Mr. M., a 70-year-old male, has been living at the assisted living facility where you work
Case Study: Mr. M
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.
| Course Code | Class Code | Assignment Title | Total Points | |||
| NRS-410V | NRS-410V-OL191 | Case Study: Mr. M. | 120.0 | |||
| Criteria | Percentage | Unsatisfactory (0.00%) | Less Than Satisfactory (75.00%) | Satisfactory (79.00%) | Good (89.00%) | Excellent (100.00%) |
| Content | 80.0% | |||||
| Clinical Manifestations of Mr. M. | 10.0% | Clinical manifestations are omitted. | Clinical manifestations are partially presented. There are major omissions and inaccuracies. | Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. | Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. | Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms. |
| Diagnoses and Secondary Diagnoses | 10.0% | A discussion on what primary and secondary medical diagnoses should be considered for Mr. M. is omitted; or, medical diagnoses presented are inaccurate. | 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. | 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. | 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. | 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. |
| Explanation of Expected Abnormalities During Nursing Assessment | 15.0% | 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. | 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. | 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. | A discussion of abnormalities a nurse would expect to find during a nursing assessment is presented. General rationale and evidence are provided for support. | 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. |
| Effects of Health Status on Physical, Psychological, and Emotional Aspects of Patient and Family | 15.0% | 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. | 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. | 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. | 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. | 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. |
| Interventions for Support | 15.0% | Interventions that can be put into place to support Mr. M. and his family are omitted. | Some interventions that can be put into place to support Mr. M. and his family are partially presented. More information is required. | Some interventions that can be put into place to support Mr. M. and his family are summarized. There are minor inaccuracies. | Key interventions that can be put into place to support Mr. M. and his family are discussed. Some detail is needed for clarity. | All relevant interventions that can be put into place to support Mr. M. and his family are thoroughly discussed. |
| Actual or Potential Problems Based on Condition | 15.0% | Fewer than three actual or potential problems faced by the patient are presented. The problems posed are not relevant to his condition. | 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. | 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. | 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. | 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. |
| Organization, Effectiveness, and Format | 20.0% | |||||
| Thesis Development and Purpose | 5.0% | Paper lacks any discernible overall purpose or organizing claim. | Thesis is insufficiently developed or vague. Purpose is not clear. | Thesis is apparent and appropriate to purpose. | Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. | Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. |
| Argument Logic and Construction | 5.0% | Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. | Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. | 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. | Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. | 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) | 5.0% | Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. | Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. | 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. | 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. | Writer is clearly in command of standard, written, academic English. |
| Paper Format (use of appropriate style for the major and assignment) | 2.0% | Template is not used appropriately, or documentation format is rarely followed correctly. | Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. | Appropriate template is used. Formatting is correct, although some minor errors may be present. | Appropriate template is fully used. There are virtually no errors in formatting style. | All format elements are correct. |
| Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) | 3.0% | Sources are not documented. | Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. | Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. | Sources are documented, as appropriate to assignment and style, and format is mostly correct. | Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. |
Expert Answer and Explanation
Assessment and Treatment of Patients with Memory Decline
In order to effectively treat patients, providers should understand the patient’s health needs, and they can do this by gathering as much details about the patient as possible. Patient assessment involves looking at the clinical symptoms, medical history, and collecting any pertinent information that can help during the diagnosis process. Assessing patients can also help determine their emotional and psychological problems which intertwine with the patient’s physiological health (Jaul & Barron, 2017). Mr. M’s case represents a clinical scenario that can be addressed through the use of appropriate assessment and intervention as described in this paper.
Clinical Manifestation present in Mr. M.
Memory lapse and unsteady gain are some of the manifestations present in Mr. M. For the patient, remembering the number of his room and the names of his kin is becoming a challenge. The patient experiences difficulty feeding, bathing and performing other Activities of Daily Living (ADLs) and he needs assistance with the ADLs. To manage a sleep disorder is having, the patient uses Zolpidem, and he appears tired. M’s objective data shows that he has prehypertension considering that his BP level is 123/78. Furthermore, 28.4 Body Mass Index (BMI) shows the patient’s weight is excessive.
Primary and Secondary Medical Diagnosis to consider and the Data provided for Support
When working with Mr. M., a provider should consider the primary and secondary diagnosis. Besides Alzheimer, stroke is the primary diagnosis for the patient. The rational for this diagnosis is that hypertension increases one’s likelihood of experiencing stroke. The infection of the Urinary Tract (UT) is the other diagnosis that one would expect to find in Mr. M. This is because the presence of the leukocytes in urine is a sign of the infection.
It can also be a sign of inflamed UT especially in kidneys, and considering that the patient is on Lisinopril and Lipitor, it is possible that the two drugs might be responsible for the damage of his kidneys (Ruszkowski, Masajtis-Zagajewska, & Nowicki, 2019). The two medications can equally damage the liver, and liver damage is the secondary diagnosis for Mr. M.
Abnormalities that Mr. M. is likely to have
Given Mr. M’s health issues, he is at risk of developing certain abnormalities. Kidney disorder is an abnormality the patient is at risk of developing because he is taking some medications that have the potential of interfering with his kidneys. The high number of leukocytes means the patient’s risk of developing leukemia is high. Changes in BP and body temperature are the other abnormalities that Mr. M is likely to experience. The patient may experience these changes because any variation in the patient’s physiological health can cause the vital signs to change.
Physical, Psychological and Emotional Effects of M’s Health Status (on him and on his family)
Mr. M’s health status may have emotional, physiological and physical toll on him and on the people close to him. The patient cannot effectively ambulate because of his condition, and he is experiencing cognitive decline, and this exposes him to the risk of violence. The risk of injury for this patient is high given his tibial fracture. Aggressiveness and agitation are signs of emotional toll of the condition. On the other hand, fear and being apprehensive seem to indicate negative effect of his condition on his psychological wellbeing. For family, seeing Mr. M having cognitive decline can be emotionally and psychologically exhausting.
Interventions that can support Mr. M. and his Family
Mr. M, together with his family can benefit from a range of interventions focused on promoting his emotional, psychological and physiological wellbeing. Getting help from a therapist is one way in which Mr. M can recover from his aggressive behavior, and this intervention can also be effective for the family. The therapist can use cognitive behavioral therapy (CBT) to help her. Involving a physiotherapist to help Mr. M, and guide through the process of performing ADLs is the other intervention that can support his recovery.
The physiotherapist, given their specialty, understands how to help a patient who is unable to perform ADLs. Having the patient be in adult care setting can address his loneliness, and reduce his risk of getting lost (Motamed-Jahromi & Kaveh, 2021). Additionally, the family should occasionally visit him at the facility so that they can bond more. This intervention can help him recall the names of his family members. However, medication can be administered to improve his memory.
Four Actual or Potential problems that Mr. M faces
There are key health issues that Mr. M is facing. Dementia is problem that he seems to face because it can occurs if his narrowing of arteries as a result of hypertension occurs (Bondi, Edmonds, & Salmon, 2017). Atherosclerosis is the other condition that might affect the patient. This is because being overweight is a risk factor for the disorder.
Considering that being hypertensive tends to interfere with the manner in which one’s heart functions, the patient is at risk of experiencing heart failure. Stroke is the fourth problem that could affect the patient, the reason being that the elevated BP may interfere with the supply of the brain to the brain (Hannawi et al., 2018).
Conclusion
In overview, effective diagnosis of a patient requires knowledge of conducting assessment including ability to critically think. Diagnosis, either primary or secondary, can help identify the needs of the patient, and the information can help a provider determine the treatment that can help promote recovery. Assessment should include gathering of comprehensive details of the patient.
References
Bondi, M. W., Edmonds, E. C., & Salmon, D. P. (2017). Alzheimer’s Disease: Past, Present, and Future. Journal of the International Neuropsychological Society : JINS, 23(9-10), 818–831. Doi: https://doi.org/10.1017/S135561771700100X.
Hannawi, Y., Yanek, L. R., Kral, B. G., Vaidya, D., Becker, L. C., Becker, D. M., & Nyquist, P. A. (2018). Hypertension Is Associated with White Matter Disruption in Apparently Healthy Middle-Aged Individuals. AJNR. American journal of neuroradiology, 39(12), 2243–2248. https://doi.org/10.3174/ajnr.A5871.
Jaul, E., & Barron, J. (2017). Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Frontiers in public health, 5, 335. Doi:https://doi.org/10.3389/fpubh.2017.00335.
Motamed-Jahromi, M., & Kaveh, M. H. (2021). Effective Interventions on Improving Elderly’s Independence in Activity of Daily Living: A Systematic Review and Logic Model. Frontiers in public health, 8, 516151. https://doi.org/10.3389/fpubh.2020.516151.
Ruszkowski, P., Masajtis-Zagajewska, A., & Nowicki, M. (2019). Effects of combined statin and ACE inhibitor therapy on endothelial function and blood pressure in essential hypertension – a randomised double-blind, placebo controlled crossover study. Journal of the renin-angiotensin-aldosterone system : JRAAS, 20(3), 1470320319868890. https://doi.org/10.1177/1470320319868890.
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nrs 410v case study mr m, case study mr m
FAQs
Lymphocytes: Exploring the Key Players of the Immune System
Introduction
The human body is equipped with a remarkable defense mechanism known as the immune system, which protects us from harmful pathogens. At the forefront of this complex system are white blood cells called lymphocytes. In this article, we delve into the fascinating world of lymphocytes, exploring their functions, types, location, appearance, normal range, and the implications of high or low levels. Additionally, we highlight common tests used to evaluate lymphocyte health and discuss typical symptoms of lymphocyte-related conditions.
What are lymphocytes?
Lymphocytes are a type of white blood cell that form an integral part of the immune system. They are produced in the bone marrow and can be found in various tissues and organs including the lymph nodes, spleen, and thymus gland.
What do lymphocytes do?
Lymphocytes play a pivotal role in adaptive immunity, coordinating responses to specific threats such as bacteria, viruses, and other foreign substances introduced into the body. They identify and neutralize these invaders, providing long-lasting immunity against future encounters.
How do T cells and B cells work?
There are two main types of lymphocytes: T cells and B cells. T cells, also known as T lymphocytes, mature in the thymus gland, while B cells, or B lymphocytes, develop in the bone marrow. These cells work in tandem to defend the body against different types of threats.
T cells are responsible for cell-mediated immunity, recognizing and directly attacking cells infected by viruses or affected by cancer. B cells, on the other hand, initiate the production of antibodies, molecules that target and disable specific pathogens circulating in bodily fluids.
Where are lymphocytes located?
Lymphocytes are found in various tissues and organs throughout the body. They are particularly concentrated in lymphoid tissues such as lymph nodes, spleen, tonsils, and Peyer’s patches in the gut. This strategic distribution allows lymphocytes to efficiently survey the body for foreign invaders.
What do lymphocytes look like?
Under a microscope, lymphocytes appear as round or slightly indented cells with a large nucleus that occupies most of the cytoplasm. They are smaller than other white blood cells, with a diameter ranging from 7 to 20 micrometers.
What is the normal range of lymphocytes?
The normal range of lymphocytes in the blood varies depending on the age of the individual. In adults, lymphocytes typically account for 20 to 40% of the total white blood cell count. In absolute numbers, the normal range is typically around 1,000 to 4,800 lymphocytes per microliter of blood.
What does a high level of lymphocytes mean?
An increased lymphocyte count, known as lymphocytosis, may indicate several conditions such as viral infections (e.g., mononucleosis), bacterial infections (e.g., pertussis), chronic lymphocytic leukemia, or autoimmune disorders like rheumatoid arthritis.
What does a low level of lymphocytes mean?
A decreased lymphocyte count, known as lymphopenia, can occur in conditions such as HIV infection, severe sepsis, immunodeficiencies, Hodgkin’s lymphoma, or due to certain medications like corticosteroids.
What are the common tests to check the health of my lymphocytes?
Medical professionals may perform various tests to assess lymphocyte health. A complete blood count (CBC) provides an overall view of different types of blood cells, including lymphocytes. Additionally, flow cytometry can be employed to quantitatively analyze and categorize lymphocytes based on surface markers.
What are common symptoms of lymphocyte conditions?
Symptoms associated with lymphocyte abnormalities may vary depending on the underlying cause. Some common signs include swollen lymph nodes, fatigue, recurrent infections, night sweats, unexplained weight loss, and prolonged fever.
Conclusion
Lymphocytes form a crucial part of the immune system, defending the body against harmful pathogens and providing long-term immunity. Understanding their role, appearance, normal range, and implications of high or low levels is essential for assessing immune health. By recognizing common symptoms and employing appropriate tests, medical professionals can diagnose and treat conditions related to lymphocyte dysfunction effectively.
References:
- Sally A. Romero and Stephen R. Master. Immunopathology. In: Kumar Abbas Fausto, Aster Jon (eds). Robbins and Cotran Pathologic Basis of Disease. Elsevier Saunders, 2021.
- Murphy K, Weaver C. Janeway’s Immunobiology. 9th edition. Garland Science, 2016.
- Hoffbrand AV, Moss PAH, Pettit JE. Essential Haematology. 7th edition. Wiley-Blackwell, 2015.
