Memory Loss Treatment in Nursing Practice Case Study

Case Scenario Summary

Mr. M is an elderly male patient whose health has been deteriorating quickly for the past two months. He exhibits symptoms of memory loss, such as failing to recall numbers, names, and short-term events. During these times, he appears to be agitated, fearful, and easily provoked into aggressive. He has been found sleepwalking and required help to get back to his room every time. The patient became incapable of performing even the simplest of tasks, such as bathing, clothing, and feeding oneself, requiring assistance in every case. The nurses at the ADL facility are concerned and have requested additional tests to understand the root of the matter.

Patient History Summary

Mr. M is an elderly patient aged 70, with a plethora of age-related healthcare issues. His experiences include limited physical activity relating to ambulation and an unsteady gait. His history of diseases includes hypertension, hypercholesterolemia, post-appendectomy, and tibial fracture with no complications. The patient uses a variety of medications to manage the symptoms of his conditions, including lisinopril, Lipitor, Ambien, Xanax, and Ibuprofen. Mr. M has no known allergies, does not drink or smoke.

Clinical Manifestations of the Disease

The identification of clinical manifestations of the disease is an important first step toward a correct diagnosis and the development of a plan of action to improve the patient’s short-term and long-term stability (Mielsen, 2016). Clinical manifestations stand for identifiable symptoms detected by the patient or a nursing specialist in the course of a physical assessment and laboratory testing. The following findings have been identified in the course of this case study:

• The patient has an unusually high concentration white blood cells in the blood and urine. Total WBC count is 19.2 (1,000/uL);
• The patient has a slightly increased temperature of 37.1 C, whereas the norm is 36.6 C. This may indicate inflammatory processes in the body.
• The patient has trouble recalling the names of his relatives, his room number, and the words he just said or read. These symptoms indicate both short-term and long-term memory loss.
• The patient expresses confusion and aggression in the aftermath of a memory loss incident.
• The patient has trouble locating himself in space and is often found wandering at night by the nursing staff.

These manifestations indicate to a plethora of potential diseases of different origin occurring all at once, but affecting different systems of the patient’s body. The following sections will delve deeper into the potential diagnoses.

Primary, Secondary, and Tertiary Diagnoses

The most concerning symptoms, associated with the loss of mobility and capacity to take care of oneself, are connected with short-term and long-term memory loss, as well as mood swings associated with them. These symptoms coincide with symptoms of a condition known as dementia, which is characterized by memory loss, increased levels of confusion and aggression, and sleepwalking (Mielsen, 2016). The latter is often caused by sleeping disorders and result in wandering, low levels of physical activity, as well as the capacity to fall asleep in places not suitable for resting (Mielsen, 2016).

The secondary diagnosis with similar clinical manifestations is Alzheimer’s disease. Dementia is often a byproduct of the processes that are facilitated by the identified condition (Apostolova, 2016). Alzheimer’s disease has symptoms similar to those of dementia, which include mood swings, memory loss, and the loss of direction, all of which have been present in Mr. M so far (Apostolova, 2016). With the connections present between the two diagnoses, it is very likely for both to be present at the same time.

Tertiary diagnoses are derived from the analysis of symptoms that seemingly has no connection to the primary and secondary diagnosis. The laboratory analyses show an increased number of WBCs and leucocytes in blood and urine. WBCs exceed the upper limited by almost two times, and leucocytes in urine both indicate to infective and inflammatory processes present in the system (Schaeffer & Nicolle, 2016). These symptoms indicate a potential infection of the urinary tract. Additional diagnosis would include a kidney disease provoked by polypharmacy. The fact that the patient did not report any pains that are common with the urinary tract disease supports this theory (Schaeffer & Nicolle, 2016).

Nursing Assessment and Expected Abnormalities

The majority of expected abnormalities can be associated either with the primary, secondary, and tertiary diagnoses, or the incidents of polypharmacy from the drugs currently taken by the patient. The primary suspects behind the increased number of leucocytes as a result of failing kidneys are ibuprofen and lisinopril (Aronson, 2015). These drugs reduce the capacity of kidneys to function properly when used together. ACE inhibitors enter into reactions with nearly all other drugs on the list, and have the potential to cause low blood pressure, poor sense of balance, impaired thinking, and increase the levels of aggression (Aronson, 2015). The primary suspects for these abnormalities are Xanax, Lipitor, and Ambien. Their reaction causes dizziness, loss of control, and temporary dazes, which usually occur within one hour after taking medicine (Aronson, 2015).

Effects on the Patient’s Health Status

The primary and secondary diagnoses can have numerous potential health status effects on the patient. They could cause his memories, skills, and social connections to deteriorate rapidly, leaving the individual incapable of taking care of himself and resume a healthy life after the condition is stabilized (Apostolova, 2016). Many patients become estranged by their families as a result of mental health problems, which could lead to feelings of abandonment, depression, and social anxiety.

Patients with Alzheimer’s and dementia are notoriously dependent on company and compassion to resume recovery (Miesen, 2016). Friends and family members of the affected individual are also going to be under the risk of being affected, as the patient’s aggression and confusion would strain their tolerance to the limit, and cause gradual separation (Miesen, 2016). Finally, the economic aspects of managing dementia and Alzheimer’s disease will be detrimental to both the patient and his family. They will have to manage not only the expenditures associated with medical treatments but also cut time out of their work and lives to care for the patient (Apostolova, 2016).

Actual and Potential Problems Faced by the Patient

Mr. M is at risk of encountering a variety of problems that could negatively impact his quality of life. The identified issues are the following (Miesen, 2016):

• Increased chances of trauma;
• Increased costs of treatment and maintenance;
• Inability to follow the prescribed treatments without aid;
• Family alienation;
• Polypharmacy (Aronson, 2015).

All of these issues are either explaining the existent problems faced by the patient or new ones that could be developed in the short-term or long-term perspective.

Potential Interventions for Mr. M

The identified interventions that could be used to treat Mr. M as part of his care delivery plan would involve drug treatments, educational assistance, and family therapy (Miesen, 2016). Drugs and ADL assistance would take the bulk of the expenses and positive effects on the patient, as the former would help reduce or remove the symptoms, while the latter would improve their everyday life (Aronson, 2015). Education would help the patient and his family manage the symptoms, while psychological support would help improve relations and facilitate and understanding between all parties (Apostolova, 2016).

References

Apostolova, L. G. (2016). Alzheimer disease. Continuum: Lifelong Learning in Neurology, 22(2), 419-434.

Aronson, J. K. (Ed.). (2015). Meyler’s side effects of drugs: The international encyclopedia of adverse drug reactions and interactions (16th ed.). New York, NY: Elsevier.

Miesen, B. (2016). Dementia in close-up. New York, NY: Routledge.

Schaeffer, A. J., & Nicolle, L. E. (2016). Urinary tract infections in older men. New England Journal of Medicine, 374(6), 562-571.