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. Clinical Manifestations.
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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. Clinical Manifestations. 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. Clinical Manifestations. 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. Clinical Manifestations. 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. Refer to the LopesWrite Technical Support articles for assistant. Clinical Manifestations.
Clinical Manifestations for Mr. M
The clinical manifestations for the patient include memory loss; inability to perform activities of daily living; wandering off and getting lost; being fearful; aggression and agitation. Other clinical manifestations include an increased pulse rate of 93 and a slightly increased respiration rate of 22. The urinalysis findings are positive for leukocytes and cloudy, and protein 7.1 g/dL, ALT 29 U/L, and AST 32 U/L. Clinical Manifestations.
Primary and Secondary Diagnosis
The primary diagnoses for this patient include Alzheimer’s disease (AD) and urinary tract infection (UTI). The most common early sign of Alzheimer’s disease is forgetfulness and this is present in the patient. Other symptoms include challenges in planning; difficulties in completing daily tasks; speech or writing problems; inability to retrace steps; social withdrawal; changes in decision-making and poor judgment; and changes in mood and personality as characterized by being fearful, suspicious, confusion, agitation, or depressed mood (Frozza et al., 2018). The patient manifests the majority of these symptoms and thus fits the diagnostic criteria of Alzheimer’s disease. The primary diagnosis of UTI is supported by urinalysis findings being positive for leukocytes and cloudy, and protein 7.1 g/dL, ALT 29 U/L, and AST 32 U/L. Clinical Manifestations.
The secondary diagnoses for Mr. M include hypercholesterolemia, hypertension, tibial fracture status postsurgical repair, and status post appendectomy. These are conditions require attention but are not the primary diagnoses since the patient has been managing them using the prescribed treatment regimen. Clinical Manifestations.
Nursing assessment will include the use of cognitive assessment tools to identify the cognitive deficits for this patient. The expected abnormalities include language and speech deficits; memory impairment; poor judgment; and confusion. These abnormalities are expected because they are the definitive characteristics of Alzheimer’s disease (Frozza et al., 2018). It is also expected that Mr. M will have problems when it comes to orientation to place and time; writing; calculations; concentration problems; problems with executing; personality change; disorganization; and inability to follow social rules. The rationale for this is because multiple cognitive deficits like aphasia, memory impairment, apraxia, problems in executive functioning, and agnosia are typified by steady onset and ongoing cognitive decline in Alzheimer’s disease (Frozza et al., 2018). Clinical Manifestations.
The Physical, Psychological, and Emotional Effects and Impact on the Family
The mental and personality changes associated with AD affect the patient and the family as well. For example, with the AD diagnosis, Mr. M will lack insight into the physical and intellectual deficits he suffers and this will alter his social role within the family. The patient may feel frustrated and angry because of the feeling of loss of control and loss of autonomy (Alqahtani et al., 2018). Additionally, Mr. M may develop anxiety and depression due to the diagnosis and the ensuring symptoms as well as social withdrawal associated with AD. Evidence indicates that the majority of patients diagnosed with AD suffer from depression (Alqahtani et al., 2018). physically, Mr. M will not be able to carry out the usual activities of daily living. Clinical Manifestations.
The condition is also likely to significantly impact the family as well. The family members will serve as caregivers for Mr. M and this will lead to increased responsibilities. The family may also have feelings of fear and anxiety when it comes to handling Mr. M. Patients with AD are often anxious, irritable, confused, and required supervision and thus the family with have to deal with these new changes. Some family members are thus likely to experience caregiver stress. According to Molnar & Frank (2018), caregivers of individuals with AD have an increased incidence of depression due to the physical and emotional stress associated with the caregiving role to AD patients. Clinical Manifestations.
Interventions to Support Mr. M. and His Family
Social support: Both Mr. M and the family should be provided with the appropriate support from the relatives and healthcare providers. Additionally, the patient and the family can be referred to the available local support groups for people with Alzheimer’s disease. Mr. M and the family can get an opportunity to interact with other individuals and families going through the same experiences. Clinical Manifestations.
Provide supportive information to the caregivers: The family members interacting with Mr. M as his caregivers. Therefore, they must be provided with supportive information and ongoing feedback. The family members should be advised to avoid being confrontational and negative with Mr. M (Molnar & Frank, 2018).
Validation therapy: The family should be advised to use communication techniques that build a calm, close, and a caring environment for Mr. A. The objective is to make him feel safe, understood, and comfortable (Alqahtani et al., 2018). The family should avoid being judgmental towards his behavior but accept him and his feelings, as he is. Clinical Manifestations.
Four Actual or Potential Problems facing Mr. A
Changes in communication skills: Due to the memory impairment and deficits in critical thinking, Mr. M may experience difficulties during communication
Changes in personality behavior: This is attributable to the continuous damage of the brain cells and thus resulting in behavioral changes (Guan et al., 2019)
Depression: Mr. A is likely to experience depressive symptoms because of the fears, anxiety, and frustration associated with AD and its management
Non-adherence to the treatment regimen: Symptoms such as memory loss may impact his ability to adhere to treatment, including taking medications for hypertension
Stigmatization from the community: Lack of awareness of the disease may make Mr. M to be misjudged by individuals who do not understand his condition (Frozza et al., 2018). Clinical Manifestations.