Diagnosis of Dementia: The Case Study

Clinical Manifestation of Mr. M

Dementia is deterioration in cognitive functions, memory, behavior, and the ability to perform daily activities. Mostly it affects older people, although it is not part of the aging process and it does not affect consciousness. Individuals with this disorder are at risk of getting urinary tract infections (UTIs) due to their inability to sense full bladder and sphincter problems. Therefore, the family should be educated on how to take care of these individuals and prevent the occurrence of UTIs.

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The manifestation present in Mr. M shows that he is battling dementia. First, he is 70 years old, which is a risk factor for dementia which increases exponentially with age, especially when one reaches 65 years. As per the subjective data given, the patient’s condition has rapidly deteriorated to the extent of not remembering the names of the family members and the room number. Moreover, the patient has increased irritability and agitation, which is attributed to the generalized anxiety related to early development of dementia. These symptoms are consistent with the current evidence that suggests selective memory is one of the earliest signs of dementia.

Primary and Secondary Diagnosis

The primary diagnosis established for the patient is urinary tract infection (UTI). The urine sample tested positive for moderate amounts of leukocytes, and Mr. M’s urine was cloudy. The two tests suggest urinary tract infection of the involving the bladder and urethra. The patient has a high white blood cells count in the blood, which suggests that bacteremia (Rajan, n.d.) UTI is common at an advanced age because the urinary bladder tends to be not fully emptied (Rajan, n.d.). Dementia is the secondary diagnosis considering that the patient is aged. Furthermore, the patient has a cognitive impairment and selective memory loss. The patient has behavioral symptoms such as agitation and easy irritability. Additionally, he cannot remember the family members’ names and occasionally gets lost and starts wandering at night because he forgets where his room is.

Abnormalities Expected on Nursing Assessment

When examining a patient with the above symptoms, neurological assessment should be a priority for the nurse. The examination can suggest focal deficit due to vascular causes. The common abnormalities include slowed reflexes, impaired sensory responses, and other signs that affect the diagnosis of dementia (Kulesh & Shestakov, 2017). During the assessment, the patient is expected to have flawed thought process, impaired speech, signs of selective memory loss, and impaired verbal communication. The patient is also expected to lack orientation to person, time and space.

Physical, Emotional, and Psychological Effects of the Diagnosis to the Patient

Physical

Geriatric patients experience different signs of UTI compared to the young people (Rajan, n.d.) Older people may not undergo signs such as urgency and irritation, and even if they do, appropriate communication of the symptoms to the clinician may be impaired. At times, such patients may fail to realize the issue due to other conditions such as dementia. The clinical data suggest that the client’s physical activity was limited due to unsteady gait, thus making it difficult for ambulation.

Psychological

Dementia is characterized by diminished cognitive functions, reasoning, behavioral activities, and thinking. The patient’s current status suggests impairment in problem-solving skills and self-management from a psychological point of view, thus, his personality may change as the disease advances.

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Emotional

The current health status suggests an imbalance in the patient’s emotions ranging from agitation to irritability and anxiety. The emotional disparities may persist, and the individual may get into stress and depression as the disease progresses.

Impact on the Family

Caring for Mr. M. has a number of effects on the family. In addition to physical and financial issues, the family and the caregivers will experience psychological distress in caring for their patients. Their overall wellness will be affected due to dedicating their time and careers to take care of Mr. M.

Interventions That Can be Put into Place to Support Mr. M. and His Family

Although it can be challenging to get the patient to attend the appointments due to impairment in reasoning, it is crucial to conduct cognitive and neurological tests. The examinations help to capture any underlying issues such as minimizing the UTI including proper hygiene. The family should be educated on the need for quick toileting to reduce the infections due to the stool’s contact with the urethral toileting. Urinary retention may make the patent unable to empty the bladder (Girard et al., 2017) The family should be educated on a senior’s care and their current knowledge, as suggested by Cations et al. (2018). With proper attention from both family and caregivers the patient’s condition could be managed.

Actual and Potential Problems Faced by the Patient and Their Rationale

Actual

A sharp decrease in cognition as a result of pre-existing dementia may increase confusion and forgetfulness which may make the patient miss his medications. The other actual problem is sleep disturbances due to anxiety and disorientation which may make him wander at night.

Rationale

The patient is on Xanax 0.5mg, which is used for anxiety and sleep instabilities, which puts him at risk of the above problem, he also has signs of memory loss. The high cholesterol level is an indicator of the secondary diagnosis.

Potential

The above issues may alter his personality, additionally, failure to treat the UTI may potentially cause other problems such as kidney diseases (Girard et al., 2017). Dementia and cognitive impairment threaten to affect the patient’s activities of daily living. Self-care deficit may cause infection-related illness. The patient is at risk of falls and injuries due to the unstable gait.

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Rationale

The health history for Mr. M suggests impairment in self-care and problem-solving skills. The patient’s age, forgetfulness, and confusion need close monitoring.

References

Cations, M., Radisic, G., Crotty, M., & Laver, K. E. (2018). What does the general public understand about the prevention and treatment of dementia? A systematic review of population-based surveys. PloS ONE, 13(4). Web.

Girard, R., Gaujard, S., Pergay, V., Pornon, P., Martin-Gaujard, G., Bourguignon, L., & UTIC Group (2017). Risk factors for urinary tract infections in geriatric hospitals. The Journal of Hospital Infection, 97(1), 74–78. Web.

Kulesh, A. A., & Shestakov, V. V. (2017). Vascular cognitive impairment, no dementia: Diagnosis prognosis, treatment, and prevention. Neurology, Neuropsychiatry, Psychosomatics, 9(3), 68-75. Web.

Rajan, V. (n.d). UTIs and dementia in seniors: Impact and treatment options. Aging Care. Web.

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