Case Study: Mr. M.
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.
Expert Solution Preview
Introduction:
Mr. M. is a 70-year-old male residing in an assisted living facility, presenting with clinical manifestations of cognitive impairment, behavioral changes and decline in activities of daily living. In this critical thinking essay, we will evaluate Mr. M.’s situation and discuss potential primary and secondary medical diagnoses, nursing assessments and impact on physical, psychological and emotional health. Additionally, we will provide interventions and identify actual or potential problems that Mr. M. faces.
1. Describe the clinical manifestations present in Mr. M.
Mr. M. presents with cognitive decline, confusion, memory loss, wandering, agitation, aggression and fearfulness. He is becoming increasingly dependent on ADLs and has difficulty ambulating. Furthermore, he is found wandering at night and is unable to remember his room number or recognize his family members.
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.
Primary medical diagnoses that should be considered for Mr. M. include dementia, delirium, and Alzheimer’s disease. The presence of cognitive decline, short-term memory loss, and confusion, along with wandering and behavioral changes, are the hallmark clinical features of these conditions. Secondary medical diagnoses such as urinary tract infections or metabolic disturbances like hyponatremia and hypoglycemia should also be considered because they can exacerbate Mr. M.’s cognitive decline and behavioral changes.
3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
During a nursing assessment of Mr. M., abnormalities that we might find include cognitive and behavioral changes, memory loss, confusion, aggressiveness, fearfulness and anxiety. Additionally, we would expect to find changes in physical functioning and ADLs, including poorer mobility and dependence on caregivers. We might also find signs of depression or apathy, which are frequently seen in elderly patients with cognitive decline.
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.
Mr. M’s current health status may cause physical harm due to his wandering, leading to falls or other injuries. Psychologically, his cognitive decline and fearfulness can cause distress and confusion, leading to depression, anxiety or agitation. Emotionally, he may feel frustrated, helpless, or trapped, leading to a sense of helplessness and disorientation. His family may also experience emotional and psychological distress, including feelings of guilt, stress, anxiety, fear, and frustration. They may also be required to provide additional support and care.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
Interventions for Mr. M. include a comprehensive cognitive and functional assessment to identify the root cause of his cognitive decline and his behavioral changes. Treatment should be focused on the underlying conditions like dementia, Alzheimer’s disease or delirium. Activities and exercises that stimulate cognitive function and engagement can also be implemented to improve cognition and decrease anxiety. Practical interventions like supervision, safety measures, and use of visual cueing devices can help reduce wandering and agitation. For the family, education, and support are critical.
6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.
Mr. M. faces several potential problems including increased risk of falls resulting in physical injuries, communication barriers due to cognitive decline, social isolation because of withdrawal and changes in behavior, and disruption of his routines and activities of daily living. These problems are consequential because they can compromise his safety, well-being and his overall quality of life. Additionally, they can exacerbate his cognitive decline and cause further emotional distress.
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