Mr. M appears to be experiencing progressive dementia

Posted: February 15th, 2023

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.

Mr. M appears to be experiencing progressive dementia likely accelerated by an underlying urinary tract infection (UTI) based on the clinical findings presented in the case study. Over the past two months, the 70-year-old male resident of an assisted living facility has exhibited a rapid decline in cognitive functioning as evidenced by difficulty recalling family names and his room number, inability to repeat what he has just read, increased agitation, aggression, and fearfulness. He has also become dependent with activities of daily living like dressing, bathing, and feeding where previously he was independent.
The primary medical diagnosis that should be considered for Mr. M is dementia. Dementia is “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2022, para. 1). The progressive cognitive changes affecting Mr. M’s memory and orientation over a short period of time are suggestive of dementia. A secondary diagnosis of UTI should also be considered. UTIs are a common cause of delirium, especially in older adults, and can accelerate cognitive decline in those with preexisting dementia (Loeb et al., 2020). Mr. M’s urinalysis showing moderate leukocytes and cloudiness indicates the presence of bacteria or white blood cells in his urine, a classic sign of UTI (Mayo Clinic, 2022).
During a nursing assessment of Mr. M, abnormalities would be expected in his cognitive functioning, such as disorientation to time and place, inability to recall details from his medical history or recent events, and confusion. His vital signs may reveal an elevated temperature, increased heart rate, or changes in mental status indicative of an underlying infection exacerbating his condition (Loeb et al., 2020). Psychological assessment could find increased confusion, distress, withdrawal, or resistance to care related to his cognitive impairment and loss of independence.
Mr. M’s deteriorating health status is likely causing significant fear, anxiety, and emotional distress due to changes in cognition and loss of functional abilities. Physical decline from increased dependence could also lead to frustration (Alzheimer’s Association, 2022). His family is undoubtedly experiencing high levels of emotional stress, feelings of guilt or grief over watching his rapid deterioration over a short period of time. They require support to process these emotions in a healthy way.
Interventions that could help Mr. M and support his family include treatment of any underlying medical issues like UTI with a course of antibiotics based on culture and sensitivity results (Loeb et al., 2020). Non-pharmacological approaches should be tried initially to manage behavioral and psychological symptoms like agitation, including music therapy, reminiscing, or simple activities. Increased supervision and assistance is needed for activities of daily living. Involving family members in his care through visitation and care conferences can provide comfort and familiarity to Mr. M. Referral to dementia care specialists, support groups, and care planning with family is also recommended.
Potential problems Mr. M faces without appropriate interventions and support include risk for further functional and cognitive decline, falls, injury from agitation or aggression, social isolation, non-adherence to treatment, and increased caregiver stress impacting his family. Financial issues may also arise with the need for enhanced care (Alzheimer’s Association, 2022). Close monitoring and a comprehensive care plan are needed to address Mr. M’s medical, functional, safety, emotional and social needs, along with support for his family caregivers during this difficult time.
In conclusion, Mr. M appears to be experiencing progressive dementia exacerbated by an underlying UTI based on the clinical findings presented. A multidisciplinary assessment and individualized treatment approach involving both medical management and psychosocial support are required. With treatment of any precipitating factors, optimized management of behaviors, and involvement of his family in decision making and care, Mr. M’s quality of life and functioning can hopefully be maintained.
Alzheimer’s Association. (2022). What is dementia? Symptoms, causes, types & diagnosis. https://www.alz.org/alzheimers-dementia/what-is-dementia
Loeb, M., Carusone, S. C., Goeree, R., Walter, S. D., Brazil, K., Krueger, P., Simor, A., & Marrie, T. (2020). Effect of a clinical pathway to reduce hospitalizations in nursing home residents with urinary tract infections: A randomized controlled trial. JAMA, 323(13), 1279–1287. https://doi.org/10.1001/jama.2020.1619
Mayo Clinic. (2022). Urinary tract infection (UTI). https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447