Case Study: Alzheimer’s disease
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.
Case Study: Alzheimer’s Disease
Background Information
Mr. M is a geriatric patient in an assisted living facility and is recuperating from surgical intervention to repair a tibial fracture and an appendectomy. The assisted living facility is, therefore, offering nursing services round the clock to ensure that Mr. M is adequately taken care. Moreover, the facility is ensuring that the conditions he ails from are treated with the appropriate medication and adherence to the therapy instituted. He is under Lisinopril 20mgs to control hypertension, which was 123/78. He is also on Lipitor to control to treat hypercholesteremia and prevent cardiovascular disease. His body mass index (BMI) was 29.2 indicative he was overweight, Ambien to treat a sleep disorder, Xanax,a benzodiazepine,for anxiety disorder and Ibuprofen which is an anti-inflammatory due to the surgical procedures which were carried out. Furthermore, the complaint is that Mr. M health has deteriorated and he is anxious, fearful and has short term memory loss hence the need for tests to aid in the diagnosis of the cause of his heathdeterioration in the last two months of his stay at the assisted living facility. It was also noted that he was unable to accomplish tasks thathe previously did on his own becoming dependent on caregivers.
Clinical Manifestations
The clinical manifestation noted in Mr. M’s medical examination, and evaluation included the rapid onset and progression of behavior change that included aggression and agitation. He was also noted to be afraid and fearful during such moments. There were also episodes of mood swings. Moreover, he has become dependent on the caregivers for daily activities that he would normally undertake on his own which is indicative of a cognitive disorder (Bature, Guinn, Pong, & Pappa, 2017). Furthermore, there is an indication that his blood pressure is slightly elevated but under control as he is on medication for hypertension to control his blood pressure. The heart rate is also elevated,which may be attributed to hypertension and high cholesterol levels which he is being treatedfor to reduce the risk of developing a heart condition. In addition, the lymphocyte levels are elevated,whichis attributed to the surgical procedures that the patient had undergone to remove the appendix and also tibial fracture repair.
Differential Diagnosis
The clinical manifestations noted from Mr. M are indicative of Alzheimer’s disease. He fits the demographics of the individuals affected by the condition due to his age. In addition, he is predisposed to the condition due to the risk factors that include hypertension, high cholesterol, obesity, and age. High blood pressure and hypercholesteremia compromise the blood flow to the brain leading to the development and progression of Alzheimer’s and vascular dementia.Furthermore, the onset and progression of the condition were acute,andhence, the CT-Scan would not have shown the changes in the brain (Bondi, Edmonds, & Salmon, 2017). A more appropriate imaging tool would have been an MRI as it would have been more sensitive and shown the manifested changes.
Alzheimer’s manifests itself in various forms in different individuals,and it includes short term memory loss and the inability to store new memories, mood swings, poor management,and the inability and the loss of self-care, disorientation, getting lost easily, and easy agitation and aggression (Ulep, Saraon, & McLea, 2018). Dementia is also a possible diagnosis due to the loss of cognitive functions in the patient. He does not recognize his family members and forgetful of the various basic things that he normally knew, which included his room number and individuals related to him,or he interacts. The condition is ruled out due to the acute onset and progression of his symptoms.
Expected Abnormalities during Assessment
The expected abnormalities during the assessment include the elevated heart rate and slightly elevated blood pressure. Mr. M had been earlier diagnosed as suffering from hypertension,which is treated using Lisinopril. Moreover, the protein seen urine may be due to kidney dysfunction as a side effect for the medication (Ulep, Saraon, & McLea, 2018). The high BMI level can also be attributed to the benzodiazepine Xanax which the patient has been prescribed to treat anxiety disorder. He is also on Ambien for a sleeping disorder which predisposes him to an increase in weight gain. Additionally, it can also be used to explain the high cholesterol levels in his blood,which further exacerbates hypertension.
Physical, Psychological, and Emotional Effect of the Condition
Mr. M condition has adverse effects on his heath. Physically he is likely to undergo falls and hence the occurrence of fractures. He is agitated, which may lead to or predispose to the injurious activities when trying to restrain him or sustain them during a fall (Ulep, Saraon, & McLea, 2018). Psychologically, the patient is afraid as he feels that he has lost control and requires help for his daily activities, which may also be embarrassing to him, leading to withdrawal and depression. Emotionally, the patient is detached as he has no recognition of the close family members and caregivers,which also may result in depression. His family members will also be depressed and anxious as their loved one is losing their cognitive functions and cannot remember them (Bature, Guinn, Pong, & Pappa, 2017). Moreover, there is a likelihood of frustrations due to the constant need to remind Mr. M whom they are and their relationship as he is unable to remember the majority of the things as the condition have affected his short-termmemory.
Intervention Measures
Several intervention measures maybe implemented and are broadly categorized as psychosocial interventions. They include behavioral change programs to help Mr. M, his family and the caregivers the adequately adapt with the progression of the disease and how to overcome emotional and psychological problems (Pierre, Riese, Savaskan, & Von Guten, 2017). Supportive psychotherapy and reminiscence therapy are also useful in ensuring that the patients have recollection through the use of pictures, and other familiar items to aid in the recollection of past experiences. Continual modification of the living environment will ensures that there is increased vigilance on patient safety thus ensure a reduction in fatal fall and fractures.
Actual or Potential Problems faced by Mr. M
The potential problem faced by Mr. M includes the risk of falls, which will lead to fractures. Moreover, the integrity of the bone structure has also been further compromised due to the use of Ambien to control sleep disorder. Secondly, he faces the risk of depression due to the dependency on others and hence from the sleep disorder medication as a side effect and predisposing factor (Bondi, Edmonds, & Salmon, 2017). Third, there is the risk of the development of heart condition due to the anxiety medication, which leads to weight gain as his BMI is indicative that he is overweight. The fourth potential problem is the loss of dignity, leading to depression due to his reliance on caregivers and the inability to perform basic daily living activities.
References
Bature, F., Guinn, B.-A., Pong, D., & Pappa, Y. (2017). Signs and symptoms preceding the diagnosis of Alzheimer’s disease: A systematic scoping review of literature from 1937 to 2016. BMJ Open, 7(8), 1-10.
Bondi, M. W., Edmonds, E. C., & Salmon, D. P. (2017). Alzheimer’s disease: Past, present, and future. Journal of the International Neuropsychological Society, 818-831.
Pierre, O. T., Riese, F., Savaskan, E., & Von Guten, A. (2017). Best practice in the management of behavioral and psychological symptoms of dementia. Therapeutic Advances in Neurological Disorders, 10(8), 297-309.
Ulep, M. G., Saraon, S. K., & McLea, S. (2018). Alzheimer disease. The Journal of Nurse Practitioners, 14(3), 129-135.