Alzheimer’s Disease, Vascular Dementia, and Systolic Blood Pressure
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.
Title
Your Name
Subject and Section
Professor’s Name
Date
1 Describe the clinical manifestations present in Mr. M.
Two months before consultation, Mr. M. experienced temporary and intermittent memory loss, both short-term and long-term, unable to remember the texts he had just read and his family members’ names. The condition deteriorated and was associated with aggression, immense fear, and dependence on daily living activities, resulting in difficulty in ambulation and an unsteady gait pattern.
2 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.
Based on Mr. M’s presentation, the patient’s primary diagnosis is dementia. However, this is an umbrella term for all the mental diseases that concern memory. To be specific, the patient may have a primary diagnosis of Alzheimer’s Disease or Vascular Dementia. On the other hand, the secondary diagnoses are hypertension, probably stage I, hypercholesterolemia, and probable asymptomatic bacteriuria, to rule out urinary tract infection.
Primary Diagnosis
According to Becker et al. (2018), dementia refers to the disease of the mind that results in memory and cognitive impairment. Since the patient cannot remember even the most essential things or actions, especially in its most chronic stages, this affects the activities of daily living, cognition, and even behavior. In this case, the most common forms are Alzheimer’s Disease and Vascular Dementia, respectively.
Alzheimer’s Disease and Vascular Dementia both have the same presentation and course. Typically, both have gradual onset that becomes progressive as these become chronic cases. Both diseases result in memory impairment that eventually leads to dysfunction in executive function, preventing the patients from performing their routine activities, even the previously natural activities, such as going to the bathroom and the like. Aside from this, it results in visuospatial deficits and behavioral and social problems. Often, the patients are lost and unaware of the people, the surrounding, and the situation, prompting them to become aggressive due to the confusion. Moreover, the patients lose interest in the previously pleasurable events, confining them to depression. Eventually, these patients succumb to dependence on their caregivers (Long & Holtzman, 2019; Tublin et al., 2019). The only difference with vascular dementia is that it can have a sudden onset secondary to brain insults, such as cerebrovascular accident (CVA), ruptured blood vessels, and damage to blood vessels secondary to fat deposition. Thus, the risk factors for CVA are hypertension and hypercholesterolemia, both present in the patient (Johns Hopkins Medicine, 2022).
Secondary Diagnoses
Unger et al. (2020) defined hypertension as systolic blood pressure (SBP) of more than or equal to 140mmHg in the office or clinic and/or diastolic blood pressure (DBP) of greater than or equal to 90mmHg after a repeat take. This is a secondary diagnosis because it is not the primary reason for consultation, but it should still be managed since it is an existing disease of the patient.
Concurrently, the patient also has hypercholesterolemia. Grundy et al. (2019) state that this is secondary to the elevation of the lipoproteins in the serum. This is also a secondary diagnosis because this is a co-existing condition before the consultation.
Lastly, the patient might have a urinary tract infection due to moderate white blood cells (WBCs) in the urine and the characteristic of cloudy urine with the presence of proteins. This may indicate kidney injury or problems in the lower urinary tract. However, the patient does not have symptoms, and the white blood cells were not quantified nor sent for culture and sensitivity for further evaluation. Hence, this may also be a case of asymptomatic bacteriuria (Givler & Givler, 2021; Johns Hopkins Lupus Center, 2022).
3 When performing your nursing assessment, discuss what abnormalities you would expect to find and why.
During the nursing assessment, the abnormalities can be evident from the history taken down to the physical examination, especially at the neurologic and mental state examinations.
During the history taking, the clinician may find out that the degree of insight of the patient is impaired. The patient himself might complain about memory problems, including semantic and anterograde memory, such as difficulty remembering recent events or the previously known long-term memory. The patient might also complain about the language difficulties, such as difficulty speaking or even understanding the conversation. Moreover, the patient might complain of difficulty in controlling behavioral problems. These may be evident during the psychiatric interview (Shaji et al., 2018).
The formal cognitive assessment may show orientation, attention, memory, language, executive function, praxis, and visuospatial function impairments. Aside from this, the clinician might elicit associated findings such as psychosis related to dementia, including misidentification of caregivers, bizarre or complex delusions, and suicidal ideations. Lastly, a physical examination may reveal difficulty performing functional activities, requiring dependence on the caregivers (Shaji et al., 2018). This is because the patient forgets the basic actions and fails to remember the tasks he has to do. Thus, the patient is often confused about the happenings in his surroundings, prompting him to act strangely and respond to situations inappropriately.
4 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.
Cognitive dy...