Introduction
Mr. M. is a 70-year-old man residing in an assisted living home. This critical analysis essay seeks to give a general review of Mr. M.’s medical problems and the observed changes in his condition. This will be done by examining his health history, objective data, and laboratory findings. The analysis will yield insight into potential medical diagnoses, comprehend the physical and emotional repercussions for Mr. M. and his family, and guide necessary actions to promote his health. Mr. M.’s condition shows a worrying loss in his general health and cognitive abilities.
Clinical Manifestations
The health of Mr. M. is rapidly deteriorating: he is exhibiting various clinical symptoms that point to cognitive deterioration and behavioral abnormalities. Mr. M.’s memory appears to be impaired, as evidenced by his inability to recall his family members’ names and room number. His growing irritation and aggression are a result of these cognitive impairments. Mr. M. appears to be in a distressed and anxious mental state, which may be influencing his behavioral changes.
Furthermore, Mr. M. has been observed walking around at odd nighttime hours and needing assistance to return to his room. His spatial orientation and navigational skills have similarly deteriorated. Despite being perfectly capable of dressing, bathing, and eating himself a few months ago, Mr. M. has started to rely on others for such activities of daily living (ADLs). Collectively, these manifestations point to a sharp loss in Mr. M.’s cognitive ability, emotional stability, and functional independence.
On the objective front, several measurements and test findings offer further perspectives on Mr. M.’s health. Test findings indicate a white blood cell count (WBC) of 1,000/uL, less than the normal range. A rise in lymphocytes can be seen in the lymphocyte count of 6700 cells/uL. A moderate amount of leukocytes and cloudiness is found in the urinalysis. At 37.1 degrees Celsius, his temperature is within the usual range.
Diagnoses
The primary medical diagnosis that needs to be considered is Alzheimer’s disease or dementia, given his advanced age, rapid cognitive deterioration, behavioral changes, and functional dependency. Mr. M.’s memory issues, including his tendency to forget names and room numbers, are typical of the cognitive impairment brought on by dementia (Reiss et al., 2022). Additionally, he exhibited anxiety, hostility, fearfulness, and nocturnal wandering—common behavioral indicators of dementia (Reiss et al., 2022). These subjective signs and empirical evidence of declining cognitive function and growing reliance on ADLs support dementia as the most likely medical diagnosis.
Urinary tract infection (UTI) should be considered a secondary medical diagnosis in addition to dementia. The elevated white blood cells and murky urine results suggest a UTI (Nocua-Báez & Cortés, 2023). Older adults with UTIs have been documented to experience delirium-like behavioral abnormalities and cognitive deterioration (Wilson et al., 2020). Leukocytes, cloudiness in the urinalysis, and Mr. M.’s self-reported signs of declining mental function and unusual behaviors offer evidence to support the secondary medical diagnosis of a UTI.
A pertinent nursing diagnosis that can be developed is “risk for acute confusion related to underlying Alzheimer’s disease and the presence of UTI.” Mr. M.’s underlying cognitive impairment and memory difficulties are reflected in this nursing diagnosis. This nursing diagnosis is further supported by the patient’s subjective symptoms of agitation, hostility, fear, and nocturnal wandering, as well as the objective findings of a positive urinalysis for leukocytes and cloudiness.
Expected Abnormalities
Cognitive impairments are to be anticipated during the assessment if dementia is the primary diagnosis. The examination may reveal the presence of aphasia, which manifests as difficulty finding words or expressing thoughts (Myrberg et al., 2021). Aggression and heightened agitation may continue, related to the UTI’s pain and discomfort. The positive urinalysis results may also indicate abnormal urinary findings, such as cloudy urine, and Mr. M. may also have dysuria or a burning sensation when urinating (Nocua-Báez & Cortés, 2023). Finally, the examiner may also spot indications of urine incontinence or irregular urination patterns, which could factor into Mr. M.’s growing need for ADLs.
Impacts
Mr. M.’s current state is likely to hurt his physical health. Due to his restricted physical activity and unsteady stride, his general physical health may deteriorate, resulting in a loss of strength, muscle tone, and endurance (Sampaio et al., 2020). Psychologically, Mr. M.’s memory problems and cognitive impairment may cause him to feel frustrated and helpless (Reiss et al., 2022). Finally, Mr. M. may experience fear and worry on an emotional level, especially if he gets irritated and hostile. His condition is likely to cause mood swings and emotional instability.
Mr. M.’s health now profoundly affects him and his family. As their loved one deteriorates, family members may feel many emotions, including loss, despair, and guilt (Queluz et al., 2020). Providing Mr. M. with care and assistance can overwhelm the family members (Queluz et al., 2020). As they observe his cognitive decline, they could feel unsure of how to interact and communicate with him.
Potential Interventions
To assist Mr. M. and his family, a wide range of interventions can be implemented to address their needs. To the greatest extent practicable, assistance with ADLs should be given to support Mr. M.’s independence and dignity. Maintaining muscle strength and mobility can be achieved by encouraging physical activity within the limits of his abilities, such as leisurely workouts or supervised walks (Sampaio et al., 2020). Displaying personal belongings and photos in his living space might help with memory recall and calm him down by establishing a familiar setting (Reiss et al., 2022). Regular schedules and structured routines can help Mr. M. feel less confused.
Problems
Four problems Mr. M. encounters can be recognized based on his current situation. Firstly, Mr. M. has cognitive impairment, which manifests as memory loss, confusion, and a deterioration in cognitive abilities. This problem is supported by data that accounts for his cognitive impairments and behaviors. Secondly, there is a severe safety risk due to Mr. M.’s propensity to roam, as getting lost can result in slips or accidents. This problem is evident from observing his conduct during agitated and aggressive episodes.
Thirdly, Mr. M.’s capacity to carry out ADLs has deteriorated, while his reliance on caregivers has increased. This problem is in stark contrast to his history of prior independence. The fourth problem is that Mr. M.’s negative emotions and discomfort during episodes of confusion point to a precarious mental state. His cognitive disability may be to blame for these behavioral alterations, which result in anxiety and a sense of being out of control.
Conclusion
Mr. M.’s situation, in light of his failing health and diagnoses of Alzheimer’s disease and UTI, highlights the urgent need for a thorough examination and action plan. Nevertheless, Mr. M.’s quality of life can be enhanced by implementing interventions for cognitive impairment, ensuring safety, offering support with ADLs, and dealing with emotional distress. Mr. M. can receive the required healthcare through coordinated efforts among healthcare experts.
References
Myrberg, K., Hydén, L., & Samuelsson, C. (2021). Instances of trouble in aphasia and dementia: an analysis of trouble domain and interactional consequences. Aphasiology, 36(11), 1333–1350. Web.
Nocua-Báez, L. C., & Cortés, J. A. (2023). Advances and challenges in urine laboratory analysis. IntechOpen. Web.
Queluz, F. N. F. R., Kervin, E., Wozney, L., Fancey, P., McGrath, P. J., & Keefe, J. (2020). Understanding the needs of caregivers of persons with dementia: a scoping review. International Psychogeriatrics, 32(1), 35–52. Web.
Reiss, A. B., De Levante Raphael, D., Chin, N. A., & Sinha, V. (2022). The physician’s Alzheimer’s disease management guide: Early detection and diagnosis of cognitive impairment, Alzheimer’s disease and related dementia. AIMS Public Health, 9(4), 661–689. Web.
Sampaio, A. H., Marques-Aleixo, I., Seabra, A., Mota, J., Marques, E., & Carvalho, J. (2020). Physical fitness in institutionalized older adults with dementia: association with cognition, functional capacity and quality of life. Aging Clinical and Experimental Research, 32(11), 2329–2338. Web.
Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature Reviews Disease Primers, 6(1). Web.