Health History and Medical Information of a Patient with Dementia
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Assessment Description
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Health History and Medical Information
Your Name
Subject and Section
Professor’s Name
Date
1 Describe the clinical manifestations present in Mr. M.
This is a case of Mr. M., a 70-year-old male patient currently suffering from memory loss. The condition started 2 months ago as the patient began to have difficulty remembering his room number in the assisted living facility, names of family members, and the information that he has just read, demonstrating loss of long-term and short-term recall. This is associated with intermittent aggression that is often concomitant with fear. Furthermore, the patient cannot get back to his room due to forgetfulness and difficulty in ambulating due to an unsteady gait pattern. Lastly, the patient has become dependent secondary to difficulty performing daily living activities (ADLs), and the condition has been progressively deteriorating.
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.
In the case scenario, the primary diagnosis is dementia, considering Vascular Dementia versus Alzheimer’s Dementia. Conversely, the secondary diagnoses include hypertension, hypercholesterolemia, and probable asymptomatic bacteriuria.
Dementia is a term for memory loss secondary to cognitive impairments that affect ADLs, cognition, and behavior. It has several types, and two of the most common are Alzheimer’s Disease and Vascular Dementia, respectively (World Health Organization, 2018; Becker et al., 2018).
The course of Alzheimer’s Disease is insidious and progressive. Initially, this presents as learning and memory impairment. As the disease progresses, the patient suffers from problems with executive function, visuospatial, recall, complex attention, behavioral, and social problems secondary to the dysfunction in the other areas of the brain. The behavioral impairment is demonstrated by the lack of interest in details or the surroundings, eating palatable and non-palatable foods or objects, and difficulty in moving on a specific topic. Due to this, the patient will eventually have difficulty performing daily tasks requiring help from others (Long & Holtzman, 2019; Tublin et al., 2019).
Conversely, vascular dementia has a sudden or an insidious course depending on the primary etiology. It can occur as a single disease entity or part of Alzheimer’s disease. The most common cause is a cerebrovascular accident. However, one of the risk factors is hypercholesterolemia, which predisposes the patients to increased fat deposition along the blood vessels leading to reduced blood supply and oxygenation. Its symptoms are similar to Alzheimer’s disease, including forgetfulness, poor concentration and judgment, sleep, language, visuospatial, and executive function dysfunction (National Institute on Aging, 2021).
The symptoms of both types of dementia are present with the patient, particularly the forgetfulness and gradual loss of executive function. In the case of vascular dementia, the patient has the risk factor of hypertension and hypercholesterolemia. Both are being controlled using medications.
The secondary medical diagnoses are indirectly related to the cause of hospitalization. These include hypertension, hypercholesterolemia, and asymptomatic bacteriuria. The first two secondary diagnoses have been previously implicated in the patient. On the other hand, asymptomatic bacteriuria is another medical diagnosis that does not show any symptoms of urinary tract infection (i.e., cystitis, pyelonephritis) but demonstrates an increase in the white blood cells (WBCs) in the urine. In men who do not have an indwelling catheter, this is diagnosed with a urine culture result of one bacterial species with at least 100,000 colony-forming units per milliliter (CFU/mL) of urine (Givler & Givler, 2021).
In this case, the patient does not have any symptoms of UTI but has increased WBCs and protein in the urine, demonstrating the presence of urinary tract infection. Thus, the patient’s urine should be cultured for a definitive secondary diagnosis.
3 When performing your nursing assessment, discuss what abnormalities you would expect to find and why?
The history-taking should focus on the risk factors that may predispose the patient to the disease. Examples of these include comorbidities such as hypertension and diabetes, environmental exposure (i.e., heavy metal exposure from drinking water), substance abuse (i.e., alcoholism, nicotine, illicit drugs), use of various medications at a single time, poor sleeping habits, imbalanced diet, and poor cognitive lifestyle (i.e., lack of cognitive stimulation such as reading, writing, listening to music, etc.).
The abnormalities primarily observed in the physical examination are seen on the neurological examination, mainly the mental status examination (MSE). The MSE evaluates the components of cognitive dysfunction in detail and assesses the patient’s behavioral patterns. Moreover, the clinician should also administer the mini-mental state examination (MMSE), a screening examination for dementia (Shim et al., 2017). This is because the executive functions focus on memory, self-control, and complex tasks, mainly affected by the disease. Moreover, the patient’s ADLs and instrumental ADLs (IADLs) should also be assessed since these are part of the functional assessment and will determine if the patient can live independently or with support (Guarino et al., 2019; Seraji-Bzorgzad et al., 2019).
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.
Physical dysfunction is related to the limitation in ...