecting on the disease’s psychological impact, Alzheimer patient may develop depression given that the condition may cause the isolation of the patient. This isolation particularly could occur because of the patient’s aggressive behavior as well as because of the memory problem.
However, the patient may also contribute to their social alienation especially if they develop preference to be in seclusion. On the other hand, the physiological impact of the medical condition range from difficulty carrying out ADL s to the risk of developing serious health issues associated with falls. In addition, the disease may psychologically affect the patient’s family by causing them to develop stress and depression (Ganda, 2013).
Intervention Support
For a patient suffering from Alzheimer, certain interventions which extent help to the patient’s family may be of significant importance to the advancement of the health objectives. As part of the process of developing a therapy schedule, it is imperative to involve the patient’s family to plan for the treatment. This will ensure that the treatment plan integrates the elements of the patient’s or family’s spiritual and cultural beliefs which could be essential to the provision of holistic care.
Family participation in the treatment may also involve reminding the patient to take their medications, and being in constant communication with the caregiver to update them on the patient’s progress (Ganda, 2013). While the prescription of the medication is important, it is equally imperative that the support incorporate an educational program in which the family learns about how to emotionally and physically support the patient.
Potential Problems
Mr. P’s condition predisposes him to the serious health issues. For instance, he faces the risk of falling and acquiring injuries given his poor judgment. Still, the fact that he lacks the ability to make sound judgment considerably increases his risk of death. Dehydration is an additional problem Mr. P is at risk of developing considering that his condition makes it difficult for him to eat and drink properly. Furthermore, his risk of contracting infections considerably increases because he is unable to perform ADLs.
References
Budson, A. E., & Solomon, P. R. (2015). Memory Loss, Alzheimer’s Disease, and Dementia E-Book: A Practical Guide for Clinicians. Amsterdam: Elsevier.
Ganda, K. M. (2013). Dentist’s guide to medical conditions, medications, and complications. Ames : Wiley-Blackwell.
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