Case Study Analysis Essay

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.  Case Study Analysis Essay

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. Case Study Analysis Essay

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.  Case Study Analysis Essay

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Mr. M’s clinical manifestation

The case study presented encompasses a 70years old male by the name Mr. M who resides at an assisted facility and also suffering from AD and UTI. He neither drinks nor smokes despite experiencing a decreased physical activity as which is as a result of difficulties in ambulating and unsteady gait. The overall health status of Mr. M was found to be deteriorating through the troubles he was experiencing such as failing to remember the names of his loved ones, failure to recall his room number, as well as repeating what he just said some minutes ago. The patient is quick of anger and appears fearful when in episodes of aggression. During the night, the patient gets lost frequently and often requires help to find his room. Furthermore, he frequently fails to perform his ADLs. From the objective data analysis of Mr. M, his blood pressure is found to be 123/78mmHg, an elevated pulse rate of 93, temperature of 37.10c, a 99% pulse oximetry at room air, and a slightly elevated respiratory rate of 22. From the laboratory tests that were conducted his lymphocytes recorded a 6700 (cells/uL) and 19.2 (1,000/uL) for the white blood cells. A CT scan was also done and found to have no changes compared to the previous one. A positive urinalysis for moderate leukocytes and cloudy was also conducted and the results were ALT 29 U/L, 7.1 g/dL and AST 32 U/L.

Primary and Secondary Medical Diagnoses to Consider

  • Urinary Tract Infection– From the laboratory results obtained of Lymphocytes 6700 (cells/uL), a 19.2 (1,000/uL) white blood cells as well as a positive urinalysis for moderate leukocytes and cloudy are good indicators of UTI (Ahmed et al., 2018). UTIs are also attributed to confusion, aggression, withdrawals and sudden behavioral changes portrayed by Mr. M.
  • Hypercholesterolemia- The presence of high levels of cholesterol in Mr. M’s blood is a good indicator of the disease which is evident from the laboratory results of AST 32 U/L, ALT 29 U/L and 7.1 g/dL. Also, Mr. M’s hypertensive condition exposes him at a higher risk of cardiovascular conditions development. Case Study Analysis Essay
  • Alzheimer’s Disease- AD is one of the common dementia health problem that most elderly patients develop. It is a condition that is characterized by features such as memory loss, inability to complete familiar tasks, loss of vision, inability to make proper decisions, misplacing of items and behavioral changes (Weller & Budson, 2018). Some of these cognitive problems are similar to what Mr. M has been experiencing in the last 2months. Alzheimer’s disease would therefore be a possible diagnosis.
  • Hypertension- M is currently utilizing the ACE inhibitors which are essential for management of hypertension. For quality and long term outcomes, there is need for the patient to educated on the importance of close monitoring of blood pressure (Ahmed et al., 2018). It is also essential for the patient to be educated on the dietary recommendations of patients with hypertension.

Abnormalities from nursing assessment

From the patient’s objective data, there is the presence of UTI abnormalities. The normal lymphocytes levels in males usually ranges from 1000 to 4800. However, in Mr. M’s case the lymphocytes levels were approximately 6700 (cells/uL) which is quite higher than the normal. Lymphocytes are synthesized in the bone marrow and play an important role in forming the body’s immune cells. The likely cause of the elevated levels of lymphocyte cells in Mr. M’s body is the body’s response to UTI.

The normal range of WBC in the body is usually 4500 to 1100 where he recorded 19.2 (1,000/uL) which is slightly elevated. The slight elevation is a good indicator of an inflammatory infection. The positive urinalysis for moderate levels of leukocytes and cloudy indicate a correlation with diagnosis of UTI (Ahmed et al., 2018). Elderly patients who present with multiple health conditions like in the case of Mr. M should thoroughly be assessed for cognitive impairment which might be as a result of endocrine derangements, depression, dementia, effect of drugs and delirium among others. Assessment of AD among older adults can be done in different ways but the standard one in a clinical setting is cognitive status which is evidenced by depression, cognitive impairment and impaired functioning.

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Physical, Psychological and Emotional Effects of Health Status on Family

Some of the effects of AD to any patient is impairment both physically and psychologically. The physical effects include inability to perform activities of daily life by the patient as well as loss of muscles which impact inability to withhold urine and bowel movement. There are multiple effects of AD both emotionally and psychologically. The most common feelings are however loneliness, fear, anger, apathy and aggression. In matters related to family members, the caregiver is associated with all the effects since their actions may trigger anger frustrations, fear or sadness to the patient (Brodaty & Donkin, 2022). The family also bears the treatment, care or even end of life costs which might impact family conflicts.  Case Study Analysis Essay

Interventions for Support

For the purpose of management of dementia, there are various medications that are utilized by such patients. The medications however slow the condition’s regression through reducing the intensity of the symptoms but not completely healing the disease. The medications also improve the quality of life for the patient as well as reducing the burden of the caregiver. Cognitive behavioral therapy (CBT) is also another intervention that has been proven to be efficient in management of cognitive and behavioral problems such as Alzheimer’s (Weller & Budson, 2018). The aim of the CBT is helping the patient to recognize and manage their symptoms while appropriately performing their daily routines.

Potential Problems for Mr. M

There are various possible problems that Mr. M might be suffering from. UTI is the first condition. When UTI stays untreated for long, it may impact life fatal impairments such as renal impairment or sepsis. Sepsis is further attributed to acute kidney injury, thus resulting to reduced kidney functioning. The other possible condition is Alzheimer’s which is attributed to dysphagia for solids and liquids which can further cause dehydration or delirium.  When a patient goes through severe dehydration, problems such as increased heart rate, confusion, speech difficulties among other generalized weaknesses may also develop. According to Weller & Budson, (2018), delirium in Alzheimer’s disease patients is associated with symptoms such as sudden behavioral changes, decreased energy levels, easy distraction and hallucinations.

References

Ahmed, H., Farewell, D., Jones, H. M., Francis, N. A., Paranjothy, S., & Butler, C. C. (2018).

Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in

older adults in UK primary care, 2004-2014. PloS one13(1), e0190521.

https://doi.org/10.1371/journal.pone.0190521

Brodaty, H., & Donkin, M. (2022). Family caregivers of people with dementia. Dialogues in

            clinical neuroscience. https://doi.org/10.31887/DCNS.2009.11.2/hbrodaty

Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and

treatment. F1000Research7. https://doi: 10.12688/f1000research.14506.1

Case Study Analysis Essay

 

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