Clinical Manifestation

Mr. M is a 70-year-old patient living in an assisted facility with a decline in functional
and cognitive capabilities. The subjective clinical manifestation present is memory impairment,
as he has challenges recalling the names of his loved ones, remembering his room number, and
repeating information. Mr. M also has personality changes since he often becomes violent and
agitated. In addition, he is confused about his location as he wanders at night, needing help
finding his room. He has become dependent on various daily activities, such as dressing, feeding,
and bathing. Besides, looking at the objective clinical manifestation, Mr. M has a normal
temperature of 37.1 degrees, blood pressure of 123/78 mmHg, elevated heart rate of 93
beats/min, slightly high respiratory rate of 22 breaths/min, and 99 percent Oxygen saturation.
Additionally, the lab results show the following; WBC 19.2 (1,000/uL), lymphocytes 6700
(cells/uL), protein 7.1 g/dL; AST: 32 U/L; ALT 29 U/L, no changes of CT Head from the
previous scan, and also positive urinalysis showing moderate amount leukocytes and cloudy.

Medical Diagnoses

The primary diagnosis of Mr. M is Dementia, and a common type is Alzheimer’s.
According to the National Institute on Aging (2021), Dementia is a brain disorder that slowly
destroys an individual’s memory and thinking capabilities, so they cannot do simple tasks.
Alzheimer’s disease signs are getting lost, personality changes, wandering, repeating questions,
and trouble completing the usual daily tasks (National Institute on Aging, 2021) . Dementia must
be considered because Mr. M’s clinical manifestations show all these signs. He is forgetful and
has issues recalling his family members and room number. Mr. M also gets lost, wanders, and
depends on various ADLs. Urinary Tract Infection (UTI) is another primary diagnosis that
should be considered because the laboratory results show a positive urinalysis with a moderate

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amount of leukocytes and cloudy, lymphocytes 6700 (cells/uL), and an elevated WBC count of
19.2 (1,000/uL). According to the Alzheimer’s Society (2023), older people with Dementia and
UTI encounter severe confusion, behavior change, and agitation. These symptoms are similar to
Mr. M’s delirium subjective clinical manifestations.
The secondary diagnosis for Mr. M is hypertension. It needs to be considered because the
data on the patient shows that he is on ACE inhibitors to control hypertension.
Hypercholesterolemia is another secondary diagnosis since Mr. M’s objective data shows
increased blood cholesterol levels of protein 7.1 g/dL; AST: 32 U/L; ALT 29 U/L. It puts him at
risk for heart illnesses.

Nursing Diagnoses

A nursing diagnosis related to the primary medical diagnosis of Alzheimer’s disease is
impaired memory due to the decline of cognitive abilities. Nursing diagnoses of Alzheimer’s
include; personality change, poor memory, wandering, and inability to carry out daily activities
(Acello & Hegner, 2021) . All these are evident as Mr. M is repeating information, forgetting his
room number, wandering, personality changes, and having challenges recalling names. Based on
the secondary diagnoses, the nursing diagnosis is the risk of cardiovascular functioning because
Mr. M is on hypertension medication and has high cholesterol levels (Cleveland Clinic, 2022) .

Abnormalities

One of the abnormalities is cognitive impairment, as Mr. M has memory loss, wanders at
night, and has personality changes. Older adults may have cognitive impairment due to UTIs,
medication side effects, Dementia, or metabolic imbalances (National Institute on Aging, 2021) .
Thus a nurse needs to assess the cognitive status of Mr. M. Another abnormality is UTI. The
normal range of lymphocytes in adults is 1,000 and 4,800 in every one blood microliter, but Mr.

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M has lymphocytes of 6,700 (cells/uL), which is an increase. A high lymphocyte level indicates
an infection (Hamad & Mangla, 2022) . Also, a positive urinalysis with moderate leukocytes and
cloudy indicates inflammation along the urinary tract (Hourizadeh et al., 2023) .
Physical, psychological, and emotional impacts on the patient and family
Mr. M could dramatically decline his physical health due to progressive delirium, leading
to an inability to carry out ADLs. Also, there could be muscle loss resulting in challenges to
withholding urine. He can have various emotional and psychological impacts, such as fear for the
future, grief, low self-esteem, or depression. In addition, the family may step in as caregivers and
spend a lot of money due to dementia care; this means they would reduce their spending, lessen
their working hours, or stop working to be full-time family caregivers.

Interventions

One of the interventions to support Mr. M and his family is offering safe and supportive
surroundings with sufficient supervision to avoid falling or night wandering. The use of
validation therapy, such as cognitive behavioral therapy, is essential. CBT is a useful and
effective approach to treating Dementia among older individuals (Wang et al., 2020) .
Pharmacological interventions can also be used to lessen aggression and anxiety for Mr. M.
Lastly, providing education and support to the family, such as resources for respite care or full-
time caregiver support.

Potential Problems

The four actual or potential issues Mr. M faces include the risk of falling. It is due to
cognitive decline, wandering, and impaired mobility, leading to loss of independence and the risk
of injuries. Two is malnutrition. An advanced level of Mr. M’s forgetfulness could make him
forget to take food or a balanced diet, especially when there is no supervision, leading to

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malnutrition. Three, acute kidney issues. It can arise from untreated UTI, which can cause renal
impairment, a life-threatening problem. Lastly is impaired communication. Mr. M’s cognitive
decline could make him unable to communicate effectively, resulting in a misunderstanding with
the caregivers, frustrations, and conflicts.

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References

Acello, B., & Hegner, B. (2021). Nursing Assistant: A Nursing Process Approach. Cengage
Learning.
Alzheimer’s Society. (2023). Urinary tract infections and Dementia.
https://www.alzheimers.org.uk/get-support/daily-living/urinary-tract-infections-utis-
dementia
Cleveland Clinic. (2022, May 24). High cholesterol diseases.
https://my.clevelandclinic.org/health/articles/11918-cholesterol-high-cholesterol-diseases
Hamad, H., & Mangla, A. (2022, November 30). Lymphocytosis. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK549819/
Hourizadeh et al. (2023). The first known documented case of Ewingella Americana urinary tract
infection. Cureus, 15(3). doi:DOI 10.7759/cureus.35640
National Institute on Aging. (2021, July 8). Alzheimer’s disease fact sheet.
https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
National Institute on Aging. (2021, March 23). Assessing cognitive impairment in older patients.
https://www.nia.nih.gov/health/assessing-cognitive-impairment-older-patients
Wang et al. (2020). The effectiveness of modified, group-based CBT for Dementia worry among
Chinese elders. Journal of Affective Disorders, 274, 76-84.
doi:org/10.1016/j.jad.2020.05.054