The patient is a 70year-old-male called Mr. M. The patient has no known allergies, and neither smoke nor consumes alcohol. He has limited physical activities related to difficulty in walking or moving around. Over the past two months, the patient has shown signs of quick deterioration. He has trouble remembering the names of his family members, repeats what he has just read, and even has trouble recalling his room number. The patient seems to get aggressive and agitated quickly and expresses fear when he gets aggressive. He has also been found lost while wandering at night, therefore, needing help to get back to his room. He is currently unable to perform daily care activities by himself, hence becoming dependant on many ADLs. The care facility has expressed concern for his rapid decline and decided to order testing.
The patient is 69.5 inches with 87kg. He has a normal temperature (37.1 degrees Celsius), a normal blood pressure (123/78), a normal heart rate (93), normal oxygen levels (99%), and a normal respiratory rate (22). The patient also denies pain. The patient’s lab results showed a high white blood count of 19.2 (1,000/ul) which shows the possibility of an infection. The lymphocytes levels (6700 cells/uL) were also high. Compared to the previous scan, there were no changes in the CT scan of the head. The patient has normal protein levels (7.1 g/dl), aspartate aminotransferase (AST) levels are normal (32 U/L), and alanine transaminase (ALT) levels are also normal (29 U/L). Urinalysis showed a moderate amount of leukocytes and cloudy urine.
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Primary and secondary diagnosis
Primary diagnosis
The patient possibly has Alzheimer’s disease with a urinary tract infection. The patient has shown signs of deteriorating quickly. Mr. M has also shown symptoms of memory loss. He finds it hard to remember various things, including the name of his family members, his room number, and tends to repeat what he has just read. He has demonstrated aggressive behaviour, agitation and fear whenever he gets aggressive. He is also not able to care for himself, thus depends on many ADLs. Alzheimer’s disease is a disorder that leads to the degeneration and death of the brain cells. This disease causes dementia, which contributes to a continuous decline in thinking hence disrupting a person’s ability to function independently (McAdams-DeMarco et al., 2018) . Memory loss is the primary symptom in Alzheimer’s disease. The patient’s behaviours are symptoms that point to Alzheimer's disease.
Secondary diagnosis
The patient possibly has a urinary tract infection. The lab results showed that the patient has a high white blood cell count of 19.2 (1000/ ul). An increase in white blood cell count indicates an underlying problem, such as infection. The lab results show high lymphocyte levels of 6700 cells/ul, which indicates that the body is dealing with an infection. Urinalysis is also positive for moderate amount of leukocytes and cloudy urine which is an indicator of urinary tract infection.
Expected abnormalities
Alzheimer’s disease can lead to different kinds of abnormalities developing in the brain tissues. Alzheimer’s diseases cause abnormalities such as beta-amyloid deposits, senile or neuritic plaques, neurofibrillary tangles, and increased levels of tau (McAdams-DeMarco et al., 2018) . Beta-amyloid (an abnormal, insoluble protein) accumulates because the brain cells are unable to process and remove it (McAdams-DeMarco et al., 2018). Neurofibrillary tangles are twisted strands of insoluble proteins in the nerve cell (McAdams-DeMarco et al., 2018) . Senile or neuritic plaques are deposits of bundles of dead nerve cells around the core of beta-amyloid. Finally, tau, an abnormal protein, is a component of beta-amyloid and neurofibrillary, thus an increase in the levels of tau.
Effects of health status on physical, psychological and emotional aspects of patient and family
Alzheimer’s disease causes various undesirable symptoms and behaviours to a patient. It may lead to conditions such as depression, hallucination, behavioural disturbances, social isolation and sleep problems or walking disruption. The disease will cause the patient to have changes in his emotional responses since he may have less control of how to express their feelings. The patient with the disease often lack the insight of their physical deficit hence requires adequate care. As the disease progresses, the patient role in the family is affected (Valimaki et al., 2016). Alzheimer’s disease has been known to cause a great burden on caregivers which includes physical, psychological, and emotional aspects. The condition can contribute to high rates of physical and mental disorders (Valimaki et al., 2016). Factors that lead to the great psychological problems are associated with having the patient at home, the care provider is the spouse and the demanding behaviours of the cared person. The patients demanding responses can psychologically and emotionally affect his family.
Interventions for support
Alzheimer’s disease can be managed through treatment and implementing rehabilitation programs for the patient. There is no cure for the disease; however, medication such as cholinesterase inhibitors can be prescribed to the patient to help manage the patient’s symptoms and also help control some of the patient behavioural symptoms. (McAdams-DeMarco et al., 2018) The disease can also be managed through proper nutrition, physical exercise, social activity, health maintenance, and ensuring a well structured and calm environment for the patient. Rehabilitation programs are also crucial in managing the patient disease.
Actual or potential problems based on the condition
Limited physical activities and the lack of social interaction may cause depression, violent behaviour, mood swings, and personality changes. The patient poor balance may lead to fall-related injuries such as serious head injuries and fractures. The last stage of Alzheimer’s disease can make the patient immobile hence forcing them to be bedridden, thus putting them at risk of infection, bedsores, and loss of muscle function. The condition can also lead to dehydration and malnutrition when the patient finds it hard to ingest food or water.
References
McAdams-DeMarco, M. A., Daubresse, M., Bae, S., Gross, A. L., Carlson, M. C., & Segev, D. L. (2018). Dementia, Alzheimer's Disease, and mortality after hemodialysis initiation. Clinical Journal of the American Society of Nephrology , 13 (9), 1339-1347.
Välimäki, T. H., Martikainen, J. A., Hongisto, K., Väätäinen, S., Sintonen, H., & Koivisto, A. M. (2016). Impact of Alzheimer’s disease on the family caregiver’s long-term quality of life: results from an ALSOVA follow-up study. Quality of Life Research , 25 (3), 687-697.
