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Pathophysiology and Nursing Management in Client Health: Case Study Assignment Help

Pathophysiology and Nursing management in Client Health

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

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

1. Describe the clinical manifestations present in Mr. M.

1. 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.

2. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.

3. 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.

4. Discuss what interventions can be put into place to support Mr. M. and his family.

5. 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.

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Case Study 2 

In the current essay the case study of Mr. M is discussed who has been suffering from rapid denigration of his mental health. Early Identification of the symptoms and the underlying cause forms the basis of the effective management and a good prognosis. The steps involving diagnosis and the analysis of the potential clinical manifestations that may lead to acute conditions are discussed to demonstrate the understanding of the pathophysiology of the disease

Medical Diagnoses

Mr. M showed a slight elevation in the body temperature 37.1o C indicating a low-grade fever. His medical history reveals the existing health complications such as hypercholesteremia currently regulated by the usage of Lipitor. Mr. M also has hypertension however, the blood pressure reading obtained showed a value of 123/78 within the normal range. This is achieved by a ACE inhibitor Lisinopril.  Primary diagnosis includes the analysis of the deteriorating condition of the patient which in this case is the lack of mind-body coordination, poor memory retention, in addition to that agitated attitude towards self and other surrounding him. A CT-scan and an MRI scan would reveal any abnormalities in the functionality of the brain. Markers for the inflammation in the brain and speech capacity, spatial orientation should be assessed. Any physical injury that was unreported should be checked for. This aids in the understanding the sudden onset of the poor memory (dementia) and uncoordinated behavior of Mr.M 

As a part of secondary diagnosis, the temperature elevation should be supported with the estimation of complete blood picture, erythrocyte sedimentation rate to indicate the inflammation. Presence of protein in the urine proteinuria is a clear indication of the impairment in the filtration capacity of the kidney. In addition to that presence of cloudy precipitate and the elevated plasma calcium oxalate concentration direct towards the injury or denigration of the kidney function. Culture of the urine should be obtained for the assessment of urinary tract infection and the urine should be further check for the presence of calcium oxalate crystals. Serum creatinine and glomerular filtration rate also provide information about the kidney function. Thyroid function tests and folate test are performed as a routine.

Abnormalities in Nursing Assessment

Dementia is the first symptom of many neurological diseases. However, gait disturbances and poor muscle coordination is primarily associated with Alzheimer’s disease (AD). This is further confirmed by the presence of amyloid plaques in the brain and are revealed with the scan over the progression of the disease. Parkinson’s and Lewy body dementia are majorly associated with dopamine synthesis impairment. One significant feature of the AD is the reduction in the volume of hippocampus. Patients may show impaired memory. With AD language ability, verbal retrieving, fluency. Sometimes psychosis is also observed. Biomarkers of brain damage may be present in the Cerebrospinal fluid (Martorelli, Sudo, & Charchat-Fichman, 2018). Presence of plaques and tangles are a clear sign of AD (Frozza, Lourenco, & De Felice, 2018). To verify the cause of the dementia as an epileptic seizure an Electroencephalogram is carried out to check for the presence of heightened brain wave activity. 

Given his medical history the patient has been suffering from hypertension which may indirectly affect the kidney. Presence of protein in the urine reflects the impaired filtration mechanism. Kidney complications may eventually lead to chronic kidney disease (Nadkarni et al., 2017). Creatinine is a by-product of body metabolism and is constantly cleared by the kidneys alone. Hence a decrease in the glomerular filtration rate and thereby kidney function the concentration of creatinine in the blood increase which reflects in the test as high serum creatinine. 

Albuminuria is the protein output by the kidney which ranges from 30- 300milligram per day. Presence of albumin in the urine indicates glomerular nephropathy.  An ultrasound scan may reveal the presence of crystals of calcium oxalate deposited in the glomeruli. 

Physical, Physiological and Emotional Effects

Mr. M is currently experiencing a rapid degradation of his mental abilities to perform the basic task of the day-to-day activities. The lack of coordination in his limbs may cause the patient great discomfort in performing any physical task. There is a higher probability of the patient to injure himself due to the impairment of visual-spatial orientation. The hypothalamic function is affected with the progression of the disease. Hypothalamus is primarily concerned with the sleep-wake cycle and hence the circadian rhythm is altered.  It indirectly affects the insulin metabolism and thus affecting the glucose metabolism resulting in hyperglycinemia. The AD brain expresses low amount of insulin receptor further reducing the glucose available for the brain. 

Changes in the neurological system affects the dopamine and serotonin levels in the body causing modification in the mood and levels of anxiety in the patient. Depression associated with agitation is a common occurrence in the patients suffering with AD (Frozza et al., 2018).

Interventions

Alzheimer disease is approached both through pharmaceuticals and a lifestyle changes. Highly approved treatment for Alzheimer’s include the cholinesterase inhibitors such as Donepezil. However, the severe side effects on liver and other cognitive functions they are administered with a risk-benefit assessment (Briggs, Kennelly, & O'Neill, 2016).

Limited efficacy of current drug therapy has promoted non-pharmacological treatment to improve function, self-dependence, and thereby improving quality of life. This involves the changes in the immediate physical and emotional environment. The patient is assisted with the help of automation in the care facilities. Instructions are to be provided at every utility station to facilitate the daily tasks (Zucchella et al., 2018). Exercise and social interaction reduce the stress experienced and improves the behavior of the patients. Social awkwardness is reduced through regular sessions between the inmates (Cheng, 2017). Counselling the family of Mr. M is essential to understand his current condition and accommodate the changes that are evident in his behavior. 

The UTI or kidney damage should be immediately addressed through the administration of the antibiotics and increased water intake through out the day to reduce the formation of kidney stones. 

Potential Problems

Dementia due to AD causes a number of physical and psychological problems both to the patients and the family members. Rapid loss of cognitive function leads to dependence of the patients on the caregivers. This is often associated with increased emotional burden and depression. Patients may also experience urinary incontinence, dizziness and inability to communicate clearly. Social isolation, depression is a common observation (Luyckx et al., 2017)

On the other hand, Proteinuria is a risk factor for the further damage of the kidneys, this is due to the damage caused by the protein through the tubules. Presence of protein leads to inflammation further damaging the associated tissues. Patient may experience severe pain and difficulty while voiding. The total output of urine may reduce complicating the case of UTI. Creatinine concentration of the serum is increased which leads to increased heart rate, confusion, and mostly importantly fluid retention in the extremities (Staples & Wong, 2010)

Conclusion

In the current case study of Mr. M the signs and symptoms of dementia, associated with abnormal finding in the urine assessment were discussed for the possibility of the dementia due to AD. Diagnosis in such cases is performed under two categories primary and secondary which are differentiated with the former is based on acute physical and clinical manifestations and the latter is the significant observations made through the detailed clinical assessment in addition to the medical history of the individual. The potential abnormal findings associated with the current condition could be related to the determination of the AD subtype, acute kidney disorder and its future implications. Dementia often affects the patient and the family members due to its severity and a lack of complete cure also leads to severe depression, a common finding. Current trends in the treatment of Dementia include both drugs and non-drug approach. Comorbidities in these individuals should be timely treated to improve the quality of life. 

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