Critical Examination and Evaluation of Mr. M Case Study

This case study provides a critical evaluation of Mr. M, a 70-year-old male residing in an assisted living facility, focusing on his extensive medical history and current health status. The evaluation considers his past surgeries, medications, and recent symptoms, including cognitive decline, agitation, and difficulty with daily activities. The assessment highlights potential diagnoses, particularly Alzheimer's dementia, supported by subjective and objective data. The analysis delves into clinical implications, such as impaired brain functionality and the progressive nature of dementia, and discusses the impact on the patient's physical and psychological well-being. The paper also outlines a care plan that includes pharmacological interventions, validation therapy, and physical exercise, along with the need for family involvement and support to manage the patient's health issues, including hypertension and reduced mobility.

Running head: CASE STUDY EVALUATION
Critical Examination and Evaluation of Case Study
Name of the Student
Name of the University
Author Note

CASE STUDY EVALUATION
Critical Examination and Evaluation of Case Study
The following sections of the paper aim to provide a critical evaluation of a patient
and review his health condition to remark the potential health issue, diagnostic measures,
clinical implications and health outcome of the patient.
The patient, Mr. M, has a very extensive medical history, which includes
appendectomy, surgical repair of tibial fracture, hypercholesterolemia and hypertension.
Keeping in mind the age of the patient, which is over 70 years, the vast medical history
should be taken into consideration to review the potential health risks and complications. The
subjective data suggests that the patient requires assisted living and has very limited physical
activity, which can be due to the old age, as no signs of complications from the past surgeries
or treatments have been observed with the patient. The objective data present a normal
physical condition of the patient. The temperature of the patient, pox immunity and the blood
pressure are at normal levels and are not be worried about. The respiratory rate of the patient
is 22 breaths per minute, which is slightly greater than the normal level of 20 breaths per
minute but falls in the range of the normal level. However, the Body Mass Index of the
patient is 29.3, which falls in the final digit of the overweight range, and is a critical indicator
of health. The WBC count is high, indicating that either immune system is fighting off an
infection or the patient is in emotional and physical stress. The data for protein, AST and
ALT are normal, with no clinical implications to be made. The patient has been taking
ibuprofen 400mg doses as prescribed but is currently denying the feeling of pain, thus
indicating either the patient is no longer having pain or is unable to self-assess his health with
cognitive issues.
Reviewing the current symptoms of the patient, the patient should be diagnosed for
Alzheimer’s dementia. The primary diagnosis would include reviewing of patient’s past
medical history and characteristic changes. Secondary diagnosis will include thought process

CASE STUDY EVALUATION
changes, memory tests, changes in daily activities and associated behaviour (Singh-Manoux
et al., 2017). It is evident that the patient is feeling troubled in remembering things and
names, which indicates the cognitive decline of mild to moderate range. The clinical signs of
dementia include tremors, trouble in paying attention or focusing, uncoordinated movements,
reduced concentration, loss of ability to perform the daily task alone, depression, personality
changes and behavioural changes (Li et al., 2017). The patient’s description matches this;
thus, the patient should be diagnosed for dementia.
While conducting the health assessment of the patient, the nurse may find
degenerative abnormalities and mental health issues with the patient. It is possible that the
nurse may find out that the patient is swiftly losing memories and the ability to process things
consciously. As the patient is being diagnosed for dementia, the nurse can find hallucinations
occurring with the patient, which indicates Alzheimer’s disease. Impaired brain functionality
is another abnormality that can be revealed during diagnosis, as the progression of dementia
seems to be quite rapid in the patient. Furthermore, if any abnormalities in the brain activity
and functionality is revealed, the patent might have to be taken to a neurologist.
The current health status of the patient is not very promising, as dementia is a
progressive disease with no treatment until date. Physically, the patient is losing control over
the body’s ability to perform a daily task and unable to remember things. This will
significantly limit and reduce the daily physical activity levels of the patient, and he would
require assistance in performing every little task, which requires movement. This effectively
reduces and limits the physical independence of the patient. The patient can cause himself
physical injuries, as he has been found to wander at night and needs assistance to go back to
the room (Ooms & Ju, 2016).
Moreover, the patient is having frequent episodes of aggressiveness and agitation,
which is fearful for him and making him afraid, thus increasing the chance of depressive

CASE STUDY EVALUATION
symptoms and further worsening the symptoms of hypertension as the patient has passed the
medical history of it (Walker, Power & Gottesman, 2017). The patient is having difficulty in
remembering names, which will progress to a more critical stage, where he would not be able
to remember the memories associated with the family members and unable to recognise them
at all. This will psychologically impact the patient’s health, as he would have feelings of
loneliness and devastation, which can probably lead to more critical thoughts, such as suicide.
The interventions that would be included in the care plan for the patient are
pharmacological dosages, validation therapy and physical exercise (Berg-Weger & Stewart,
2017). The family members are required to participate in the therapy and help the patient to
perform physical exercises. The family members would be taught the measures to provide
suitable care and support, specially designed for the patient.
There are several health issues that the patient is actually or potentially facing
currently. Increased hypertensive symptoms, as the patient is having quick episodes of
aggression and agitation. Progressive dementia, as the patient is facing extreme difficulty in
remembering things. Reduced mobility, as the patient requires assistance to perform all daily
activities. The final problem is the overweight condition of the patient, which is evident with
the BMI of 29.3 (Glaus et al., 2019).

CASE STUDY EVALUATION
References
Berg-Weger, M., & Stewart, D. B. (2017). Non-pharmacologic interventions for persons with
dementia. Missouri medicine, 114(2), 116.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140014/
Glaus, J., Cui, L., Hommer, R., & Merikangas, K. R. (2019). Association between mood
disorders and BMI/overweight using a family study approach. Journal of affective
disorders, 248, 131-138. https://doi.org/10.1016/j.jad.2019.01.011
Li, G., Larson, E. B., Shofer, J. B., Crane, P. K., Gibbons, L. E., McCormick, W., ... &
Thompson, M. L. (2017). Cognitive trajectory changes over 20 years before dementia
diagnosis: a large cohort study. Journal of the American Geriatrics Society, 65(12),
2627-2633. https://doi.org/10.1111/jgs.15077
Liu, S., Jin, Y., Shi, Z., Huo, Y. R., Guan, Y., Liu, M., ... & Ji, Y. (2017). The effects of
behavioral and psychological symptoms on caregiver burden in frontotemporal
dementia, Lewy body dementia, and Alzheimer's disease: clinical experience in
China. Aging & mental health, 21(6), 651-657.
https://doi.org/10.1080/13607863.2016.1146871
Ooms, S., & Ju, Y. E. (2016). Treatment of sleep disorders in dementia. Current treatment
options in neurology, 18(9), 40. https://doi.org/10.1007/s11940-016-0424-3
Singh-Manoux, A., Dugravot, A., Fournier, A., Abell, J., Ebmeier, K., Kivimäki, M., &
Sabia, S. (2017). Trajectories of depressive symptoms before diagnosis of dementia: a
28-year follow-up study. JAMA psychiatry, 74(7), 712-718.
10.1001/jamapsychiatry.2017.0660
Walker, K. A., Power, M. C., & Gottesman, R. F. (2017). Defining the relationship between
hypertension, cognitive decline, and dementia: a review. Current hypertension
reports, 19(3), 24. https://doi.org/10.1007/s11906-017-0724-3