Running head: Case Study: Mr.

M 1

Case Study: Mr. M

Grand Canyon University

NRS-410V

10/13/19
Case Study: Mr. M 2

Case Study: Mr. M

Clinical Manifestations of Mr. M

Mr. M is a 70-year-old male who has been living at an assisted living facility. Mr. M has

Alzheimer’s disease and a urinary tract infection. He does not smoke or drink alcohol and has

limited physical activity related to difficulty ambulating and an unsteady gate. His medical

history includes hypertension, hypercholesterolemia, status post appendectomy, and tibial

fracture status post-surgical repair with no signs or symptoms of complications. Over the past

two months Mr. M seems to be declining and is having trouble remembering the names of his

loved ones, his room number, and repeating what he has just read. He becomes agitated and

aggressive quickly and appears to be afraid and fearful during these episodes of aggression.

During this time, Mr. M has become dependent with various activities of daily living, which has

changed from a few months ago when he was able to dress, bathe, and feed himself. Testing was

therefore ordered related to his rapid decline. The objective data presented at this time reveals

normal temperature of 37.1 degrees C, blood pressure 123/78, pulse oximetry of 99% on room

air, a slightly elevated respiration rate of 22, and elevated heart rate of 93 bpm. The elevated

respiration rate and elevated heart rate may be due to his anxiety. The laboratory results reveal a

white blood count of 19.2 (1000,/uL), lymphocytes 6700 (cell/uL), CT head shows no changes

since previous scan, urinalysis positive for moderate amount of leukocytes and cloudy, and

protein 7.1 g/dL, AST 32 u/L, and ALT 29 u/L. The abnormal lab values present show that there

is a urinary tract infection.

Primary and Secondary Medical Diagnoses

The primary medical diagnoses of Mr. M is Alzheimer’s disease and a urinary tract

infection (UTI). The secondary diagnoses are hypertension, hypercholesterolemia, status post

appendectomy, and tibial fracture status post-surgical repair. Alzheimer’s disease is the most

common form of dementia and signs and symptoms that an individual is developing early onset

Alzheimer’s disease are: memory loss, difficulty planning and solving problems, difficulty

completing familiar tasks, difficulty determining time or place, vision loss, difficulty finding the

right words, misplacing items often, difficulty making decisions, withdrawing from work and

social events, and experiencing personality and mood changes (Hansen, 2016). During the

middle stages of Alzheimer’s disease, an individual’s brain will forget how to function

physically. During the span of two months, Mr. M is having memory loss by having difficulty

remembering the names of his family members, remembering his room number and repeating

what he had just read. He also is having mood changes which is presented by his agitation and

aggression. Furthermore, he is having difficulty completing familiar tasks such as finding his

room, and more importantly being able to complete activities of daily living, such as: dressing,

bathing and feeding himself. All the signs and symptoms lead to the diagnosis of Alzheimer’s

disease. The urinary tract infection is presented by the laboratory results that were taken. Urinary

tract infections commonly occur because of bacteria entering the urinary tract through the urethra

and spreads into the bladder (Urinary Tract Infection, 2019). Elderly patients, especially those

with forms of dementia or Alzheimer’s disease, can experience behavioral symptoms such as

confusion and may be unable to specify about what they are feeling and in the case of Mr. M, he

is presenting with many episodes of confusion as well.

Expected Abnormalities During Nursing Assessment

Expected abnormalities for a patient with a urinary tract infection would be found within

the objective data. The normal lab values for WBC’s are about 4500 to 11,00 and Mr. M’s WBC

value was 19.2, it shows that there is inflammation or infection present. The normal lymphocytes

range in adults is between 1000-4800 and Mr. M’s lymphocytes were high: 6700. Lymphocytes

are white blood cells that play a role in the bodies immune cells and are made in the bone

marrow and found in the blood and lymph tissue. In Mr. M’s case, this can be a temporary

situation due to the body’s normal response due to his urinary tract infection. The urinalysis

positive for moderate amount of leukocytes and cloudy also correlate to his diagnosis of a

urinary tract infection. It is important to assess cognitive impairment for older adults because

there can be a variety of plausible causes such as medication side effects, metabolic and/or

endocrine derangements, delirium due to intercurrent illness, depression, and dementia

(Assessing Cognitive Impairment in Older Patients, 2014). During a nursing assessment for a

patient with Alzheimer’s disease, there are many scales that can be used. During clinical practice

and research, cognition is considered the key change that is being observed and the diagnostic

criteria for dementia is dependent upon the presence of cognitive impairment, behavior, impaired

function, depression, and overall dementia severity (Sheehan, 2014).

Effects of Health Status

Although there is no cure for this disease, there are things that can be done to improve the

patient’s physical, psychological, and emotional aspects of their life and increase their quality of

life. The physical aspects of a person living with Alzheimer’s disease include losing physical

function which include losing the muscle ability to hold urine and bowel movements; the decline
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is because the brain signals to the muscle is no longer working. In the late stages of Alzheimer’s

disease, individuals lose the ability to perform activities of daily living which include bathing,

feeding and dressing themselves. Psychological and emotional aspects include: anger, anxiety,

depression, fear, and loneliness. It is important to provide the best care for the patients and have

a positive long-term effect on the person they are interacting with. It is important to know the

signs and symptoms, medications that can inhibit, or medications that should not be taken with a

patient with dementia, and the treatments that can be used in dealing with a patient with

dementia. For family members, dementia can be mistaken for aging initially. It is important for

family members to understand the disease process and although this can be a difficult time, they

must have a support system and use coping mechanisms during this time. They must learn to be

patient when responding to questions, behaviors, and statements that are repetitive, redirect their

family member, remain calm, have consistent routines, and consider respite care when necessary.

Interventions for Support

Although there is no cure, researchers and new development of medications can

temporarily enhance mental abilities. The drugs do not reverse the brain damage that has already

occurred or stop the disease, it can improve symptoms and slow the progression that has

happened which can benefit the person’s quality of life and take a load off of the person caring

for them. “Accurate diagnosis continues to be an important factor in the disease course and

quality of life. Although Alzheimer’s disease is the most common form of dementia in persons

older than 65 years, there are other causes of progressive cognitive and behavioral decline,

including comorbidities (depression, sleep disorders), that if treated can change the trajectory of

the disease” (Foundas, Huey, Smith, 2014, p. ). If the person with dementia is still in the early

stages of dementia, they can benefit from cognitive training. Cognitive training inhibits the
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person to perform particular tasks in a certain way. Another treatment may be behavior

modification which is rewarding positive behavior and paying no mind to negative behavior.

Also, occupational therapy can help a person with dementia because they can educate the person

to handle certain behaviors and situations in a more acceptable way.

Actual or Potential Problems Based on Condition

A urinary tract infection can be minor and treated with drinking plenty of fluids, drinking

cranberry juice, and increasing their intake of vitamin C. however, a UTI that has lasted more

than two days can be treated with an antibiotic. If a UTI goes untreated, two actual or potential

problems that can happen would be kidney impairment and sepsis, a potentially life-threatening

complication. Acute kidney injury can occur from sepsis and cause deterioration of renal

function. An actual or potential problem of Alzheimer’s disease would be that they have

difficulty swallowing both foods and liquids which can lead to two actual or potential problems

such as serious dehydration and delirium. Serious dehydration can cause confusion, weakness,

increased heart rate, and difficulty with talking. Delirium can cause the Alzheimer’s patient to be

easily distracted, decreased energy, hallucinations, sudden change of behavior, and rambling as

they are talking.

References

Assessing Cognitive Impairment in Older Patients. (2014). Retrieved from:

https://www.nia.nih.gov/health/assessing-cognitive-impairment-older-patients

Foundas, A.L., M.D., Huey, J., M.S., & Smith, K.H., M.D. (2014). Brain aging and dementia:

Practical tips from clinical research. Psychiatric Times, 29(6), 14-15. Retrieved from:

http://search.proquest.com/docview/1022270567?accountid=131932

Hansen, K. (2016). 10 Signs of Early Onset Alzheimer’s Disease. Retrieved from:

https://www.healthline.com/health/alzheimers-disease/signs-of-early-onset-

alzheimers#symptoms-of-early-onset

Sheehan B. (2014). Assessment scales in dementia. Therapeutic advances in neurological

disorders, 5(6), 349-358. Doi:10.1177/1756285612455733

Urinary tract infection (UTI). (2019). Retrieved from: https://www.mayoclinic.org/diseases-

conditions/urinary-tract-infections/symptoms-causes/syc-20353447
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