Question

Case Study: Chapter 22

Write an Explanation after each answer

Anthony Draecus is a 72-year-old male with type 2 diabetes mellitus, hypertension, and atherosclerosis. He lives with his oldest daughter and her family. His daughter has six children ranging in age from 7 to 18 years old. Mr. Draecus’s wife of 50 years died a few months ago. Until her death he lived with her in their own home about 100 miles away. The daughter insisted that he move in with her in spite of the fact that her husband felt that her father would be better off in his own home. Anthony’s daughter has brought him to the rural health clinic since the death of his wife, where he sees a family nurse practitioner. He tells the nurse practitioner that he is always tired and short of breath, his strength has decreased, and he is hungry all the time but when he eats it upsets his stomach. His weight has not changed recently. On physical examination, Mr. Draecus is 5 feet 10 inches tall, and he weighs 210 pounds. Today his blood pressure and pulse are 170/92 and 92 beats/min, respectively. He demonstrates atherosclerotic and hypertensive changes in the eye. His lungs are clear, and his bowel sounds are normal. He has dependent edema with strong peripheral pulses. His blood glucose level is high at 210 mg/dl. Cholesterol and triglyceride levels are also high. He takes oral hypoglycemia medication, a diuretic, and an antihypertensive medication. These medications have not been changed in more than 2 years. Until the death of his wife, his diabetes and hypertension were in better control.

1. The nurse practitioner would most likely consider which of the following as the cause of Mr. Draecus’s symptoms? A. Lack of control of his diabetes mellitus B. Age-related body changes C. Stress D. Lack of control of his hypertension.

2. With Selye’s general adaptation syndrome as a foundation. Mr. Draecus’s symptoms would characterize responses of the: A. Alarm reaction B. Stage of resistance C. Stage of exhaustion D. Stress triad

3. Which one of the following actions should the nurse practitioner consider first? A. Change the hypoglycemic medications to insulin. B. Help Mr. Draecus identify his stressors. C. Control his hypertension. D. Teach Mr. Draecus’s daughter how to manage her father’s diseases.

4. Which information from Mr. Draecus’s history is characteristic of the fight-or-flight reaction? A. Diabetes mellitus, hypertension, and atherosclerosis B. Chronic fatigue, blood pressure at 107/92, and pulse at 92 beats/min C. Decreased strength, dependent edema, and clear lungs D. Hunger, normal bowel sounds, and dependent edema.

Answer 1

1. The nurse practitioner would most likely consider option "C" for Mr.Draceus symptoms.

Rationale : Stress is the reason.Lack of control of diabetes mellitus damages the arteries that makes hardening of these blood vessels which is the cause for atherosclerosis in turn which may increase blood pressure which leads to hypertension.But here all these situations are might be because of stress that he lost his wife.

2. According to Selyes general adaptation syndrome, Mr Draecus symptoms characterise the responses of option "A" that is Alarm reaction stage.

Rationale : After the initial stressful situation the body develops some physical and physiological changes due to the alterations in the production of hormones.

3. The nurse should first help to identify his stressors. Option B.

Rationale : Though his uncontrolled diabetes made him to face all these situations, his stress level in loosing wife is an ultimate reason for everything so first priority becomes identifying stressors then automatically change in the medications works.

4. Option A from Darecus history indicates fight or flight response that is the situation that takes place during alarm reaction stage and thus diabetes, atherosclerosis and hypertension are resulted as a response