Discussion: Old Male with Cardiomyopathy

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Old Male with Cardiomyopathy  

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

The case scenario discussed in this week’s assignment is about 70-year-old Mr. M a resident of the assisted living facility who presents with difficulty in recalling, agitation, aggression, and difficulty in ambulation. The conditions have rendered him dependent on others. He is being managed for hypertension which is well controlled and hypercholesterolemia. His assessment reveals that he is obese and the laboratory results show leukocytosis and feature suggestive of urinary tract infections. The purpose of this assignment is to describe Mr. M’s clinical manifestations, discuss his primary and secondary diagnoses, then highlight the physical, psychological, and emotional impact of his diagnoses on him and the family including the nursing interventions that could be employed in addressing these effects.

Clinical Manifestations

Mr. M is an elderly male who presents with memory problems for the past 2months with reports of trouble in recalling names of people and even objects such as things he read or his room number. This is associated with aggressive behaviors and has rendered him dependent on others to help with activities of daily living. The urinalysis done on the patient showed that his urine was cloudy in appearance with a considerable amount of leukocytes detected. The patient’s forgetfulness may be diagnosed as dementia which accounts for most of these cases, especially in old patients (Arvanitakis et al., 2019). Due to the forgetfulness in dementia, the patient may be frustrated at his inability to remember information thus the agitation and aggression that is reported by Mr. M. The agitation and aggression may also relate to deterioration in personality that usually results from dementia (Gale et al., 2018).

The urinalysis results obtained are consistent with a diagnosis of urinary tract infections (UTI). This condition has an interesting relationship with dementia as more cases are reported in dementia due to reduced hygiene levels and neglected personal care (Yourman et al., 2020). Further, dementia may be worsened by UTI due to increased inflammatory response in UTI with most patients experiencing delirium and disorientation despite the previously stable dementia (Arvanitakis et al., 2019). UTIs should therefore be properly diagnosed and promptly managed in dementia to prevent deterioration.

Primary and Secondary Diagnoses

            The patient’s primary diagnosis is dementia and UTI. Dementia that manifests with memory problems and personality changes is probably due to Alzheimer’s disease (AD) which accounts for 80% of dementia and is characterized by gradual onset and deterioration in memory (Parnetti et al., 2019). On the other hand, UTIs have been diagnosed based on urinalysis results. His primary diagnoses are therefore AD and UTI.

Mr. M’s secondary diagnoses as derived from his past medical history include hypercholesterolemia and hypertension. He had reported that he had been diagnosed with hypercholesterolemia and hypertension that was managed with 40mg Lipitor and 20mg of lisinopril daily respectively. Given they are still on these medications during the current presentation, it can be assumed that he is still suffering from hypercholesterolemia and hypertension (Gale et al., 2018). However, the normal blood pressure of 123/78mmHg that was obtained confirms that hypertension is well controlled at the current doses of antihypertensive drugs. Hypercholesterolemia should however be controlled aggressively to minimize the risk of cardiovascular events.

Abnormalities during Nursing Assessment

When the nurse analyzes the health information provided about Mr. M, some abnormalities can easily be identified. Such abnormalities include abnormal urinalysis results consistent with UTI, a history of progressive memory loss suggestive of dementia, as well as elevated lymphocyte levels. Leukocytosis and lymphocytosis may be induced by the body’s response to an infectious pathogen such as the one implicated in UTI (Yourman et al., 2020). In addition to these abnormalities and laboratory reports, some abnormalities that are anticipated during patient examination include cognitive disturbance, poor memory, and low intelligence during mini-mental status examination due to dementia (Parnetti et al., 2019).

Psychological, Emotional, and Physical Effects of the Disease on Mr. M and the Family

            Dementia results in a decline in physical and psychological function. The neglect of physical hygiene and personal care predisposes the patients to infections such as UTIs and even pressure sores that develop when the patients assume the same sitting or lying posture for a long time without shifting (Gale et al., 2018). The forgetfulness may also affect the eating schedule with patients going without meals for long especially when they live alone. As such, their physical well-being including body mass as well as physique thus the increased risk of infections (Parnetti et al., 2019). The loss of muscles and dementia itself may affect the patient’s ability to control bowels and thus further deteriorates personal hygiene.

In addition to the physical effects, the condition also poses psychological impacts on the patients including anger, depression, and anxiety. The depression results from the increased dependence on other family members to help with activities that the patient could initially able to achieve (Gale et al., 2018). Further, forgetfulness is also frustrating and may contribute to depression (Arvanitakis et al., 2019). The family members are equally affected by the AD especially due to the required financial support, the need to play a physical caregiving role, as well as the depression that results when they witness their loved ones being affected by the illness (Parnetti et al., 2019).

Nursing Interventions to Assist Mr. M and the Family

            The nursing interventions will seek to address the physical and psychological needs resulting from the patient’s diagnosis. Timely administration of antibiotic medications would be appropriate for the management of the suspected UTI, cognitive behavioral therapy (CBT) would be indicated for improving the cognitive status of the patient, as well as family education that would improve family involvement in patient care (Arvanitakis et al., 2019). Further, the nurse can refer the patient to other healthcare workers such as nutritionists and occupational therapists whose services would be needed (Yourman et al., 2020). They can also link the patient to the support groups in the society where they would be assisted with physical resources as well as pieces of advice that improve their wellbeing.

Actual or Potential Problems

            Mr. M has the risk of developing pressure ulcers, deep venous thrombosis (DVT), sepsis, and depressive illness. The pressure ulcers would develop due to neglect of physical care and prolonged sitting or sleeping in the same posture whereas DVT would result from stasis due to being bedridden (Kassahun, 2018). On the other hand, sepsis results from untreated UTI, and depression would be a consequence of the chronic illness, DVT, that reduces the health status (Yourman et al., 2020). These problems should be prevented or screened for and promptly treated.

Conclusion

            Chronic conditions such as dementia that present with memory loss may result from degenerative illnesses or may be triggered by acute illnesses such as UTIs to progress to delirium. The conditions have physical and psychological impacts on the patients and their families thus the need for nurses’ involvement in supporting the affected individuals. Some of the assistance strategies include drug administration, linking with support groups, as well as provision of family education. These measures help in prevention of complications including DVT and sepsis.

References

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia: Review. JAMA: The Journal of the American Medical Association, 322(16), 1589–1599. https://doi.org/10.1001/jama.2019.4782

Gale, S. A., Acar, D., & Daffner, K. R. (2018). Dementia. The American Journal of Medicine, 131(10), 1161–1169. https://doi.org/10.1016/j.amjmed.2018.01.022

Kassahun, W. T. (2018). The effects of pre-existing dementia on surgical outcomes in emergent and nonemergent general surgical procedures: assessing differences in surgical risk with dementia. BMC Geriatrics, 18(1). https://doi.org/10.1186/s12877-018-0844-x

Parnetti, L., Chipi, E., Salvadori, N., D’Andrea, K., & Eusebi, P. (2019). Prevalence and risk of progression of preclinical Alzheimer’s disease stages: a systematic review and meta-analysis. Alzheimer’s Research & Therapy, 11(1), 7. https://doi.org/10.1186/s13195-018-0459-7

Yourman, L. C., Kent, T. J., Israni, J. S., Ko, K. J., & Lesser, A. (2020). Association of dementia diagnosis with urinary tract infection in the emergency department. Journal of the American College of Emergency Physicians Open, 1(6), 1291–1296. https://doi.org/10.1002/emp2.12268

Question

Considering Mr. Ps condition and circumstance, write an essay of 500-750 words that includes the following:

· Describe your approach to care.

· Recommend a treatment plan.

· Describe a method for providing both the patient and family with education and explain your rationale.

· Provide a teaching plan (avoid using terminology that the patient and family may not understand).

Discussion: Old Male with Cardiomyopathy

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.