Case Study Analysis-75-Year-Old Male

Case Study Analysis-75-Year-Old Male

The 75-year-old male patient presents an issue concerning the increased frequency of urination. Based on the daughter’s health history narration, the 75-year-old man has frequently been forgetful and sometimes does not remember the location of the bathroom and repeatedly asks the same questions. Based on the patient’s age, the presented symptoms, and available health history, the most possible nursing diagnosis is an altered thought process related to neurodegenerative changes in the brain associated with Alzheimer’s disease (AD), as evidenced by difficulties in recognizing familiar environments, memory deficits, loss of bladder control, and occasional forgetfulness causes asking the same question repeatedly. Memory loss and loss of bladder control lead to the inability to remember familiar faces and locations and frequent urination, which are common in people with AD (Kumar et al., 2022). The other possible diagnoses are urinary issues and the risk of uncontrolled blood glucose associated with diabetes mellitus, as evidenced by frequent urination.

Diagnostic Tests to Perform

The diagnostic tests for this patient to confirm the nursing diagnoses include a cognitive assessment using the Montreal Cognitive Assessment (MoCA). The MoCA has been empirically validated and is reliable in testing for mild cognitive impairment and AD (Rashedi et al., 2021). The MoCA will help obtain more information on the patient’s health history to support the diagnosis and care planning. The other diagnostic tests are; a urinalysis to test for urinary issues and confirm or rule out any urinary problems, including any possible infections such as urinary tract infections (UTIs), a liver problem, diabetes, or kidney problems; an MRI to assess the brain’s structure to confirm or rule out any abnormalities leading to the observed symptoms; and a blood glucose test using a fasting plasma glucose (FPG) test to rule out or confirm diabetes mellitus.

Treatment Plan

The treatment plan for the 75-year-old male patient will be based on the outcomes of the diagnostic test as well as subjective diagnoses. For instance, if AD is confirmed, the patient will be started on cholinesterase inhibitors or NMDA receptor antagonists. For this specific patient, NMDA receptor antagonists, specifically memantine, will be prescribed for an extended-release dose of 7 mg to be taken orally once a day. Memantine is effective in slowing the progression of AD; however, in case of poor cognition and extremely reduced ability to do daily activities, a combination of memantine and donepezil is advised (Guo et al., 2020). The patient will also be put under behavioural care, specifically cognitive behavioural therapy (CBT), to help the patient and their caregiver manage stress, depression, and anxiety associated with AD (Tay et al., 2019).

If a UTI is confirmed, the patient will be put on nitrofurantoin dual-release capsules 100 mg to be taken orally every 12 hours for seven days. Nitrofurantoin is a broad-spectrum antibiotic that can help manage major bacteria-causing UTIs. In case the patient has diabetes mellitus, he will be put on insulin therapy as well as a lifestyle modification program which will include changes in diet and physical activity. In all cases, the patient and his daughter will be educated on the possible side effects and safe medication administration. Additionally, the daughter or any other available caregiver will be required to help the 75-year-old male patient keep a bladder diary to track their daily fluid consumption and triggers for frequent urination.

In summary, the patient’s treatment and care plan will utilize both pharmacological and nonpharmacological approaches. However, the decision will be based on confirmed diagnostic tests, the patient’s health history, and the tolerability of available medications.

References

Guo, J., Wang, Z., Liu, R., Huang, Y., Zhang, N., & Zhang, R. (2020). Memantine, donepezil, or combination therapy—What is the best therapy for Alzheimer’s disease? A Network Meta-Analysis. Brain and Behavior, 10(11), e01831. https://doi.org/10.1002/BRB3.1831

Kumar, A., Sidhu, J., Goyal, A., Tsao, J. W., & Svercauski, J. (2022). Alzheimer’s disease (Nursing). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK568805/

Rashedi, V., Foroughan, M., & Chehrehnegar, N. (2021). Psychometric properties of the Persian Montreal cognitive assessment in mild cognitive impairment and Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders Extra, 11(1), 51–57. https://doi.org/10.1159/000514673

Tay, K. W., Subramaniam, P., & Oei, T. P. (2019). Cognitive behavioral therapy can be effective in treating anxiety and depression in persons with dementia: A systematic review. Psychogeriatrics, 19(3), 264–275. https://doi.org/10.1111/

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A 75 year old male presents at your clinic accompanied by his daughter. He states that he is going to the bathroom “a lot” and doesn’t like it. His daughter states that he sometimes doesn’t remember where the bathroom is and asks the same question several times without seeming to notice.

Case Study Analysis-75-Year-Old Male

What diagnostic tests will you perform? What will be your plan of treatment?