Background
Mr. M. is a 70-year-old nursing home resident with the present manifestations of hypertension, high LDL cholesterol levels, and a history of appendectomy and tibial fracture surgery. Currently, the most evident clinical manifestation in the patient’s condition is his rapid deterioration in cognitive health status, including memory lapses, anxiety, and lack of comprehension of his surroundings. Although the patient’s heart rate and blood pressure are within the normal range, they are still slightly elevated and can trigger the patient’s hypertension and, consequently, increase the risk of cardiovascular diseases.
Such an elevation can be justified by Mr. M.’s anxiety and confusion, as he feels rather stressed about the sudden worsening of his condition. The anger, for its part, may also be explained by the patient’s lack of understanding of his surroundings and causes for rapid deterioration. The CT head scans show no evidence of brain injury or disruption in blood supply, so the risks of stroke and ischemia can be eliminated. Finally, the presence of rapid disruptions in the patient’s ADL performance is an alarming sign of cognitive and physical disparities.
Primary and Secondary Diagnoses
Given the present case scenario, the most significant issues concern memory lapses, sudden mood swings, and the abrupt inability to perform such ADLs as dressing, bathing, and feeding himself. All these clinical manifestations present a considerable risk of dementia. According to Taylor and Close (2018), dementia is “a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person’s ability to function” (p. 303). Such a description explicitly correlates with the challenges faced by Mr. M., as his sudden decline in short-term memory functioning has eventually led to confusion and the inability to function autonomously with no external assistance.
No changes in CT head scans may as well contribute to the diagnosis of dementia, as computer tomography is incapable of tracking such cognitive dysfunctions as dementia and Alzheimer’s disease. Moreover, anxiety, which is listed among other Mr. M.’s symptoms, is considered a well-known risk factor of dementia (Becker et al., 2018). Finally, the patient’s prior intake of statins in the form of Lipitor may also become a trigger for dementia evolvement (Schultz et al., 2018). Considering the arguments above, it may be concluded that the patient is highly likely to be diagnosed with dementia.
As far as the secondary diagnoses are concerned, the most likely clinical outcomes of the present symptoms include vascular dementia and Alzheimer’s disease. While vascular dementia is most frequently triggered by a certain neurological condition such as stroke and ischemia, in Mr. M.’s case, the history of hypercholesterolemia may also serve as a contributing factor (Smith, 2017). The risk of having Alzheimer’s disease, for its part, is higher in this case, both due to the overall prevalence statistics and no evident precedents to the disease emergence.
While there currently exist preventive initiatives to reduce the risk of Alzheimer’s disease among the aging population, no exhaustive data demonstrate the causes and triggers of this condition (James & Bennett, 2019). For this reason, given no explicit contributing disease and the patient’s age, the secondary diagnosis of Alzheimer’s disease is the most reasonable option to consider.
Abnormalities
The clinical manifestations explicitly point to the presence of cognitive impairment. For this reason, during the assessment, the nurse should expect to note drastic changes in the patient’s behavioral patterns and cognitive function. Mr. M. is likely to forget the answers to basic questions such as where he currently is or what is his middle name. Simultaneously, the patient may start recalling events from the past and perceive them as something taking place in the present, as the cognitive impartment erases the line between what is stored in long-term and working memory. The confusion may cause sudden aggressive episodes or so-called “temper tantrums,” so the nurse should expect changes in behavior, and, in some cases, it would be beneficial to engage with a psychotherapist and a physician during further assessments.
Moreover, if the patient is suspected of having Alzheimer’s disease, he is likely to experience issues with coordination, as cognitive distortions caused by dementia lead to some severe disruptions in one’s gait. For this reason, cerebellar examination during the assessment is expected (Newman, 2020). However, while the nurse should be prepared for the assessment in terms of possible outcomes, the examination’s emphasis should be placed on providing emotional support for Mr. M. because he has every right to be terrified.
Physical, Psychological, and Emotional Effects
The incidence of gait disruptions and falls is the most adverse effect of dementia. According to Taylor and Close (2018), gait and balance impairments, common for dementia, result in a significantly elevated risk of falls.
For this reason, it is critical to ensure patient assistance and fall prevention. As far as the psychological effects are concerned, the patient is prone to experience a series of psychological issues such as anxiety, depression, and aggression cultivated by confusion and a sense of helplessness. For this reason, the patient requires mental health support and counseling. Finally, dealing with Alzheimer’s is an emotionally challenging endeavor, as the implication of this disease is irreversible, and the patient is to come to terms with his need for assistance and external support for the rest of his life.
Nursing Interventions
Since Alzheimer’s disease is non-treatable, the only medications considered during the treatment are the ones to manage symptoms, with possible prescriptions including Exelon and Aricept. The primary focus of the medical interventions should include occupational therapy, memory training, counseling, and encouraging resiliency. Resiliency stands for encouraging the patient to feel optimistic and hopeful about the future, as such perception of one’s health goes a long way in the treatment’s success (Whitney, 2018). Moreover, it would also be critical to educate caregivers and guardians of the patient on the specifics of Alzheimer’s disease for them to support and assist Mr. M.
Problems Faced by Patient
The primary issue Mr. M. faces is the loss of memory and general cognitive decline (Taylor & Close, 2018). Over time, the patient will not be able to think rationally and have a functioning working memory, and such a condition requires constant assistance and observation. Another problem potentially faced by Mr. M. is the elevated risk of falls and imbalance. In order to prevent injuries and fractures, it is of utmost importance to promote occupational therapy and the usage of assisting walking devices (Taylor & Close, 2018). The third issue includes the risk of depression and other mental disorders (El Haj et al., 2020).
The risks of depression are especially relevant for nursing homes where the patients feel isolated from their families and guardians, so securing communication and interaction with others is key in combating depression and anxiety in patients. Finally, a serious problem for the patient is accepting the terminal diagnosis with dignity, as many patients tend to refuse care and assistance in denial of their condition. Hence, education and motivation are necessary to promote the patient’s well-being.
References
Becker, E., Rios, C. L. O., Lahmann, C., Ruecker, G., Bauer, J., & Boeker, M. (2018). Anxiety as a risk factor of Alzheimer’s disease and vascular dementia. The British Journal of Psychiatry, 213(5), 654-660. Web.
El Haj, M., Altintas, E., Chapelet, G., Kapogiannis, D., & Gallouj, K. (2020). High depression and anxiety in people with Alzheimer’s disease living in retirement homes during the Covid-19 crisis. Psychiatry Research, 291. Web.
James, B. D., & Bennett, D. A. (2019). Causes and patterns of dementia: An update in the era of redefining Alzheimer’s disease. Annual Review of Public Health, 40, 65-84. Web.
Newman, G. (2020). Coordination. MSD Manual. Web.
Schultz, B. G., Patten, D. K., & Berlau, D. J. (2018). The role of statins in both cognitive impairment and protection against dementia: A tale of two mechanisms. Translational Neurodegeneration, 7(1), 1-11. Web.
Smith, E. E. (2017). Clinical presentations and epidemiology of vascular dementia. Clinical Science, 131(11), 1059-1068. Web.
Taylor, M. E., & Close, J. C. T. (2018). Dementia. Handbook of Clinical Neurology, 159, 303-321. Web.
Whitney, S. (2018). Elimination complexities. In Pathophysiology clinical applications for client health [E-book]. Grand Canyon University. Web.