Nursing Assessment and Medical Diagnoses

Clinical Manifestations

Clinical manifestations are objective symptoms of the disease as perceived by the nurse performing a medical check, or the patient in the course of their illness. In Mr. M’s scenario, clinical manifestations of the disease are as follows:

  • Increased number of WBCs (white blood cells) in the blood and in urine;
  • Slightly increased body temperature (37.1 C);
  • Trouble recalling people, words, and places;
  • Increased levels of aggression when lost or confused;
  • Sleepwalking and increased dependence on ADLs and other medicaments.

Primary and Secondary Medical Diagnosis

The primary diagnosis for the patient is dementia, as the patient offers an array of symptoms associated with the disease, which includes short-term memory loss, aggression, and sleepwalking (Alzheimer’s Association, 2018). It is noted that patients with that diagnosis have sleep disorders that often result in nighttime wandering, sleepiness, drowsiness, and reduced levels of physical activity.

The secondary diagnosis for the patient is Alzheimer’s disease, which is often confused with dementia, during primary assessments (Alzheimer’s Association, 2018). Finally, a separate diagnosis could be made in regards to the patient’s laboratory analyses, which include almost two times the number of WBCs (19.2 vs. 10 as the upper limit for adults) as well as a moderate number of leucocytes in the urine. These findings indicate a possible infection of the urinary tract (Ray, 2015).

Nursing Assessment: Expected Abnormalities

Aside from the abnormalities already discovered as part of clinical manifestations, the patient is likely to suffer from a reduced kidney capacity. It is possible that the leucocyte count is increased because of the interaction between drugs that the patient is currently taking. Ibuprofen and lisinopril may affect one’s kidney functions and result in symptoms similar to the infection of the urinal tract (Rodrigues, 2019).

Additional abnormalities may include lower blood pressure, impairments in thinking, judgment, and motor coordination. While nearly all drugs interact with one another in a way that affects blood pressure, Xanax and Ambien cause mind-related issues (Rodrigues, 2019).

Physical, Psychological, and Emotional Effects of the Patient’s Health Status

Dementia has a myriad of effects on the affected person. As the disease becomes more progressive, the patient would lose their memories, skills, and the capacity to retain connections to other people (Livingston et al., 2017). Social isolation, coupled with physical helplessness and emotional detachment, may cause unwanted mental health problems, including depression and suicidal thoughts (Livingston et al., 2017). The family will also be affected, as Mr. M may stop recalling them or lash out in aggression due to confusion induced by the disease. It is going to be a very hard time for the patient and his family, which may result in potential healthcare issues for them as well.

Potential Interventions

The interventions for Mr. M and his family should include the following (Livingston et al., 2017):

  • Drug treatment. Mr. M should take the appropriate medicine to help inhibit the negative effects of dementia;
  • Mr. M and his family should be made aware of the symptoms of their disease as well as the means of how to cope with them;
  • Mr. M and his family should receive all the required psychological support in order to maintain a healthy attitude towards the situation.

Actual and Potential Problems

Actual and potential problems faced by Mr. M are as follows (Livingston et al., 2017):

  • The inability to recall important information about his scheduled appointments or medicine intake. The main dangers of dementia and Alzheimer’s disease lie in the reduced patient agency and autonomy.
  • Potential alienation of the family. Mr. M’s relatives and caregivers may suffer from depersonalization and care fatigue, which would impact their relationship in the long-term.
  • Increased chances of trauma. Dementia and Alzheimer’s have a negative effect on patient autonomy. Coupled with the side effects of all the drugs, there is an increased chance of a traumatic event.
  • Increased financial costs. Treatment and maintenance of a low-mobility patient suffering from dementia will place an additional burden on the patient and his family.

References

Alzheimer’s Association. (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429.

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., … & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.

Ray, T. (2015). Manual of Nephrology. Nephrology Nursing Journal, 42(3), 295-296.

Rodrigues, A. D. (2019). Drug-drug interactions. Boca Raton, FL: CRC Press.

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