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. Get custom essay samples and course-specific study resources via course hero homework for you service – 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. Ace my homework – Write my paper – Online assignment help tutors – Discuss the impact it can have on his family.
Ace my homework – Write my paper – Online assignment help tutors – 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 Ace homework tutors – APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. I need help writing my essay – research paper review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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Clinical Manifestations Present in Mr. M:
Based on the information provided, the key clinical manifestations present in Mr. M include cognitive decline, memory loss, agitation, aggression, wandering behavior, loss of independence with activities of daily living, and rapid deterioration over the past 2 months. Specifically, he has trouble recalling names of family members and his room number. He also has difficulty repeating what he has just read. He appears afraid and fearful when he becomes agitated or aggressive. He has also been found wandering at night and frequently gets lost, needing assistance to return to his room. Additionally, he has become dependent with dressing, bathing, and feeding himself, whereas a few months ago he was fully independent with these activities.
Primary and Secondary Medical Diagnoses to Consider:
The primary medical diagnosis that should be considered based on Mr. M’s presentation is dementia. The rapid cognitive and functional decline, memory loss, disorientation, and behavioral changes are consistent with a dementia process. Specifically, based on the onset and progression of symptoms between 2-6 months, Alzheimer’s disease should be strongly considered as the cause of the dementia. Secondary diagnoses that may be contributing to or exacerbating the dementia include depression, given his increased agitation, aggression and fearfulness. His urinalysis also showed moderate leukocytes and cloudiness, so a urinary tract infection should also be ruled out as a potential secondary diagnosis, as infections can worsen cognitive symptoms in older adults with dementia.
Expected Abnormalities on Nursing Assessment:
On physical examination, I would expect the nurse to find signs of poor self-care like poor hygiene, disheveled clothing, and weight loss from inability to feed himself independently. Neurologically, the nurse may observe confusion, disorientation to time/place, short-term memory impairment, and difficulty following simple commands or repeating phrases. Behaviorally, the nurse should assess for signs of agitation, aggression, wandering tendencies, and fearfulness. The nurse should also evaluate his functional status and note dependence with activities like bathing, dressing, toileting and eating. Vital signs may show signs of dehydration, infection or other underlying medical issues contributing to his decline.
Effects on Physical, Psychological, and Emotional Well-Being:
The progression of Mr. M’s dementia has likely taken both a physical and psychological toll. Cognitively, he is no longer able to care for himself or remember basic facts. Emotionally, he appears afraid, distressed by his confusion and declining abilities. This loss of independence and cognitive changes can damage self-esteem and quality of life. His family is also psychologically and emotionally impacted, experiencing grief over his losses as well as stress from caring for him. They may feel guilt, sadness or anger over his condition. Physically, his functional and nutritional status have declined from inability to complete ADLs. Proper support is needed to maintain his dignity and quality of life.
Interventions to Support Mr. M and his Family:
Nursing interventions should include comprehensive assessment and care planning with his medical provider to address potential underlying or exacerbating issues. Enhanced supervision is needed given his wandering and getting lost. Reminiscence therapy, reality orientation, consistent routines and labeling may help reduce confusion and agitation. His family requires education on dementia, communication strategies, and caregiver self-care. Referrals to community resources can help provide respite and support. Medications may help address behavioral symptoms if nonpharmacological options prove insufficient. Maintaining function through exercises and engaging activities is important for well-being. A palliative care approach focusing on comfort should guide decisions about interventions and placement if needed.
Actual or Potential Problems Faced:
Wandering and getting lost pose safety risks like falls or elopement from the facility. 2. Physical decline from inability to complete ADLs independently risks health issues like pressure ulcers, infections or malnutrition. 3. Agitation and aggression endanger himself and caregivers and worsen the stress of his condition. 4. Lack of understanding of his confusion can lead to frustration for Mr. M and inappropriate responses from untrained staff. 5. Financial costs of long-term care and lack of community support strains his and his family’s resources. 6. Loss of independence, identity and cognitive abilities threatens his dignity and psychological well-being. 7. Guilt and stress on family caring for him without adequate education and respite increases risk for poor health outcomes.
In conclusion, Mr. M appears to be experiencing progressive dementia likely due to Alzheimer’s disease. A comprehensive evaluation and care plan is needed to address his medical, functional, safety, behavioral and psychosocial needs along with support for his caregivers. Maintaining quality of life and dignity in light of cognitive and physical losses is paramount.
References:
Alzheimer’s Association. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 15(3), 321–387. https://doi.org/10.1016/j.jalz.2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers.01.010
Brummel-Smith, K. (2020). Comprehensive geriatric assessment. Clinics in geriatric medicine, 36(1), 1–17. https://doi.org/10.1016/j.cger.2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers.08.001
Cohen, M. N., & Eisdorfer, C. (Eds.). (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). The loss of self: A family resource for the care of Alzheimer’s disease and related disorders. WW Norton & Company.
Gitlin, L. N., & Hodgson, N. (Eds.). (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Care for the family caregiver: A guide to helping informal caregivers of older adults. Springer Publishing Company.
Piersol, C. V., Jensen, H. I., & Ashcraft, A. S. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Optimizing care for persons with Alzheimer’s disease and related dementias: An integrated approach. American family physician, 98(2), 96-103.
RUBRIC
Attempt Start Date: 23-Sep-2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers at 12:00:00 AM
Due Date: 29-Sep-2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers at 11:59:59 PM
Maximum Points: 120.0
Case Study: Mr. M.
No of Criteria: 11 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less Than Satisfactory75.00 %Satisfactory79.00 %Good89.00 %Excellent100.00 %Content80.0 Clinical Manifestations of Mr. M.10.0Clinical manifestations are omitted.Clinical manifestations are partially presented. There are major omissions and inaccuracies.Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.Diagnoses and Secondary Diagnoses10.0A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is omitted; or, medical diagnoses presented are inaccurate.A partial discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. There are major inaccuracies. Rationale and evidence for the diagnoses are lacking.A general discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. There are some inaccuracies. A summary provides some rationale and evidence to explain why the diagnoses are relevant.A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. General rationale and relevant data are used to explain why the diagnoses should be considered. There are minor inaccuracies.A detailed discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. Strong rationale and reliable data are used to explain why the diagnoses are relevant and should be considered.Explanation of Expected Abnormalities During Nursing Assessment15.0A discussion of what abnormalities a nurse would expect to find during a nursing assessment is omitted; or, the expected findings are not relevant for the patient or his health status.An incomplete summary of some abnormalities a nurse would expect to find during a nursing assessment is presented. There are inaccuracies. No rationale or evidence is provided for support.A general discussion on the abnormalities a nurse would expect to find during a nursing assessment is presented. There are minor inaccuracies. Some rationale or evidence is provided for support.A discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. General rationale and evidence are provided for support.A thorough discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. Strong rationale and evidence are provided for support.Effects of Health Status on Physical, Psychological, and Emotional Aspects of Patient and Family15.0The effects of the health status on the physical, psychological, and emotional aspects of the patent, and the impact the health status has on the family, are omitted.The effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, are partially summarized. The effects presented are questionable, and support for the discussion is not provided.The effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, are summarized. Overall, the described effects on the patient and impact to the family are relevant. Some support for the discussion is provided.A discussion of the effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, is presented. Support for the discussion is provided.A thorough discussion of the effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, is presented. Strong support for the discussion is provided.Interventions for Support15.0Interventions that can be put into place to support Mr. M. and his family are omitted.Some interventions that can be put into place to support Mr. M. and his family are partially presented. More information is required.Some interventions that can be put into place to support Mr. M. and his family are summarized. There are minor inaccuracies.Key interventions that can be put into place to support Mr. M. and his family are discussed. Some detail is needed for clarity.All relevant interventions that can be put into place to support Mr. M. and his family are thoroughly discussed.Actual or Potential Problems Based on Condition15.0Fewer than three actual or potential problems faced by the patient are presented. The problems posed are not relevant to his condition.Three actual or potential problems faced by the patient are partially presented. It is unclear how some of the posed problems are relevant to his condition. There are inaccuracies.At least four actual or potential problems faced by the patient are summarized. The posed problems are generally relevant to his condition. There are minor inaccuracies. Some information or rationale is needed.Four or more actual or potential problems faced by the patient are discussed. The posed problems are relevant to his condition. Rationale provided generally supports the discussion.Four or more actual or potential problems faced by the patient are thoroughly discussed. The posed problems are clearly related to his condition. Strong rationale is provided and supports the discussion.Organization, Effectiveness, and Format20.0 Thesis Development and Purpose5.0Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction5.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.Ace my homework – Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)2.0Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)3.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage 100
