Pathophysiology and Nursing Management of Client’s Health.

Pathophysiology and Nursing Mgt of Client’s Health. Evaluate the Health History and Medical Information for Mr. M., presented below…

Pathophysiology and Nursing Management of Client’s Health.

Introduction

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

1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. 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:

1. Describe the clinical manifestations present in Mr. M.
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.
3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
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.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
6. 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

Critical Evaluation of Mr. M.’s Situation

Solution

            When offering healthcare services to a patient, the information collected using various means and methods becomes crucial in guiding and directing care. Initial encounters comprise asking the patient their medical history reinforced by a review of health history toupdate the same with changes deemed necessary.

For patients living in assisted living facilities, getting the individual’s medical history may reveal relevant chronic illnesses and other disease states in which the patient may not be taking medications, but that are bound to have lasting effects on the patient’s health in context.

As such, healthcare providers should take a complete health history and medical information to get more insights on the medical issues of the patient that capture all illnesses and diseases currently under medication and management and those that have a residual impact on the health of the patient. Consequently, this paper performs a nurse evaluation of the selected patient’s health history and medical information.

Summary of the Case Scenario

            The selected patient is Mr. M, a 70-year-old male living in an assisted living facility where I work. The patient does not smoke, neither does he take alcohol. He has limited physical activity connected to movement and an unsteady gait. His medical history indicates hypertension controlled using ACE inhibitors, hypercholesterolemia, and a tibia fracture with no signs of complications.

The patient’s current medications are Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN. However, over the last two months, the patient’s has been deteriorating as he has trouble recalling names and even forgets his room number. He gets agitated easily and appears to be afraid and fearful when aggressive.

He has been found wandering at night and often gets lost, requiring help to get back to his room. He has become dependent on many ADLs contrasting this with a few months ago when he could dress, bathe and feed himself. Lab tests ordered by the ALF return findings of a temperature of 37.1, a low-grade fever, lower blood pressure at 123/78, a normal heart rate, and a respiration rate above normal at 22.

The pulse oximeter readings are also normal at 99%. Other lab results like the WBC and lymphocytes are unremarkable as both fall within the normal range of 198.2 (1000/uL and 6700(cells/uL), respectively, as does the CT head. The urinalysis results should be investigated further since it was cloudy and was positive for a moderate amount of leukocytes, a key indicator of urinary tract infection.

Description of the Clinical Manifestations Present in Mr. M

            The patient presents with clinical signs and symptoms associated with Alzheimer’s disease. AD is the most common type of dementia clinically manifesting with multiple presentations like memory loss. Severe loss of memory and confusion do not constitute a normal part of the aging process, although forgetfulness can be triggered by stress, anxiety, and depression in old age (Rature et al., 2017).

These researchers further note that anxiety and getting agitated common for individuals suffering from AD, as do the patient’s confusion with the place that causes the patient to get lost within the ALF easily. Mr. M constantly keeps on wandering at night, gets lost, and has to be guided back to his room.  

With time the patient has had difficulties recalling the names of his loved ones, while short-term memory also seems to have taken a toll because Mr. M cannot repeat sentences that have been read to him a little while ago. At this juncture, it is essential to acknowledge that AD has several other symptoms, but the limited scope of the paper highlights the patient’s difficulties in dressing with buttoning and unbuttoning clothes, becoming a challenge during the mid and late stages of AD due to a decline in motor skills.

Primary And Secondary Medical Diagnoses Should Be Considered For Mr. M

            The information presented in the case scenario points to a primary medical diagnosis of AD, with the physician having to use several methods and tools to establish whether the individual with memory difficulties has possible AD dementia. Silva et al. (2019) opine that AD has acquired risk factors like hypertension and hypercholesterolemia besides advancing age, both of which increase the risk of an individual developing AD.

It is instructive that Mr. M has these two comorbidities making AD the primary medical diagnosis. The secondary medical diagnosis for the patient is anxiety and panic disorder. This is because the patient seems afraid and fearful when he gets agitated for no plausible causes (Turner et al., 2020). The differential diagnosis would help to make a definitive diagnosis for AD.

Abnormalities One Would Expect To Find When Performing a Nursing Assessment

            Contemporary health practice acknowledges that patients’ health assessments fall under the purview of physicians and nurses. However, whether the nurse will conduct a comprehensive health assessment, abbreviated or interval health assessment, focused health assessment, or special population health assessment, some abnormalities indicate a particular disease.

In the case of AD, some of the abnormalities would include irritability, difficulty in repeating phrases slowed physical movement compared to how Mr. M was doing before the onset of AD symptoms two months previously. Other abnormalities would be loss of cognition with the inability to perform even simple arithmetic problems. This is because AD causes progressive degeneration of neural cells (Chi et al., 2018).

The Physical, Psychological, And Emotional Effects of Mr. M’s Current Health Status on Him and His Family and the Interventions to Support them

            Grather (2018) notes that the development and progression of AD physically impairs the patient’s motor skills like movement, while on the psychological front, the patient experiences more significant loss of memory and cognitive issues manifesting wandering, getting lost, and handling money bills, amongst others. Emotionally, the patient gets agitated quickly and gets afraid for no specific reason.

On the other hand, the family members caring for the patient get physically exhausted, become stressed, and like the patient family members could also experience strain, frustration, stress, or even depression. To support the patient and his family. To prevent or slow down AD progression, the patient is advised to maintain an appropriate weight, control the blood pressure and get daily exercises, amongst others

. In addition, taking supplements like Vitamins B12, C, E and D significantly helps to decrease the risk of AD. Mr. M’s family is also supported through education on stress coping skills, how to deal with an AD patient compassionately, and joining support groups.

Four Actual or Potential Problems Mr. M Faces

            The four A’s of AD (namely amnesia, aphasia, apraxia, and agnosia) concisely summarize the problems Mr. M is already experiencing or will encounter in the future. Amnesia or memory loss conventionally begins with short-term memory loss, and this is a challenge to the patient because adherence to current medication needed to manage high blood pressure and high blood cholesterol could have devastating effects on his health.

Aphasia or impaired communication means the patient cannot only find the right words to express themselves but are also unable to understand, receive , and interpret  what others tell them, leading to strained relations and poor patient satisfaction. The third challenge for Mr. M is apraxia due to a deficit in voluntary motor skills. This implies that physical activities to control hypertension are also hampered.

The impaired physical ability functioning could progress to a state when even eating is a challenge.  Lastly, agnosia manifests with a marked inability to receive or appropriately understand information from the common senses like vision, hearing, smell, taste, and touch. For example, the inability to understand the feeling of a full bladder would challenge the patients’ hygiene that could further cause more health issues.

Conclusion

            In conclusion, this essay has determined that the patient in the case scenario is likely to experiences the symptoms of AD before diagnosis, as evidence by the four groups of symptoms categorized in groups of amnesia,aphasia, apraxia, and agnosia.  Likewise, offering support to the AD patient and their families should similarly take four pillars to prevent and slow down AD development through diet and supplements, ensuring psychological well-being, yoga/ meditation, and physical and mental exercise.

References

Bature, F., Guinn, B. A., Pang, D., & Pappas, Y. (2017). Signs and symptoms preceding the diagnosis of Alzheimer’s disease: a systematic scoping review of literature from 1937 to 2016. BMJ Open, 7(8).

Giebel, C. (2020). Current dementia care: what are the difficulties, and how can we advance care globally?.

Grabher, B. J. (2018). Effects of Alzheimer’s disease on patients and their family. Journal of nuclear medicine technology, 46(4), 335-340.

Silva, M. V. F., Loures, C. D. M. G., Alves, L. C. V., de Souza, L. C., Borges, K. B. G., & das Graças Carvalho, M. (2019). Alzheimer’s disease: risk factors and potentially protective measures. Journal of biomedical science, 26(1), 1-11.

Turner, R. S., Stubbs, T., Davies, D. A., & Albensi, B. C. (2020). Potential new approaches for diagnosis of Alzheimer’s disease and related dementias. Frontiers in neurology, 11, 496.