NRS 428 Case Study Evaluate the Health History and Medical Information for Mr. M
Sample Answer for NRS 428 Case Study Evaluate the Health History and Medical Information for Mr. M Included After Question
Assessment Description
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.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
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A Sample Answer For the Assignment: NRS 428 Case Study Evaluate the Health History and Medical Information for Mr. M
Title: NRS 428 Case Study Evaluate the Health History and Medical Information for Mr. M
The case of Mr. M., a 70-year-old male living in an assisted living home whose health has been quickly declining over the past two months, is examined in this critical thinking essay. Mr. M. is having trouble remembering crucial details, is having memory problems, and shows signs of agitation and violence. The goal of this analysis is to explore potential medical diagnoses, evaluate Mr. M.’s subjective and objective clinical manifestations, and discuss how his current health status affects him and his family. This essay seeks to provide complete support and care for Mr. M. at this crucial time in his life by developing nursing diagnoses and suggesting solutions. This approach is crucial for understanding and addressing the complex healthcare needs of elderly individuals with cognitive decline (Yourman et al., 2020).
Subjective and Objective Clinical Manifestations
Subjective clinical manifestations include difficulty recalling family members’ names and room numbers, memory lapses, agitation and aggression, fear, and anxiety, and difficulty with daily living activities (ADLs). Objective clinical manifestations, such as difficulty with self-care tasks, elevated white blood cell and lymphocyte counts, cloudy urine with leukocytes, and mild liver enzyme abnormalities, are measurable and observable signs detected during physical examinations or diagnostic tests. These manifestations provide insight into Mr. M.’s cognitive decline, mood disturbances, and fear-related reactions. Objective clinical manifestations, such as infection and liver function abnormalities, further support the presence of cognitive impairment and suggest potential underlying health issues (Yourman et al., 2020). Further evaluation and interventions are needed to address Mr. M.’s health concerns and improve his overall well-being.
Primary and Secondary Medical Diagnoses:
Primary Diagnosis: Alzheimer’s Dementia (AD)
Alzheimer’s dementia is a progressive neurodegenerative disorder affecting memory, cognitive function, and behavior (Tahami-Monfared et al., 2022). In this case scenario, Mr. M. experiences memory decline, confusion with night wandering, aggression, and impaired daily living activities (ADLs), resulting in a decline in executive functioning and difficulty performing previously manageable tasks.
Secondary Diagnosis: Asymptomatic Bacteriuria (ABU)
Asymptomatic bacteriuria (ABU) is the presence of bacteria in urine without clinical symptoms of a urinary tract infection. In elderly individuals, like those with dementia, ABU is common due to reduced communication and recognition of urinary symptoms (Simpson et al., 2018). Healthcare providers should exercise caution when diagnosing and treating ABU in dementia patients.
Nursing Diagnosis: Impaired Memory
Impaired memory is a nursing diagnosis for Mr. M. due to chemical imbalances in the brain, a characteristic feature of Alzheimer’s disease. This leads to brain cell destruction and neural communication disruption, affecting memory encoding, storage, and retrieval. Interventions to support memory function, enhance communication, and promote a safe environment can be tailored based on this diagnosis (Simpson et al., 2018). Addressing chemical imbalances and exploring pharmacological interventions may also be part of the overall management plan for AD (Tahami-Monfared et al., 2022).
Expected Abnormalities in Nursing Assessment
General Assessment: During a general assessment, Mr. M. presented nervousness, disorientation, and aggressive behavior, along with explosive behavior when questioned about his cognitive decline (Simpson et al., 2018). He showed some paranoia and inappropriate social behavior.
Neurological Exam: Abnormalities may include reduced attention span, short-term memory loss, impaired executive functioning, and dysarthria.
Mental Status Exam: The mental status exam may also reveal disorientation to person, time, and place, disorganization, impaired reasoning, problems with calculation, abstract thought and judgment, and decreased attention span.
Genitourinary Exam: this exam may not reveal any immediate abnormalities, but it is crucial to rule out any kidney stones or other urinary tract issues that may contribute to the leukocytes and cloudy appearance in the urinalysis.
Physical, Psychological, and Emotional Effects:
Physical Effects: Mr. M.’s cognitive decline and health conditions significantly impact his physical health, increasing the risk of falls and fractures, affecting his overall well-being and potential injuries. Additionally, cognitive decline causes dependence on others for daily activities, impacting self-care and hygiene (Breijyeh & Karaman, 2020). This leads to skin issues, pressure sores, and infections, compromising physical health.
Psychological Effects: Aggression and agitation, triggered by confusion, frustration, and communication difficulties, can be frustrating for Mr. M. and his caregivers. Cognitive decline affects memory, orientation, and information processing, increasing confusion and disorientation. This can increase the risk of depression and anxiety, impacting his overall well-being and quality of life (Simpson et al., 2018).
Emotional Effects: Mr. M.’s condition causes emotional strain and burnout for his family members and caregivers, causing exhaustion and fatigue. Witnessing his cognitive decline and loss of independence can be distressing, while the progressive nature of Alzheimer’s dementia can lead to feelings of helplessness and grief. Coping with these challenges can be overwhelming and negatively impact the family’s overall well-being (Grabher, 2018).
Interventions to Support Mr. M. and His Family:
Supportive Psychotherapy: Supportive psychotherapy and group psychotherapy are valuable interventions for Mr. M. to address his psychological and emotional needs. Supportive psychotherapy provides a safe space for discussing thoughts, feelings, and fears related to cognitive decline and aggressive behaviors. Group therapy fosters camaraderie, alleviates depression and anxiety, enhances social interactions, and improves interpersonal functioning (Grabher, 2018).
Caregiver Training: this is essential for Mr. M.’s family to provide optimal care, focusing on managing challenging behaviors, assisting with daily living, and ensuring a safe environment. This training promotes dignity, independence, and well-being while reducing caregiver burnout and boosting family members’ confidence and competence (Breijyeh & Karaman, 2020).
Social Support Groups: this approach provides a supportive network, community, and emotional validation. Members share experiences, challenges, and successes, learning coping strategies and tips for managing dementia (Breijyeh & Karaman, 2020). Participating in these groups enhances Mr. M.’s family’s caregiving journey, reduces stress, and offers valuable insights.
Actual or Potential Problems for Mr. M.:
Impaired Memory: Mr. M.’s impaired memory is a significant issue due to Alzheimer’s disease progression and brain imbalances, affecting daily life, interpersonal interactions, and identity, affecting his ability to recall events and retain information (Simpson et al., 2018).
Self-Care Deficits: Bathing, dressing, and feeding independently are all impacted by neuromuscular and cognitive impairment. This may lead to frustration, helplessness, and loss of independence (Tahami-Monfared et al., 2022).
Confusion: Mr. M. experiences cognitive decline and memory deficits, leading to confusion about his environment, time, and situation, causing distress and increased vulnerability to accidents and lostness (Tahami-Monfared et al., 2022).
Risk for Injury: Confusion, impaired decision-making, and disorientation increase the risk of injury. May be unaware of hazards or misinterpret situations, leading to unsafe actions or accidents. Implementing safety measures and close supervision is crucial (Simpson et al., 2018).
Conclusion
The status of Mr. M. shows signs of rapid deterioration, including memory loss, disorientation, and aggression in line with Alzheimer’s dementia, due to asymptomatic leukocytes in his urine. ABU is considered a secondary diagnosis. Physical, psychological, and emotional impacts of his health status on him and his family. Mr. M. and his family may benefit from supportive interventions, caregiver education, and social support as they deal with the challenges they face. Memory loss, self-care issues, confusion, and a risk of injury are all actual or prospective issues.
References
Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease: Causes and Treatment. Molecules (Basel, Switzerland), 25(24), 5789. https://doi.org/10.3390/molecules25245789
Grabher, B. J. (2018). Alzheimer’s disease and the Effects it has on the Patient and their Family. Journal of Nuclear Medicine Technology, jnmt-118.
Simpson, G. M., Stansbury, K., Wilks, S. E., Pressley, T., Parker, M., & McDougall, G. J., Jr (2018). Support groups for Alzheimer’s caregivers: Creating our own space in uncertain times. Social work in mental health, 16(3), 303–320. https://doi.org/10.1080/15332985.2017.1395780
Tahami Monfared, A. A., Byrnes, M. J., White, L. A., & Zhang, Q. (2022). Alzheimer’s Disease: Epidemiology and Clinical Progression. Neurology and therapy, 11(2), 553–569. https://doi.org/10.1007/s40120-022-00338-8.
Yourman, L. C., Kent, T. J., Israni, J. S., Ko, K. J., & Lesser, A. (2020). Association of dementia diagnosis with urinary tract infection in the emergency department. Journal of the American College of Emergency Physicians open, 1(6), 1291–1296. https://doi.org/10.1002/emp2.12268
Rubric Criteria
Total120 points
| Criterion | 1. Unsatisfactory | 2. Less Than Satisfactory | 3. Satisfactory | 4. Good | 5. Excellent |
| Diagnoses and Secondary Diagnoses
Diagnoses and Secondary Diagnoses |
0 points
A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is omitted; or, medical diagnoses presented are inaccurate. |
9 points
A partial discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. There are major inaccuracies. Rationale and evidence for the diagnoses are lacking. |
9.48 points
A general discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. There are some inaccuracies. A summary provides some rationale and evidence to explain why the diagnoses are relevant. |
10.68 points
A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. General rationale and relevant data are used to explain why the diagnoses should be considered. There are minor inaccuracies. |
12 points
A detailed discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is presented. Strong rationale and reliable data are used to explain why the diagnoses are relevant and should be considered. |
| Clinical Manifestations of Mr. M.
Clinical Manifestations of Mr. M. |
0 points
Clinical manifestations are omitted. |
9 points
Clinical manifestations are partially presented. There are major omissions and inaccuracies. |
9.48 points
Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. |
10.68 points
Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. |
12 points
Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms. |
| Thesis Development and Purpose
Thesis Development and Purpose |
0 points
Paper lacks any discernible overall purpose or organizing claim. |
4.5 points
Thesis is insufficiently developed or vague. Purpose is not clear. |
4.74 points
Thesis is apparent and appropriate to purpose. |
5.34 points
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. |
6 points
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. |
| Effects of Health Status on Physical, Psychological, and Emotional Aspects of Patient and Family
Effects of Health Status on Physical, Psychological, and Emotional Aspects of Patient and Family |
0 points
The effects of the health status on the physical, psychological, and emotional aspects of the patent, and the impact the health status has on the family, are omitted. |
13.5 points
The effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, are partially summarized. The effects presented are questionable, and support for the discussion is not provided. |
14.22 points
The effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, are summarized. Overall, the described effects on the patient and impact to the family are relevant. Some support for the discussion is provided. |
16.02 points
A discussion of the effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, is presented. Support for the discussion is provided. |
18 points
A thorough discussion of the effects of the health status on the physical, psychological, and emotional aspects of the patient, and the impact the health status has on the family, is presented. Strong support for the discussion is provided. |
| Actual or Potential Problems Based on Condition
Actual or Potential Problems Based on Condition |
0 points
Fewer than three actual or potential problems faced by the patient are presented. The problems posed are not relevant to his condition. |
13.5 points
Three actual or potential problems faced by the patient are partially presented. It is unclear how some of the posed problems are relevant to his condition. There are inaccuracies. |
14.22 points
At least four actual or potential problems faced by the patient are summarized. The posed problems are generally relevant to his condition. There are minor inaccuracies. Some information or rationale is needed. |
16.02 points
Four or more actual or potential problems faced by the patient are discussed. The posed problems are relevant to his condition. Rationale provided generally supports the discussion. |
18 points
Four or more actual or potential problems faced by the patient are thoroughly discussed. The posed problems are clearly related to his condition. Strong rationale is provided and supports the discussion. |
| Explanation of Expected Abnormalities During Nursing Assessment
Explanation of Expected Abnormalities During Nursing Assessment |
0 points
A discussion of what abnormalities a nurse would expect to find during a nursing assessment is omitted; or, the expected findings are not relevant for the patient or his health status. |
13.5 points
An incomplete summary of some abnormalities a nurse would expect to find during a nursing assessment is presented. There are inaccuracies. No rationale or evidence is provided for support. |
14.22 points
A general discussion on the abnormalities a nurse would expect to find during a nursing assessment is presented. There are minor inaccuracies. Some rationale or evidence is provided for support. |
16.02 points
A discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. General rationale and evidence are provided for support. |
18 points
A thorough discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. Strong rationale and evidence are provided for support. |
| Interventions for Support
Interventions for Support |
0 points
Interventions that can be put into place to support Mr. M. and his family are omitted. |
13.5 points
Some interventions that can be put into place to support Mr. M. and his family are partially presented. More information is required. |
14.22 points
Some interventions that can be put into place to support Mr. M. and his family are summarized. There are minor inaccuracies. |
16.02 points
Key interventions that can be put into place to support Mr. M. and his family are discussed. Some detail is needed for clarity. |
18 points
All relevant interventions that can be put into place to support Mr. M. and his family are thoroughly discussed. |
| Paper Format (use of appropriate style for the major and assignment)
Paper Format (use of appropriate style for the major and assignment) |
0 points
Template is not used appropriately, or documentation format is rarely followed correctly. |
1.8 points
Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. |
1.9 points
Appropriate template is used. Formatting is correct, although some minor errors may be present. |
2.14 points
Appropriate template is fully used. There are virtually no errors in formatting style. |
2.4 points
All format elements are correct. |
| Documentation of Sources
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) |
0 points
Sources are not documented. |
2.7 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. |
2.84 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. |
3.2 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct. |
3.6 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. |
| Argument Logic and Construction
Argument Logic and Construction |
0 points
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. |
4.5 points
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. |
4.74 points
Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. |
5.34 points
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. |
6 points
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. |
| Mechanics of Writing (includes spelling, punctuation, grammar, language use)
Mechanics of Writing (includes spelling, punctuation, grammar, language use) |
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. |
4.5 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. |
4.74 points
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. |
5.34 points
Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. |
6 points
Writer is clearly in command of standard, written, academic English. |
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
|
Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three or more of the following elements
|
| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in the all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three of the following elements
|
| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
|
Demonstrated 3 of the following:
|
Demonstrated 2 of the following:
|
Demonstrated 1 or less of the following:
|
||
| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
AND
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
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Failed to demonstrate the following:
|
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| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
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