Introduction
The patient in the case under consideration, Mr. M., is a 70-year-old male living in an assisted living facility. The patient presents with difficulty ambulating and an unsteady gait resulting in limited physical activity throughout the day. Mr. M. has a history of hypertension controlled with angiotensin-converting enzyme (ACE) inhibitors and hypercholesterolemia. The patient underwent appendectomy and tibia reparation surgery with no noted complications. Currently, Mr. M. is exhibiting memory lapses and has difficulties recalling his family’s names and room numbers in the facility, and often gets lost on the premises. He also shows signs of aggression and disorientation and is incapable of carrying out most activities of daily living.
Patient examination reveals Mr. M. has a body temperature of 37.1 °C, blood pressure of 123/78, heart rate of 93 bpm, respiratory rate of 22 breaths per minute, and oxygen level of 99%. The obtained laboratory results indicate the patient has an increased white blood count of 19.2 (1,000/uL), elevated lymphocyte count of 6700 (cells/uL), and normal protein levels of 7.1 g/dL, 32 U/L AST, and 29 U/L ALT.
Primary and Secondary Medical Diagnosis
The primary diagnosis for Mr. M. is the onset of dementia. The disorder manifests through various cognitive and psychological changes, including memory loss, difficulty with visual and spatial abilities, confusion, disorientation, difficulty handling complex tasks, personality changes, paranoia, and agitation (“Dementia,” 2021). These symptoms are consistent with the ones exhibited by the patient, such as sudden memory loss, mood swings, and inability to perform activities of daily living. The secondary diagnosis is urinary tract infection supported by the elevated white blood count, elevated lymphocyte count, and leukocytes in urine. A urinary tract infection is an infection of any organ within the urinary system, including kidneys, bladder, urethra, and ureters (“Urinary tract infections,” 2020). This infection often presents with cloudy urine, which the patient has. It also can manifest with pain during urination, which the patient denies. However, the patient’s altered mental state should be considered when discussing pain with him.
Nursing Assessment
Further nursing assessments will need to be scheduled to confirm the primary diagnosis of dementia and the secondary diagnosis of urinary tract infection. According to Belleza (2021a), nursing assessments of patients with suspected dementia should include a psychiatric interview and serial assessments of psychiatric status. As acute changes in Mr. M.’s mental status have already been noticed by the staff of the living assisted facility, the next step in the assessment is a psychiatric interview. When assessing the patient for a urinary tract infection, nurses should collect additional information on the frequency, urgency, and hesitancy of urinary patterns and the presence of pain during urination (Belleza, 2021b). A urine culture and a CT scan can be ordered to determine the presence of bacteria in urine and abnormal obstructions in the urinary tract (“Urinary tract infections,” 2020). Thus, during the nursing assessment for dementia and a urinary tract infection, nurses should look for several characteristic abnormalities to confirm the suspected diagnoses.
Effects of Health Status on the Patient and Patient’s Family
Dementia and urinary tract infection diagnoses can substantially impact the physical, psychological, and emotional well-being of the patients and their families. Patients with dementia cannot perform self-care tasks and ensure their safety, which can lead to them sustaining physical injuries (“Dementia,” 2021). In addition, cognitive and psychological changes can lead to a patient exhibiting sudden mood changes and developing depression and anxiety (“Dementia,” 2021). Such a diagnosis can also be emotionally challenging to process for the patient’s family, whom he can no longer recognize. Meanwhile, a UTI infection can be physically challenging for the patient due to the pain associated with it. The patient can also experience mood swings, agitation, confusion, and restlessness (Hall, 2021). The diagnosis can present a psychological and emotional burden on the family as they may struggle with seeing their loved ones in a confused or agitated state.
Support Interventions
A variety of medication and therapy interventions can be offered to support the patient. Thus, if the dementia diagnosis is confirmed, Mr. M. can be prescribed cholinesterase inhibitors to slow the progression of the disease and antidepressants and anxiolytics to ease restlessness and agitation (Salamon, 2018). In addition, cognitive stimulation and daily orientation therapies can be offered to the patient to help them in their daily routines (Salamon, 2018). The family of the patient can also be offered therapy and professional support to cope with the diagnosis and be trained to help the patient function normally. Antibacterial agents can be offered for the treatment of urinary tract infections. In addition, the patient and his family can be educated on infection prevention measures.
Actual and Potential Problems
Several actual and potential problems should be considered when discussing this case. Thus, if no treatment is provided for the urinary tract infection, the patient can experience renal failure and urosepsis due to the spread of the infection (Belleza, 2021b). As a patient with suspected dementia, Mr. M. is also at risk of physical injury as he can get confused and lost in a familiar environment. In addition, vitamin deficiency and dehydration pose a potential concern as the patient can forget to eat and drink. Finally, the most urgent problem for the patient will be uncontrolled aggression, which follows as a consequence of disorientation. The patient cannot permanently take sedatives, which will disrupt his rhythm of life and weaken the cognitive functions of the brain. Based on this, it is worth creating an atmosphere and conditions that minimize outbreaks of aggression.
References
Belleza, M. (2021a). Dementia. Nurseslabs.
Belleza, M. (2021b). Urinary tract infection nursing care and management study guide. Nurseslabs.
Dementia. (2021). Mayo Clinic.
Hall, R. (2021). 3 things you didn’t know about UTIs. Norton Healthcare.
Salamon, M. (2018). Dementia treatments: Medication, therapy, diet, and exercise. WebMD.
Urinary tract infections. (2020). Cleveland Clinic.