Nursing

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.

ANSWER

Mr. M Case Study

Introduction

General health care and disease prevention require nurses to understand chronic and acute diseases and their effects on the human body. They also need to have a broad knowledge of treatment and medication used to address their signs and symptoms. Nurses have to demonstrate a great understanding of the biological and psychological abnormalities, clinical manifestations, and treatment procedures that influence the patients across different ages. This paper will examine the medical and health history of Mr. M and offer a critical analysis of his condition. There is a need to help patients with intense care needs, promote wellness and prevent illness.

Clinical Manifestations

Mr. M., a 70-year-old male, has a medical account of status post appendectomy, hypertension controlled with ACE inhibitors, hypercholesterolemia, and tibia fracture status post-surgical repair. He has limited physical activity linked to difficulty in unsteady gait and ambulating. Mr. M does not consume alcohol and is a non-smoker. The current medications consist of  Ambien 10mg PRN, Lipitor 40mg daily, Lisinopril 20mg daily, ibuprofen 400mg PRN, and Xanax 0.5 mg PRN. Over the last two months, the patient has been deteriorating quickly. For instance, he has the challenge of remembering names of family members and recalling the room number, and even retelling what he just said.

Mr. M is turning aggressive and agitated speedily. He seems to be fearful and afraid when he gets violent. During the night, he has been wandering and recurrently gets lost, requiring help to return to his room. Mr. M needs help with his activities of daily living, such as bathing, dressing, and feeding. Due to his rapid decline, the facility decided on order testing, which revealed that his normal temperature was 37 ℃, BP 123/78 HR 93 RR 22 Pox 99%, white blood count (WBC) of 19.2 (1000, /uL), and lymphocytes 6700 (cell/uL).

Primary and Secondary Diagnoses

Based on Mr.’s signs and symptoms, the likely primary diagnosis is Urinary tract infection. The urinary tract infection attacks any part of the urinary system, including ureters, kidneys, urethra, and bladder (Storme et al., 2019). The lab tests indicate an infection linked to the elevated white blood cells and leukocytes to 6700 (cell/uL), with the urine having a cloudy appearance. Urinary tract infection has presented symptoms and signs of urinary urgency, frequency, dysuria, leukocytosis, and elevated white blood cells.

For older adults such as MR. M, they present cognitive deficits such as mental confusion, impaired communication, anorexia, incontinence, and reduced functional status. Mr. M is finding it challenging to remember the names of his family members and cannot repeat words that he just read. His lab tests indicate signs of urinary tract infection due to an increase in the white blood cell count in the urine. The results also indicate positive results for leukocytosis, which means an inflammation or infection in the urinary tract.

The secondary diagnosis is Alzheimer which is a kind of dementia that impacts thinking, memory and behavior. The symptoms grow rapidly, such that they interfere with daily functions. Age is one of the greatest risk factors for Alzheimer’s. The majority of individuals at the age of 65 and above can be in the middle or late stage of Alzheimer’s. Therefore, the age factor is maybe why Mr. M might be experiencing the signs and symptoms of Alzheimer’s. The early signs of Alzheimer’s disease include memory impairment, difficulty in solving problems and planning, struggling to recall conversations or recent events, difficulty in completing familiar tasks, deteriorating vision and personality, and mood swings. Over the last two months, Mr. M has been showing signs related to Alzheimer such as the declined cognitive ability. He is finding it challenging to complete daily functions such as bathing, dressing, and feeding himself.

Expected Abnormalities

The nursing assessment can assess the expected abnormalities through the objective data. The objective and subjective data obtained during the nursing assessment would be effective in identifying abnormalities. The lab results indicate a white blood cell count of 19.2 (1000/uL), lymphocytes 6700 (cell/uL), cloudy, and protein 7.1 g/dL, AST 32 u/L, and ALT 29 u/L. Elevated white blood cells indicate UTI complications. The lab values for a patient with normal White blood cells are 4500 to 11000, while that of Mr. M is 1000. The immediate conclusion is that there is an inflammation or infection in the urinary tract. Normal adults record lymphocyte levels of around 1000 to 4800, while that of Mr. M is 6700. The high levels of lymphocytes could signal urinary tract infection. Cognitive disabilities could help in identifying the most probable disease in the diagnostic criteria. Typical signs such as burning or pain during urination, frequent urination and cloudy urine appearance are other abnormalities expected for a patient with a urinary tract infection. The abnormal lab values present have shown the expected abnormalities that indicate the presence of urinary tract infection.

Psychological and emotional effects

Urinary tract infection leads to emotional and psychological effects such as anger, anxiety, and aggression which tend to worsen in the last stage due to emotional distress. Patients may also experience sleep disturbances, verbal and physical outbursts. At some point, the patient experiences depressive symptoms and affective disorders, which lead to behaviors such as agitation and withdrawal (Ahmed, Farewell, Francis, Paranjothy, and Butler, 2018). Behavioral disturbances have been the most challenging for caregivers to deal with. For instance, acts of aggression are frightening to both the caregivers and the family. Sleep disturbance in patients with Urinary tract infection has adverse effects, including the probability of day-night reversal, agitation, and increased caregiver stress. Looking after a family member with a severe urinary tract infection can be increasingly stressful, and coping with this stress can lead to bodily issues such as loss of appetite, migraines, and fatigue. This leads to family members developing behavioral, psychological, and social problems of their own.

Interventions

Management of urinary tract infections involves patient education and pharmacologic therapy. Acute pharmacologic therapy is an ultimate medication for urinary tract infections. The antibacterial agent eliminates bacteria from the urinary tract with low effects. However, due to reinfection with a new bacteria, patients should also focus on long-term pharmacologic therapy, where patients begin therapy on their own when the symptoms reoccur. An education-based intervention program is essential in promoting preventive urinary tract infection behaviors (Ahmadi, Shamsi, Roozbahani, and Moradzadeh, 2020). For instance, the family members are educated on the management approaches for the infection, such as ensuring that the patient has drunk adequate amounts of fluids to facilitate renal blood flow and flushing out the bacteria from the urinary tract.

Potential Problems

Untreated UTI can lead to life-threatening complications such as permanent kidney damage and sepsis. The infection may spread and attack the kidneys, thus causing permanent damage, which will lower kidney function, thus the risk of kidney failure. The patient may also experience structure, functional and metabolic abnormalities such as diabetes, catheters, bladder abscesses, papillary necrosis, emphysematous pyelonephritis, and infected cysts (Storme et al., 2019).  Frequent urination may result in potential problems such as delirium and dehydration. This can result in increased heart rate, weakness, confusion, and challenge when talking.

References

Ahmadi, Z., Shamsi, M., Roozbahani, N., & Moradzadeh, R. (2020). The effect of an educational intervention program on promoting preventive behaviors of urinary tract infection in girls: a randomized controlled trial. BMC pediatrics, 20(1), 1-10.

Ahmed, H., Farewell, D., Francis, N. A., Paranjothy, S., & Butler, C. C. (2018). Risk of adverse outcomes following urinary tract infection in older people with renal impairment: Retrospective cohort study using linked health record data. PLoS medicine, 15(9), e1002652.

Storme, O., Tiran Saucedo, J., Garcia-Mora, A., Dehesa-Dávila, M., & Naber, K. G. (2019). Risk factors and predisposing conditions for urinary tract infection. Therapeutic advances in urology, 11, 1756287218814382.