NRS 410 Case Study Mr. M.

Sample Answer

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