Question

case study

Sameer is a 59 year-old man who is known to have hypertension and hypercholesterolemia for 12 years. He also suffers from Type 1 Diabetes Mellitus (T1DM) since he was 18 years of age. Sameer was also diagnosed with Atherosclerosis 5 years ago. This morning, he was brought in to the Emergency Department (ED) with severe headache, changes in his Level of Consciousness (LOC) and slurred speech. On arrival to the ER, Sameer’s BP was 195/105 mmHg and his SpO2 was 88% on room air. The nurse has commenced him on a high flow O2 therapy. During the nursing assessment, his blood sugar was 330 mg/dL and his serum ketones were 7mEq/L. Sameer’s wife explained that the husband had not been taking his medications regularly. She also stated that Sameer had been under a lot of pressure from his employer due to financial restraints. Sameer received a prompt medical review and a few diagnostic investigations have been carried out. The urgent brain CT scan results didn’t show any bleeding in the brain but there was a significant arterial occlusion of the brain. The Arteria Blood Gas (ABG) analysis showed a pH of 7.22 and the urinalysis showed ketones ++. Sameer was instantly admitted to the ICU for immediate treatment and close monitoring.

Q1. Name three clinical findings for each of the two medical diagnosis.

Q2. Identify the two main critical medical diagnosis that Sameer’s doctor must have concluded before admitting Sameer to the ICU

Answer 1

Our patient sameer have hypertension and hypercholesterolemia aslo have type 1 Diabetes mellitus ( pancreas produce little or no insulin) and atherosclerosis ( the build up of fats , cholesterol and other substances in and on artery wall) it cause obstruction of blood flow.

Q1.  He have sever headache, slurred speech , change in level of consciousness . Because our patient as stroke . Why that time nurse giving oxygen therapy?because giving oxygen to people who have had a stroke could possibly help to prevent or reduce brain damage . Low oxygen supply in brain , brain cells start to damage.

The most important test in emergency stroke evaluate is glucose or bloodsugar .because level of blood glucose which are too high or too low can cause symptom which may be for stroke. Here our patient has 330mg/dl its too high

stroke patient blood pressure also high . So , here our patient bp is 195/105mmHg.

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Q2. A. Lacunar stroke ( ​​penetrating branches of the circle of willi or vertebral or basilar arteries )

B. Respiratory acidosis - in ABG ph is 7.22. ( normal ph is 7.35 - 7.45) if the ph is less than 7.35 is called acidemia and if the ph is more than 7.45 is called alkalemia

here , our patient has ph 7.22 so, respiratory acidosis

C. urinalysis showed ketone ++ mean high ketone lead may indicate DIABETIC KETOACIDOSIS (DKA ) a complication of diabetes lead to a coma and even death.

thats why sameer instantly admitted to ICU.