Pathological Case Assessment
The primary and secondary medical diagnoses for Mr. M are dementia and Urinary Tract Infection, respectively. The main symptoms of Mr. include memory impairment, trouble recalling, and recognizing everyday things, mental confusion, wandering at night, and getting lost and dependent on most ADLs. Dementia is characterized by cognitive impairment and loss of ability to perform daily activities (Malara et al., 2016). As noted in the case, Mr. M. recently lost his ability to bathe, dress, and feed himself, confirming an altered mental status. A secondary medical diagnosis for Mr. M is urinary tract infection. Tract infection in elderly patients is verified by an elevated white blood cell (WBC) (19.2 (1,000/uL). The urinalysis is positive for a moderate amount of leukocytes and cloudy, confirming the UTI as a medical diagnosis. Further, the patient has a high level of lymphoma, indicating the presence of bacterial infection (Nicolle, 2016). Therefore, Mr. M is suffering from dementia and urinary tract infection.
Structural and Functional Abnormalities
In conducting a nursing assessment, structural abnormalities, including bladder diverticulum, is highly expected. Harbored pathogens cause the deformity in the urethra, bladder, or even blockages, which cause infection leading to an enlarged bladder, which prevents the body from eliminating all the urine to empty the bladder. The nurse is also likely to see other possible anatomic abnormalities predisposed by UTI, such as delayed bladder neck maturation, urethral duplications, VUR, and congenital obstructive abnormality A.K.A urethral valves (Nicolle, 2016). Vesicoureteral reflux (VUR) results from congenital defects and can also be caused by flaccid bladder due to tract surgery of injury to the spinal code. The central functional abnormalities include the inability to empty urine. The above mentioned functional and structural abnormalities lead to the obstruction of urine flow and poor emptying of the bladder. Tumors and calculi obstruct the flow of urine as an emptying of the bladder is impaired by prostatic enlargement, cystocele, and dysfunction of the neurogenic bladder due to infection.
Physical, Psychological, and Emotional Effects
Living with dementia will have adverse physical, emotional, and psychological impact on Mr. M and his family. The physical effects of dementia include injury when the patient wanders into risky places, weight loss, dehydration, and difficulty in swallowing (Malara et al., 2016). Others include mobility problems, loss of balance, loss of appetite, poor bowel control, loss of sight, and lack of sleep as they become active at night due to sundowning conditions. Upon diagnosis, the patient may experience emotional impacts such as uncontrollable anger, shock, disbelief, and fear, which may be difficult to contain. The patient may feel afraid of what the future holds and scared by the confusion and unforceful moments. The condition of dementia also triggers anxiety and depression, further complicating his altered mental status. The effect of dementia can be overwhelming and devastating to the family. The disease can trigger sadness, anger, and frustration among family members. It can also generate adverse financial and economic burdens to the family related to the cost of medication and supporting the patient.
Family Interventions
The family has to deal with conflicts of dementia and make prudent decisions related to treatment, finances, living with new arrangements, and end of life care for the patient. The first intervention in dealing with dementia is to share responsibilities. The caregiving can be evenly distributed among family members through careful matching roles to each member of the family based on resources, ability, preferences, and emotional capacity. As some members will be charged with legal and financial responsibility, others will be tasked with respite care, and household errands (Wilz et al., 2018). Regular meetings such as weekly or monthly can be arranged to deliberate on specific concerns related to the care and needs of the patient. Honest communication and avoiding criticism for other family members. More importantly, support is required for members tasked with daily hands-on care for the patient.
Actual and Potential Problems
In his current condition, Mr. M. is already experiencing multiple problems. These including inability, perform daily tasks such as bathing, dressing, and self-feeding. The patient has trouble recalling, and recognizing everyday things, mental confusion, the possibility of getting lost, loss of concentration, depression, and mood swings (Malara et al., 2016). The physical problems include incontinence, lack of balance, difficulty in walking, pain, and loss of appetite, poor control of bowel, loss of sight, and lack of sleep. Mostly, the patient is facing physical problems as well as emotional and psychological distress due to UTI and dementia.
Conclusion
The pathological case assessment points to dementia and UTI diagnoses for the presenting symptoms and lab test results. The likely structural and functional abnormalities include bladder diverticulum, delayed bladder neck maturation, urethral duplications, VUR, congenital obstructive abnormality, and inability to empty urine due to the bacterial infections. Finally, living with dementia has adverse physical, emotional, and psychological impact on the patient and family members.
References
Malara, A., De Biase, G. A., Bettarini, F., Ceravolo, F., Di Cello, S., Garo, M., … & Rispoli, V. (2016). Pain assessment in elderly with behavioral and psychological symptoms of dementia. Journal of Alzheimer’s Disease, 50(4), 1217-1225.
Nicolle, L. E. (2016). Urinary tract infections in the older adult. Clinics in geriatric medicine, 32(3), 523-538.
Wilz, G., Weise, L., Reiter, C., Reder, M., Machmer, A., & Soellner, R. (2018). Intervention helps family caregivers of people with dementia attain own therapy Goals. American Journal of Alzheimer’s Disease & Other Dementias®, 33(5), 301-308.