Case Study Mr M NRS410V

Case Study Mr M NRS410V

Case Study Mr M NRS410V

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 known 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

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

  1. Describe the subjective and objective clinical manifestations present in Mr. M.
  2. Based on the information presented in the case scenario, state what primary and secondary medical diagnoses should be considered for Mr. M. Formulate a nursing diagnosis from the medical diagnosis and explain why these should be considered and what data is provided for support.
  3. What abnormalities would you expect to find and why when performing your nursing assessment using the identified primary and secondary medical diagnoses.
  4. 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.
  5. Discuss what interventions can be put into place to support Mr. M. and his family.
  6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide a rationale for each.

Also Read:

NRS410V Neurological, Perceptual and Cognitive Complexities

You are required to cite a minimum of three 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.

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.

Case Study: Mr. M. Sample Exerpt

Description of the Clinical Manifestations

Mr. M is a 70-year-old male residing in an assisted facility. He is a known hypertensive and hypercholesterolemic patient with limited physical activity attributed to an unstable gait caused by a previous tibial fracture repair. He has deteriorated over the last few months and currently presents with a condition known as agnosia, in which an individual is not able to acknowledge and identify people or objects, or sounds using their normal functioning senses (Kumar & Wroten, 2022).

This is evidenced by an inability to recognize his family members’ names, trouble recalling his room number, and the most immediate content of what he read. Moreover, he presents with features consistent with dementia, including impaired intellectual functions, impaired memory, emotional lability, and deterioration of personality with lack of personal care (Arvanitakis et al., 2019).

This is evidenced by complete dependence on others for activities of daily living (ADLs), frequently getting lost, inability to find his way home, dress, bathe and feed himself, agitation, and aggressiveness. From the objective data, pleocytosis with a lymphocyte predominance together with turbid urine and moderate leukocytosis is suggestive of an infectious process.

Primary and Secondary Diagnoses and Rationale

The primary diagnosis for Mr. M is dementia, a chronic mental disorder characterized by impairment of intellectual functions, recent memory, and deterioration in personality (Arvanitakis et al., 2019). This is justified by the evidence of a decline in both memory and thinking, sufficient enough to impair personal activities of daily living such as feeding, bathing, personal care, and emotional lability, as is true for Mr. M. The secondary diagnosis is hypertension, hypercholesterolemia to which he is on Lisinopril and Lipitor respectively and urinary tract infection evidenced by pleocytosis and cloudy urine. Order Here for Full Solution.

References

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia: Review. JAMA: The Journal of the American Medical Association, 322(16), 1589–1599. https://doi.org/10.1001/jama.2019.4782

Kumar, A., & Wroten, M. (2022). Agnosia. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493156/

Scott, H. (2022). The changing self: The impact of dementia on women’(findings from the Improving the Experience of Dementia and Enhancing Active Life programme). Dementia (London, England), 21(2), 503–518. https://doi.org/10.1177/14713012211047351

Singaram, S., & Naidoo, M. (2020). The physical impact of long bone fractures on adults in KwaZulu-Natal. The South African Journal of Physiotherapy, 76(1), 1393. https://doi.org/10.4102/sajp.v76i1.1393

Case Study: Mr. M. – Rubric

Rubric Criteria

Clinical Manifestations of Mr. M.

Criteria Description

Clinical Manifestations of Mr. M.

5. Target

12 points

Subjective and objective clinical manifestations are thorough.

4. Acceptable

10.68 points

Subjective and objective clinical manifestations are detailed.

3. Approaching

9.48 points

Subjective and objective clinical manifestations are present.

2. Insufficient

9 points

Subjective and objective clinical manifestations are present, but lack detail or are incomplete.

1. Unsatisfactory

0 points

Subjective and objective clinical manifestations are omitted.

Diagnoses and Secondary Diagnoses

Criteria Description

Diagnoses and Secondary Diagnoses

5. Target

12 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are thorough.

4. Acceptable

10.68 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and data that supports the medical and nursing diagnoses are detailed.

3. Approaching

9.48 points

Discussion on what primary and secondary medical diagnoses should be considered, nursing diagnosis formulated from the medical diagnosis, and rationale and evidence used to support the medical and nursing diagnosis are present.

2. Insufficient

9 points

Discussion on what primary and secondary medical diagnoses should be considered, and/or nursing diagnosis formulated from the medical diagnosis, and/or rationale and evidence used to support the medical and nursing diagnosis are present, but lack detail or are incomplete. .

1. Unsatisfactory

0 points

Discussion on what primary and secondary medical diagnoses should be considered, and/or nursing diagnosis formulated from the medical diagnosis, and/or rationale and evidence used to support the medical and nursing diagnosis is omitted.

Explanation of Expected Abnormalities During Nursing Assessment

Criteria Description

Explanation of Expected Abnormalities During Nursing Assessment

5. Target

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.

4. Acceptable

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.

3. Approaching

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.

2. Insufficient

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.

1. Unsatisfactory

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.

Health Status Effect on Physical, Psychological, and Emotional Aspects of Patient and Family

Criteria Description

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family.

5. Target

18 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is thorough.

4. Acceptable

16.02 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is detailed.

3. Approaching

14.22 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and the impact the health status has on the family is present.

2. Insufficient

13.5 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and/or the impact the health status has on the family are present, but lack detail or are incomplete.

1. Unsatisfactory

0 points

Description of the physical, psychological, and emotional effects of the health status on the patient, and/or the impact the health status has on the family.is omitted.

Interventions for Support

Criteria Description

Discussion of interventions that can be put into place to support patient and his family

5. Target

18 points

Discussion of interventions that can be put into place to support the patient and his family is thorough.

4. Acceptable

16.02 points

Discussion of interventions that can be put into place to support the patient and his family is detailed.

3. Approaching

14.22 points

Discussion of interventions that can be put into place to support the patient and his family is present.

2. Insufficient

13.5 points

Discussion of interventions that can be put into place to support the patient and his family are present, but lack detail or are incomplete.

1. Unsatisfactory

0 points

Discussion of interventions that can be put into place to support the patient and his family is omitted.

Actual or Potential Problems Based on Condition

Criteria Description

Discussion and rationale of four or more actual or potential problems faced by the patient

5. Target

18 points

Discussion and rationale of four or more actual or potential problems faced by the patient are thorough.

4. Acceptable

16.02 points

Discussion and rationale of four or more actual or potential problems faced by the patient are detailed.

3. Approaching

14.22 points

Discussion and rationale of four or more actual or potential problems faced by the patient are present.

2. Insufficient

13.5 points

Discussion and rationale of four or more actual or potential problems faced by the patient are present but lack detail or are incomplete.

1. Unsatisfactory

0 points

Discussion and rationale of four or more actual or potential problems faced by the patient are omitted.

Thesis, Position, or Purpose

Criteria Description

Communicates reason for writing and demonstrates awareness of audience.

5. Target

6 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

4. Acceptable

5.34 points

The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.

3. Approaching

4.74 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

2. Insufficient

4.5 points

The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.

1. Unsatisfactory

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

Development, Structure, and Conclusion

Criteria Description

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

5. Target

6 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

4. Acceptable

5.34 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

3. Approaching

4.74 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

2. Insufficient

4.5 points

Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.

1. Unsatisfactory

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

Evidence

Criteria Description

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

5. Target

6 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

4. Acceptable

5.34 points

Relevant evidence that includes other perspectives is used.

3. Approaching

4.74 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

2. Insufficient

4.5 points

Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.

1. Unsatisfactory

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

Mechanics of Writing

Criteria Description

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

5. Target

3.6 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

4. Acceptable

3.2 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

3. Approaching

2.84 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

2. Insufficient

2.7 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

1. Unsatisfactory

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

Format/Documentation

Criteria Description

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

5. Target

2.4 points

No errors in formatting or documentation are present.

4. Acceptable

2.14 points

Appropriate format and documentation are used with only minor errors.

3. Approaching

1.9 points

Appropriate format and documentation are used, although there are some obvious errors.

2. Insufficient

1.8 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

1. Unsatisfactory

0 points

Appropriate format is not used. No documentation of sources is provided.

Total120 points

Case Study Mr M NRS410V Resources

Case Study Mr M NRS410V

  1. Pathophysiology: Clinical Applications for Client Health

Read Chapter 2 in Pathophysiology: Clinical Applications for Client Health.

2. Cost-Effectiveness of Emergent MRI During Stroke Alert to Diagnose Stroke Mimics: Single-Center Experience

Read “Cost-Effectiveness of Emergent MRI During Stroke Alert to Diagnose Stroke Mimics: Single-Center Experience,” by Kapoor, Sharma, Iser, Chaudhari, Nalleballe, Brown, Veerapaneni, Sheng, Elkhider, Veerapaneni, Onteddu, and Sidorov, from Journal of Neurosciences in Rural Practice (2021).

3. Couples Coping in the Community After the Stroke of a Spouse: A Scoping Review

Read “Couples Coping in the Community After the Stroke of a Spouse: A Scoping Review,” by Ramazanu, Alie, and Vico Chung, from Nursing Open (2020).

4. Long-Term Effects on Survival After a 1-Year Multifactorial Vascular Risk Factor Intervention After Stroke or TIA: Secondary Analysis of a Randomized Controlled Trial, a 7-Year Follow-Up Study

Read “Long-Term Effects on Survival After a 1-Year Multifactorial Vascular Risk Factor Intervention After Stroke or TIA: Secondary Analysis of a Randomized Controlled Trial, a 7-Year Follow-Up Study,” by Hagberg et al., from Vascular Health and Risk Management (2019). Case Study Mr M NRS410V

5. This Is Not Only About Memory: A Systematic Review on Neuropsychology Heterogeneity in Alzheimer’s Disease

Read “This Is Not Only About Memory: A Systematic Review on Neuropsychology Heterogeneity in Alzheimer’s Disease,” by Martorelli, Sudo, and Charchat-Fichman, from Psychology and Neuroscience (2019).

6. This Is Our Life Now. Our New Normal: A Qualitative Study of the Unmet Needs of Carers of Stroke Survivors

Read “‘This Is Our Life Now. Our New Normal’: A Qualitative Study of the Unmet Needs of Carers of Stroke Survivors,” by Denham et al., from PLOS ONE (2019). Case Study Mr M NRS410V

7. Optional- Disentangling Heterogeneity in Alzheimer’s Disease and Related Dementias Using Data-Driven Methods

For additional information, the following is recommended:

“Disentangling Heterogeneity in Alzheimer’s Disease and Related Dementias Using Data-Driven Methods,” by Habes, Grothe,Tunc, McMillan, Wolk, and davatzikos, from Biological Psychiatry (2020).

8. Optional- Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in Epileptic Patients: A Multidimensional Comparison of the Psychiatric Profile of Patients Suffering From Epilepsy and Patients Suffering From Psychogenic Nonepileptic Seizures. Case Study Mr M NRS410V

For additional information, the following is recommended:

“Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in Epileptic Patients: A Multidimensional Comparison of the Psychiatric Profile of Patients Suffering From Epilepsy and Patients Suffering From Psychogenic Nonepileptic Seizures,” by Guillen et al., from Frontiers in Psychiatry (2019). Neurological Perceptual And Cognitive Complexities NRS410V

Suicidal Ideation and Traumatic Exposure Should Not Be Neglected in Epileptic Patients: A Multidimensional Comparison of the Psychiatric Profile of Patients Suffering From Epilepsy and Patients Suffering From Psychogenic Nonepileptic Seizures – PMC (nih.gov)