1 Case Study on Health History and Evaluation of Mr. M Sylvanus Osaghae College of Nursing and Health Care Professions NRS 410V Pathophysiology and Nursing Management of Clients’ Health Grand Canyon University January 30, 2022
2 Case Study on Health History and Evaluation of Mr. M This paper seeks to evaluate the health history and medical information on the case scenario of Mr. M, in order to establish a profound understanding on the pathophysiological process of the disease affecting the patient and identify appropriate and effective nursing interventions and medical treatment strategies that will provide the best health outcome across the lifespan. The case scenario on Mr. M reflects the confluence of several diseases and co- morbidities that affect both physical and physiologic systems of the body, which results in a profound deterioration of health outcomes and decreased quality of life. Health evaluation and assessment is a significant process to identify the different factors and clinical manifestations that must be addressed to bring about an effective nursing care intervention and treatment for Mr. M. Clinical Manifestations Clinical manifestations of Mr. M are reflected in the course and history of the disease alone with the significant changes and notable observations of the patient’s health, behavior and functionality. Among the remarkable clinical manifestations that is illustrated in patient’s medical history is the issue on hypertension that is significantly controlled only through pharmacologic interventions because of several restrictions to physical activity and movement. Healthy Diet and lifestyle interventions is assumed to be poorly implemented or complied because of the finding of hypercholesterolemia. Other factors would include the post-surgical procedure of appendectomy and surgical repair of the tibia which further restricts patient’s movement resulting in a more sedentary life style and lack of physical activity that further contributes to a decreased health outcome and morbidity. The case study presents Mr. M as an elderly patient corresponding to the age of 70 years old. The aging process along with the co-morbidities described in the latter profoundly reflects a
3 significant deterioration of the patient’s health. The case scenario significantly describes the mental deterioration of the patient that is characterized by memory loss, decreased ability to recognize and recall names of family members, loss of orientation to his environment and behavioral changes. The clinical manifestation that critically depicts deterioration is noted on the profound changes of the patient’s ability to perform activities of daily living. Mr. M was noted to be independent and within 1 month he has shifted to become fully dependent in almost all aspects of ADL including feeding.
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