Neurological, Cognitive Or Perceptual

Neurological, Cognitive Or Perceptual

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. Neurological, Cognitive Or Perceptual

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. Neurological, Cognitive Or Perceptual

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 900-words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe the clinical manifestations present in Mr. M.

1. 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. Neurological, Cognitive Or Perceptual

2. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.

3. 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.

4. Discuss what interventions can be put into place to support Mr. M. and his family.

5. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each. Neurological, Cognitive Or Perceptual

You are required to cite 2 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. Also, you must have a conclusion with a minimum of 5 sentences to wrap up the case study


Individuals who have neurological insult (trauma to the brain ), whether mild or severe, may experience cognitive and perceptual difficulties. Researchers have found that 75-90% of children with learning disabilities present with motor difficulties, which often are accompanied by perceptual deficits. In one study, over half of patients admitted for cognitive rehabilitation due to head injury also presented with visual perceptual impairments. In addition, individuals who have experienced strokes or inflammatory or infectious brain diseases, such as meningitis or encephalitis, are at risk for perceptual and cognitive disorders. Neurological, Cognitive Or Perceptual

Cognitive and perceptual rehabilitation is indicated when a patient or client presents with deficits in these areas during the medical, physical therapy, or occupational therapy assessment. Difficulties may appear in equilibrium and vestibular functions, automatic postural reactions, fine and visual motor performance, motor planning abilities, and/or sensory integration. The individual may remember events incorrectly and have difficulty perceiving new information. In addition, he or she may have inappropriate responses to sensory input due to deficits in sensory processing. Neurological, Cognitive Or Perceptual

Unilateral spatial inattention, a visual perceptual dysfunction occurring most frequently in patients who have had a stroke, traumatic brain injury, or tumor, may be detected by asymmetries in performance. For example, in drawing a clock, the individual may place all of the numbers on the right half of the clock only. When an individual has visual, auditory, or tactile agnosia, he or she is unable to recognize and name a common object using one of the senses of sight, hearing, or touch, respectively. Visuospatial disorders are manifested by the inability to discern spatial relationships. Visuoconstructive disabilities occur when an individual is unable to synthesize parts into a whole, such as building a tower from blocks or copying a line drawing. Vestibular impairments may present as dizziness or imbalance with certain movements or head positions. Many standardized tests exist to assess perceptual performance in children or adults.

Intervention is found in either direct therapy or indirect therapy. Direct therapy usually focuses on the particular tasks or skills to be learned, with compensatory behaviors filling in for abilities that are missing. In contrast, indirect therapy focuses on rehabilitating the underlying dysfunction of the central nervous system (CNS), in hopes that improvement of the dysfunction will transfer to skill attainment. Neurological, Cognitive Or Perceptual

Sensory integration and motor control approaches are considered indirect therapies. Sensory integration is an approach, used often with children, in which sensory input is provided within the context of a meaningful activity, usually play-related. The goal is that the child will display appropriate responses and gain experience in organization of sensory input. When using the motor control approach, task-oriented behavior is practiced to enhance perceptual information from the feedback and feedforward mechanisms in the CNS. Verbal and visual cues, in addition to varying the practice situation, are all used to assist in facilitating appropriate performance that can be applied to a variety of situations. Neurological, Cognitive Or Perceptual

An example of direct therapy is functionally relevant motor skill training. Balance, locomotion, body awareness, and eye-hand coordination tasks are practiced in the context of activities of daily living, e.g., tying a shoe. Tasks are broken down into simple parts, then as a whole, and practiced in a variety of ways for carryover to different situations. Visual perceptual rehabilitation usually takes the form of direct therapy as well. Clients are trained to use eye and head movements along with visual markers to scan their environment, compensating for unilateral spatial inattention. Clients with visuospatial and visuoconstructive disorders are trained by progressing from simple to more complex tasks, using verbal, proprioceptive, and vestibular input to aid in performing the tasks. Treatment of vestibular impairments takes place in a similar fashion. The patient is habituated to certain head movements through practice, then is progressed to more complex ones as tolerance increases Neurological, Cognitive Or Perceptual