Description Of The Clinical Manifestations Paper

Description Of The Clinical Manifestations Paper

Case Study: Mr. M.

Mr. M is a 70-year-old male residing in an assisted facility. He is a known hypertensive and hypercholesterolemic patient with limited physical activity attributed to an unstable gait caused by a previous tibial fracture repair. He has deteriorated over the last few months and currently presents with a condition known as agnosia, in which an individual is not able to acknowledge and identify people or objects, or sounds using their normal functioning senses (Kumar & Wroten, 2022). This is evidenced by an inability to recognize his family members’ names, trouble recalling his room number, and the most immediate content of what he read. Moreover, he presents with features consistent with dementia, including impaired intellectual functions, impaired memory, emotional lability, and deterioration of personality with lack of personal care (Arvanitakis et al., 2019). This is evidenced by complete dependence on others for activities of daily living (ADLs),  frequently getting lost, inability to find his way home, dress, bathe and feed himself, agitation, and aggressiveness. From the objective data, pleocytosis with a lymphocyte predominance together with turbid urine and moderate leukocytosis is suggestive of an infectious process.

Primary and Secondary Diagnoses and Rationale

The primary diagnosis for Mr. M is dementia, a chronic mental disorder characterized by impairment of intellectual functions, recent memory, and deterioration in personality (Arvanitakis et al., 2019). This is justified by the evidence of a decline in both memory and thinking, sufficient enough to impair personal activities of daily living such as feeding, bathing, personal care, and emotional lability, as is true for Mr. M. The secondary diagnosis is hypertension, hypercholesterolemia to which he is on Lisinopril and Lipitor respectively and urinary tract infection evidenced by pleocytosis and cloudy urine.

Nursing Assessment and Expected Abnormalities

The nursing assessment range from the physical appearance of the patient to systemic features and vital signs. Systemically, Mr. M is likely to present with disorientation in time, place, and person and emotional lability due to memory impairment affecting registration, storage, and retrieval of new information. Moreover, he may also present with a shortened limb and unsteady gait due to a previous tibial fracture. Physically, he may appear obese or overweight from his basal metabolic index (BMI of 27.92 kg/m2), unkempt due to lack of personal care associated with dementia, and impaired social and visuospatial skills attributed to global deterioration of mental functions. The vital signs have been provided and are within the normal ranges for age. Fever may be present, depicting an ongoing infectious process; a urinary tract infection.

Physical, Psychological, and Emotional Effects of Mr. M’s Current Health Status.

Physically Mr. M’s tibial fracture and limb shortening are likely to compromise his activities of daily living, including mobility, exercising, driving, and performing daily chores. Furthermore, it can render him bed-ridden or in a wheelchair predisposing him to the adverse effects of immobility that include deep venous thrombosis, pulmonary embolism, thrombo-embolic stroke, and hypostatic pneumonia (Singaram & Naidoo, 2020). To the family, they are likely to bear the consequences of Mr. M’s condition both monetary and time-wise by buying a wheelchair and hourly turnings to prevent the development of pressure sores.

Psychologically and emotionally, dementia is likely to cause fear, anxiety, denial, depression, apathy, hallucinations, disinhibition, and sleep and appetite changes to Mr. M, as already illustrated in his presentation (Scott, 2022). On the other hand, the family members are likely to experience a lack of understanding, guilt, and a sense of loss.

Interventions to Support Mr. M and His Family

Mr. M can benefit from pharmacological and non-pharmacological treatments for his dementia. Pharmacologically, Food and Drug Administration (FDA) has approved drugs for Alzheimer’s disease dementia, yielding symptomatic benefits for cognitive symptoms. These drugs include donepezil, rivastigmine, and galantamine. Non-pharmacological approaches basically form the basis of treatment and include physical exercise, cognitively stimulating activities such as reading, training on good personal hygiene, social interactions, and family financial planning.

The pre-existing comorbidities, including hypertension and hypercholesterolemia, are managed with Lisinopril and Lipitor, respectively. Insomnia is managed with Ambien PRN, and anxiety is managed with Xanax PRN. A prescription for Cephalexin 500mg QDS daily for three days is adequate to treat the likely urinary tract infection. Nevertheless, physiotherapy provides optimal support for tibial fracture and dementia patients with pain, pressure sores, urinary incontinence, and pressure ulcers.

Active or Potential Problems

Mr. M’s current health situation poses him with several active or potential problems. He is unable to perform ADLs due to his impaired mental functions. Furthermore, he is physically immobile due to a tibial fracture. This predisposes him to chest infections, thromboembolic stroke, pulmonary embolism, deep venous thrombosis, and pressure sores. Physical immobility further worsens his comorbid conditions due to lack of exercise. With the progression of dementia, he is more likely to develop urinary incontinence and disorientation in time, place, and person due to impaired cognition.

Conclusion

Gender and aging form the most critical aspects of non-modifiable risk factors of any disease process. Mr. M is a victim of these variables. The comorbidities, which include hypertension and hypercholesterolemia, are most probably due to his age and gender. Even with his comorbidities under control, he develops dementia and urinary tract infection that largely compromises his quality of life. This commands optimization of his comorbidities and treatment of the new conditions both pharmacologically and non-pharmacologically. Notably, the interventions used to manage dementia patients are primarily supportive rather than curative and include cognitive skills training and social interactions.

 References

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia: Review. JAMA: The Journal of the American Medical Association, 322(16), 1589–1599. https://doi.org/10.1001/jama.2019.4782

Kumar, A., & Wroten, M. (2022). Agnosia. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493156/

Scott, H. (2022). The changing self: The impact of dementia on women’(findings from the Improving the Experience of Dementia and Enhancing Active Life programme). Dementia (London, England), 21(2), 503–518. https://doi.org/10.1177/14713012211047351

Singaram, S., & Naidoo, M. (2020). The physical impact of long bone fractures on adults in KwaZulu-Natal. The South African Journal of Physiotherapy, 76(1), 1393. https://doi.org/10.4102/sajp.v76i1.1393

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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.