Nursing Case Study: Diagnosing and Managing Mr. M's UTI and Dementia

This nursing case study focuses on Mr. M, a patient presenting with a potential urinary tract infection (UTI) indicated by elevated leukocytes in his urine, alongside concerns of memory loss and increased dependency in daily activities. The case study delves into the primary and secondary diagnoses, with the possibility of UTI being the main concern, and the memory issues potentially linked to electrolyte imbalances or medication side effects rather than structural brain changes. The assessment includes evaluating the patient's symptoms, risk factors, and laboratory outcomes, with nursing interventions aimed at addressing the UTI, preventing falls, and managing memory-related issues. Potential problems, such as the risk of falls, memory issues, and psychological effects, are explored, along with rationales for these concerns. The study also highlights the impact of the patient's condition on his family, emphasizing the stress and responsibilities they face. The case study concludes with a reference list of relevant sources.

Running head: NURSING CASE STUDY 1
Nursing Case study
Student name:
Student ID
Author’s note

NURSING CASE STUDY 2
Table of Outcomes
Primary and secondary diagnosis and justification.........................................................................2
Nursing assessment and expected outcomes...................................................................................2
Physical, psychological, and emotional effects of health status on patient and his family.............3
Possible interventions......................................................................................................................3
Four Potential problems and rationale.............................................................................................4
Reference.........................................................................................................................................6

NURSING CASE STUDY 3
Clinical manifestation
High amount of leukocytes is on rise in urine and the urine is cloudy, suggesting
possibility of UTI. Mr. M has normal body temperature. Additionally, one of the concerns is loss
of memory and high level of dependency in daily living activities. The high rate of dependency
coupled with no change in brain structure upon CT scan is cause of concern in the mentioned
case study. Nevertheless, WBC increase in urine is the major concern in patient
Primary and secondary diagnosis and justification
Possibility of UTI due to presence of high level of leucocytes in urine: The high amount
of white blood cells in urine is often seen to indicate symptoms of infection (Finlay et al. 2015).
However, the chances of forgetfulness aim to rule out the secondary diagnosis of UTI. The issue
of forgetfulness can be termed as dementia; however, there remains no evidence of cerebral
atrophy in the CT scan. Hence, the possibility forgetfulness can be attributed to poor sodium
potassium balance leading to confusion and memory problems. On the contrary, lengthy delirium
is linked with smaller brain volumes (Friedman et al. 2017). Thus high level of potassium can be
termed as a main reason for forgetfulness. Additionally, the patient suffers from balance
problems that can lead to greater implication such as fall related injuries
Nursing assessment and expected outcomes
Nursing intervention Outcome
Assess signs and symptoms of UTI Burning sensation while urinating, cloudy
urine
Risk factors for UTI catheter use, blockage in urinary tract due to
stone or enlarged bladder
Laboratory outcome
WBC count Increased, acting as systematic response to

NURSING CASE STUDY 4
infection
Urinalysis Presence of WBC and RBC linked with
inflammation process during infection
Urine culture and sensitivity Determines the suitable antibiotics
Encourage patient to void after span of 3 hours Prevent bladder distention, avoid re-infection
and flush the bacteria
Consumption of Vitamin C increased Bacteria fails to survive in acidic environment
Limit use of catherer Use of catherer increases the chance of UTI
Finish the course of antibiotics Patient should complete the antibiotic course to
avoid re-infection
Encourage fluid intake Increase urine production to flush out the
bacteria
Hence, distribution related to electrolyte balance is cause of confusion among the elderly
people admitted in healthcare settings, coupled with lack of fluids. However, fluroquinolones are
first-line treatment for uncomplicated urinary tract infections (Jenkins & Mostafa, 2016). The
presence of UTI can be attested through presence of leukocytes in urine samples
Physical, psychological, and emotional effects of health status on patient and his family
The limited level of mobility can be termed as a cause of concern in case of both the
patient and his family. The high level of dependency, coupled with limited flexibility can affect
the mental health of the patient. As stated by Homan (2016), mental and physical health is highly
associated, poor mental health exposes an individual to chronic health condition. In case of high
rates of dependency, there is a possible decline of cognitive abilities with limited scope of
involvement in mentally stimulating activities. In addition to that the family members are
exposed to high level of stress as they are provided with high responsibilities and no knowledge
about medical condition

NURSING CASE STUDY 5
Possible interventions
Following are the interventions that can be added for ensuring better memory:
Obtaining enough sleep: Sleep helps in consolidating memories and aligning the metabolic
functions
Adequate hydration: Optimum level of hydration can provide better levels of electrolyte balance
Teach back method: The patient should know about his current medical condition and the ways it
can affect his future health conditions. The same method can be applied to the family members
where the level of knowledge is analysed for a better provision of care.
Four Potential problems and rationale
Possibility of UTI: The presence of moderate level of leukocytes in the urine can be termed as a
matter of concern, indicating bladder infection. The chances of poor kidney function are
additionally highlighted through high rates of protein excretion (Kline & Lewis, 2016). Thus,
there remains a high chance of kidney disease that needs to be avoided
Risk related to fall: Mr. M is seen to exhibit poor muscle coordination making him susceptible to
fall related incidents. The lack of coordination can be attributed as a side effect of Ambien
(Shapiro, 2016). The risk of fall can lead to comorbid issues and further complications
Memory related issues: The severe memory related problem and confusion can be explained
through poor electrolyte balance. In addition to that, medications such as Lisinopril causes
increase in potassium level and Xanax is responsible for causing memory problems (Sordahl et
al. 2019). The continuous effects of the mentioned drugs can lead to the mentioned adverse side-
effects.

NURSING CASE STUDY 6
Poor effect on psychological health: The increasing loss of memory and greater dependency on
others to perform daily task can act as an engendering factor for poor mental health condition.
The high rates of dependency can make the patient feel frustrated. The events of limited level of
independence can often be termed as a leading reason of poor mental health condition. A
research study conducted by Homan (2016), states the importance of mental wellbeing and poor
mental health can lead to cognitive impairment and even increased risk of health degradation

NURSING CASE STUDY 7
Reference
Finlay, J., Franke, T., McKay, H., & Sims-Gould, J. (2015). Therapeutic landscapes and
wellbeing in later life: Impacts of blue and green spaces for older adults. Health &
Place, 34, 97-106.
Friedman, E. M., Ruini, C., Foy, R., Jaros, L., Sampson, H., & Ryff, C. D. (2017). Lighten UP!
A community-based group intervention to promote psychological well-being in older
adults. Aging & mental health, 21(2), 199-205.
Homan, K. J. (2016). Self-compassion and psychological well-being in older adults. Journal of
Adult Development, 23(2), 111-119.
Jenkins, A., & Mostafa, T. (2015). The effects of learning on wellbeing for older adults in
England. Ageing & Society, 35(10), 2053-2070.
Kline, K. A., & Lewis, A. L. (2016). Gram-positive uropathogens, polymicrobial urinary tract
infection, and the emerging microbiota of the urinary tract. Microbiology spectrum, 4(2).
Shapiro, B. T. (2016). Estimating the cost of strategic entry delay in pharmaceuticals: The case
of Ambien CR. Quantitative Marketing and Economics, 14(3), 201-231.
Sordahl, J. A., Litke, J., Lewis, J., & Dunay, M. (2019). Medication Effects on Cognition.
In Physician's Field Guide to Neuropsychology (pp. 561-574). Springer, New York, NY.