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. 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.
Expert Solution Preview
Introduction:
Mr. M. is a 70-year-old male living at an assisted living facility, presenting with cognitive decline, difficulty ambulating, and dependence on activities of daily living (ADLs). The objective data shows leukocytosis, cloudy urine, and elevated protein and liver function tests.
1) Describe the clinical manifestations present in Mr. M.
Mr. M. presents with cognitive decline, including difficulty recalling names and room numbers, forgetting what he has just read, and becoming agitated and aggressive quickly. He also has difficulty ambulating and is now dependent on many ADLs. These symptoms suggest a neurological or cognitive impairment.
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.
Primary diagnoses that should be considered for Mr. M. include dementia and delirium, which may require further testing such as a CT scan or MRI. Secondary diagnoses may include urinary tract infection (UTI), as evidenced by the positive urinalysis and leukocytosis, and medication side effects, due to the use of Xanax and Ambien. The elevated liver function tests could also indicate liver disease or medication toxicity. These diagnoses are supported by the objective data presented.
3) When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
During the nursing assessment, abnormalities that may be identified include cognitive deficits, gait abnormalities, and dependence on ADLs. The presence of confusion, agitation, and aggression can also be observed. These abnormalities are consistent with the clinical manifestations presented and may suggest underlying neurological or cognitive impairment.
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.
Mr. M.’s current health status may negatively impact his physical, psychological, and emotional well-being. He may experience frustration, embarrassment, and loss of independence due to his dependence on ADLs. His cognitive decline may cause confusion, agitation, and aggression, leading to social isolation and poor quality of life. His family may experience emotional distress and caregiver burden due to the sudden decline in Mr. M.’s health.
5) Discuss what interventions can be put into place to support Mr. M. and his family.
Interventions that can be put into place to support Mr. M. and his family include medication adjustments to minimize side effects, management of underlying medical conditions, such as UTI, and cognitive rehabilitation programs to improve cognitive function. Physical therapy can also be initiated to improve gait abnormalities and physical independence. Emotional support and counseling may be necessary for Mr. M. and his family to cope with the impact of his disease.
6) Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.
Mr. M. faces several actual or potential problems, including cognitive decline, loss of independence, social isolation, and increased risk of falls. The cognitive decline may impact his ability to perform ADLs and lead to further decline. The loss of independence may lead to frustration and depression. Social isolation may occur as a result of agitated and aggressive behavior, leading to a reduced quality of life. Finally, gait abnormalities increase the risk of falls, which can lead to further injury and decline in health.
