Mr. M is a 70-year-old man who seems to have Alzheimer’s disease. The patient also has a urinary tract infection (UTI). Because of his difficulties related to the ambulating and unsteady gait, his physical activity has been limited.  The patient’s medical history issues include hypertension, tibial fracture, status post appendectomy, and hypercholesterolemia.Mr. M’s health has been deteriorating in a worrying trend in the last two months. Occasionally, he forgets his room number, the names of his loved ones, and repeats what he reads. The patient is also dependent on various Activities of Daily Living (ADLs), which changed in the last two months. Due to the rapid health decline, testing was requested. Below are the test results;

 Both the elevated heart and respiration rate may be a result of the patient’s anxiety. On conducting the CT scan, no changes are evident from the scan previously done.  The urinalysis turned positive for a reasonable volume of leukocytes and cloudy. The patient has a UTI.

Diagnosis and Secondary Diagnosis

The primary condition Mr. M has is Alzheimer’s disease and a UTI. Secondary diagnoses involve tibial fracture post-surgical repair, hypertension, hypercholesterolemia, and status post appendectomy. According to a study by Wiels et al. (2020), during the onset of Alheizmer, patients suffer from memory loss, planning difficulties, issues solving problems and conflicts, problems recognizing time and place. Some people also develop mood changes and withdrawal from social functions (Wiels et al., 2020). During the middle stage of the condition, the patient’s brain tends to forget how to function physically.

During the last two months, Mr. M has had issues recalling his loved ones’ names, his room number, and what he reads.  He also seems to have mood changes in that he has aggression and agitation. He also has issues doing his daily chores, including dressing, bathing, and feeding, which lead to Alzheimer’s disease diagnosis.  When bacteria gets to the urinary tract through the urethra and spread to the bladder, it leads to a condition known as the urinary tract infection (Alpay et al., 2018).  Because of Alzheimer’s disease, a patient may experience behavioral symptoms, including confusion and inability to specify what they want (Wiels et al., 2020). From the clinical presentation, Mr. M suffers from confusion as well.

Expected Abnormalities during the Nurse Assessment

Likely abnormalities with UTI are evident in the data presented above. In examining the normal lab values for WBCs, it is supposed to be 4,500 to 11,000. However, Mr. M has 19.2, which indicates he may be having inflammation or an infection somewhere.  When it comes to normal lymphocytes, it should be around 1,000-4,800. From Mr. M’s report, his lymphocytes are 6,700, which is a bit high.

Lymphocytes are WBCs that have a huge part in one’s immune system.  The cells are found in both the blood and the lymph tissues and are made up of bone marrow. The urinalysis positive for moderate leukocytes and cloudy also relates to the patient’s UTI diagnosis. Assessing the primary cause of cognitive impairment for the elderly is imperative since it can have many reasons. Such causes include drug’s side effects, metabolic disorders, and depression, among others. According to the dementia diagnostic criteria, a patient has to have a cognitive impairment, impaired function, behavioral changes, among others, to be diagnosed as Alzheimer’s (Wiels et al., 2020).

The Condition’s Effect on Health Status

 Even though Alzheimer’s disease does not have a cure, various management techniques improve the patient’s physical, psychological, and emotional aspects. Alzheimer’s disease patients have multiple physical impairments, including the inability to hold urine, issues related to a bowel movement, loss of physical function, inability to perform daily activities, including bathing and feeding. The psychological and emotional aspects of Alzheimer’s disease include agitation, depression, fear, and anxiety. In some cases, the patient’s family may view Alzheimer’s as old age. In this case, it is important for the physician to educate the family on the condition’s symptoms, management, and coping mechanisms (Wiels et al., 2020).

Intervention for Support

Alzheimer’s does not have a 100% cure. However, various medications to enhance mental abilities have been developed. Drugs do not reverse the patient’s brain damage. On the contrary, they reduce symptoms as well as slowing the disease progression.  In managing this condition, accurate diagnosis is an important factor. Apart from medication, cognitive training can be conducted when the disease is still in its early stages. Another major treatment modality is a behavioral modification, where positive behaviors are rewarded. Occupational therapy can also be of much help where patients are trained to handle certain behaviors more acceptably.

Actual/Potential issues related to Alzheimer’s and UTI

UTI can be easily managed through drinking plenty of fluids, cranberry juice, and Vitamin C intake. If it has lasted for long, antibiotics are the best option. Untreated UTI may lead to kidney impairment and sepsis (Alpay et al., 2018). Acute kidney injury occurs from sepsis, which can later result in the deterioration of the renal function. Alzheimer’s actual or potential problems include difficulties swallowing foods and fluids that may lead to dehydration and delirium. Severe dehydration causes confusion, increased heart rate, problems talking, and body weaknesses. Delirium, on the other hand, causes many issues, including decreased energy, sudden behavior change, rambling, hallucinations, and low concentration.

References

Alpay, Y., Aykın, N., Korkmaz, P., Güldüren, H., & Çevik Çağlan, F. (2018). Urinary tract infections in the geriatric patients. Pakistan Journal of Medical Sciences, 34(1). https://doi.org/10.12669/pjms.341.14013

Silva, C. (2020). What are Lymphocytes and what are Healthy Levels to have? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/320987

Wiels, W., Baeken, C., & Engelborghs, S. (2020). Depressive Symptoms in the Elderly—An Early Symptom of Dementia? A Systematic Review. Frontiers in Pharmacology, 11. https://doi.org/10.3389/fphar.2020.00034