Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe the clinical manifestations present in Mr. M.
2. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide

1. Describe the occurrence of the TYPE 2 DIABETES utilizing the epidemiological triangle 
   1. Agent
   2. Host
   3. Environment
2. Describe how the various chains are broken for effective control and prevention.

 Answer the following questions and review the suggested learning activities. Send me your answers here.  *I suggest typing your remediation work in a word document and then copy/paste it here when completed, as the message box may time out. 

1.The nurse is working in an antenatal clinic. What findings would the nurse report to the provider during the third trimester of pregnancy?

2. Suggested Maternal Newborn Learning Activity: Teaching Reinforcement of the Antenatal Client

3. ​A nurse is collecting data on a client during the first prenatal visit.  What three (3) manifestations would indicate that the client may have gonorrhea?   

Social Cognitive Theory

This theory was introduced by Albert Bandura, which stated that individuals could learn positively by using interactive behavior, human dialogue, direct experiences, and common observations. The sole purpose of the theory is to comprehend and predict the individual or group behavior and to identify methods by which change or modification can be achieved. The major changes include the promotion of health activities, change in behavior, and improved personality. It is also indicated in the theory that environmental variations, behavior changes, and individual personal factors are the real causes to affect one’s behavior (White et al., 2019). Social cognitive theory is predominantly helpful when collaborated with educational institutions to improve behavior changes like introducing advanced knowledge into practice. Prochaska and DiClementi’s Model of Behavior Change is one of the most beneficial and productive models for health behavior changes.

Stages of Change Theory

Prochaska and DiClementi’s Model of Behavior Change was initially established to target the customers that need a change in health behavior, especially smokers under therapy treatment. There were four stages of this theory at the start, but now it has five different stages along with additional consideration of multiple audiences rather than individual cases. These stages of change theory are as follows: Precontemplation refers to the condition in which an individual does not understand and unaware consciously or unconsciously of the fact that change is a necessity for him/her. Contemplation indicates the situation of the person who is well aware of the problem and started to think about changing his or her attitude. Preparation for action indicates whenever the individual is ready to accept the challenge to change the attitude and start preparing to change is considered as “the act of preparation.” This stage may be clear within 02 weeks after making the decision to change. The action starts with the engagement of an individual into the change activities and understands how to cope with the behavioral change. Maintenance is considered as the final stage, which varies with individuals, but normally it may take up to six months. Any change in behavior must be strengthened in order to sustain the change.

Appraisal of evidence

There is a lot of evidence that proved that this model or theory could create a difference in the health behavior of an individual. Prochaska, DiClemente, and Norcross defined ten procedures that can evaluate and inspire the movement across the stages, which include Re-evaluation of environmental activities, Individual self-freedom, Social freedom, Sense of dramatic relief, Awareness levitation, Re-evaluation of self-esteem, Improvement in the relationships, Strengthening of management, Incitement control and Counter conditioning.  These are some of the processes that can be achieved through this model or theory. The evidence depicted that this model is quite promising in the counseling of the patients who have HIV (AIDS) and sexually transmitted diseases (STDs). It has also been reported as the supplement for improving the efficacy and implementation of interventions intended to minimize a load of musculoskeletal wounds (Rothmore, Aylward, & Karnon, 2015; Oakman et al., 2016). There are some shortcomings in every designed model, and still, some space is always available to improve things. Similarly, this model did not address the two key elements, i.e., the impact of environment and structure on behavioral health changes, which are necessary for planning a translation of new information into a practice setting.

Networking with the stakeholders

Stakeholders are the crucial and key element of this model because they can help an individual to improve his or her behavior in a complex environment. They mostly identify those people who will be a part of the change, affected by the change, and persuasive in the change process. Apart from this, they are responsible for investigating the character of all stakeholders, their commitment, affective for or against the change (Rothmore et al., 2016). Teamwork is also an additional supplement for the accomplishment of any change. Therefore, understanding the stakeholders or their role in the rehabilitation process is the most essential part of this model.  

Identifying and addressing barriers to implementation

Translation project or any change model has so many external barriers and facilitators to devalue the whole process. It is very necessary to identify and address those barriers for the improvement of the model or theory. Both the challenges and barriers can be broken down by considering some basic elements like adopter behavior, organizational structure, innovative ideas, and improve communication. This model also identified and addressed the barriers and challenges that occurred during the transitional phase of individual health activities.

References

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare. Springer Publishing Company. doi:10.1891/9780826147370

Oakman, J., Rothmore, P. & Tappin, D. (2016). Intervention development to reduce musculoskeletal disorders: Is the processs on target? Applied Ergonomics 56, 179–185. doi:10.1016/j.apergo.2016.03.019.

Rothmore, P., Aylward, P., & Karnon, J. (2015). The implementation of ergonomics advice and the stage of change approach. Applied Ergonomics, 51, 370–76. doi:10.1016/j.apergo.2015.06.013 

Rothmore, P., Aylward, P., Oakman, J., Tappin, D., Gray, J., & Karnon, J. (2016). The stage of change approach for implementing ergonomics advice—Translating research into practice. Applied Ergonomics, 59, 225– 233. doi:10.1016/j.apergo.2016.08.033

Thanks for your discussion post.  There are many behavior change models.  Each of them has some similarities, however, it must be considered that in any behavioral change model it is the individual that is actually the change agent and the provider that facilitates the change.   Although you started discussing Social Cognitive theory, it seems as though you spent most of the discussion on the Transtheoretical Model. An important stage in the model is that of relapse.  It changes the model from being linear to one that is cyclical.    The provider must be able to assess the stage of change and facilitate movement through each of the stages.