Question

In: Nursing

Mrs. PH, 78 years old, a nursing home resident was taken to the hospital after feeling...

Mrs. PH, 78 years old, a nursing home resident was taken to the hospital after feeling unsteady on her feet and then suffering from a fall. She was also complaining of feeling nauseous and appeared to be very irritable and confused. Nursing home staff stated she was normally pleasant to be around and her current behavior was uncharacteristic. Neurologic evaluation revealed no deficits or signs that she had any neurologic damage, and all other vital signs were normal. Her medical history revealed she has a history of hypercholesterolemia, depression, chronic back pain, sciatica, acid reflux, and osteopenia. She was also taking several medications: esomeprazole, fluoxetine, carbamazepine, oxycodone, atorvastatin, low-dose aspirin, and calcium and vitamin D supplements. Blood work showed the following results: Mrs. PH’s Test Results Results Reference range Serum sodium 108 mmol 135–145 mmol Potassium 4.5 mmol 3.5–5.0 mmol Serum calcium 8.9 mg/dL 8.6-10.3 mg/dL Creatinine 40 µmol/L 40–90 µmol/L Estimated glomerular filtration rate 90 mL/min/1.73 m2 >90 mL/min/1.73 m2 Serum osmolality 254 mOsm/kg >275 mOsm/kg Urine osmolality 140 mOsm/kg <100 mOsm/kg Urine sodium 39 mmol/L <20 mmol/L Thyroid function tests Normal Chest X-ray Normal Computed tomography of the head Normal

A1. (2 pts) Which lab results are abnormal? Highlight or list them below.

A2. (4 pts) Based on the lab results, provide a diagnosis for Mrs. PH. Explain how you arrived at your diagnosis, specifically the test results and symptoms that are consistent with your diagnosis.

A3. (6 pts) For the medications Mrs. PH is taking, list which condition they were likely prescribed for based on her medical history.

A4. (3 pts) For the diagnosis you provided, which medication(s) is/are most like contributing to her problem?

Expert Solution

Answer to A1:

Lab test	Test Results	Reference range	Interpretation
Serum sodium	108 mmol	135–145 mmol	Abnormal- low sodium levels.
Potassium	4.5 mmol	3.5–5.0 mmol	Normal – within the reference range.
Serum calcium	8.9 mg/dL	8.6-10.3 mg/dL	Normal – within the reference range.
Creatinine	40 µmol/L	40–90 µmol/L	Normal – within the reference range.
Estimated glomerular filtration rate	90 mL/min/1.73 m2	>90 mL/min/1.73 m2	Normal – Borderline to the reference range.
Serum osmolality	254 mOsm/kg	>275 mOsm/kg	Abnormal – lesser than the reference range.
Urine osmolality	140 mOsm/kg	<100 mOsm/kg	Abnormal
Urine sodium	39 mmol/L	<100 mOsm/kg	Normal – within the reference range.
Thyroid function tests	Normal	Normal	Normal
Chest X-ray	Normal	Normal	Normal
Computed tomography of the head	Normal	Normal	Normal

Therefore Serum sodium, Serum osmolality, and Urine osmolality results are abnormal.

Answer to A2:

A low blood sodium level is caused due to:

Dehydration
Excessive or overhydration.
Kidney or liver disease
Adrenal gland disorders such as Addison’s disease.
Hypothyroidism
Addison's disease.

A low blood osmolality level is caused due to:

Excessive or overhydration.
Dehydration
Hyponatremia - low blood sodium.

A high urine osmolality level is caused due to:

Congestive heart failure
Dehydration
Kidney failure
Addison’s disease.

Also, Mrs. PH showed the following symptoms:

Nausea
Confusion
Irritability
Fall or fainting
Extreme fatigue – unsteadiness

From the symptoms and the lab results, it can be concluded that Mrs. PH had severe dehydration.

Answer to A3:

List of medications and their indications as per Mrs. PH’s medical history.

Esomeprazole – It is a proton pump inhibitor that reduces the production of stomach acid. It is used to treat acid reflux in the stomach.

Fluoxetine – It is a selective serotonin reuptake inhibitor (SSRI) class of antidepressants. Used to treat depression.

Carbamazepine – Used to treat neuropathic pain and epilepsy. Since Mrs. PH had sciatica, she was prescribed Carbamazepine.

Oxycodone – It is an opioid analgesic used to treat moderate to severe pain. Prescribed for chronic back pain and sciatica.

Atorvastatin – Used to treat high levels of cholesterol (Hypercholesterolemia) and to lower the risk of heart attack and stroke.

Low dose aspirin – Prescribed to lower the risk of heart attack and stroke.

Calcium and Vitamin D supplements – Prescribed to protect bone health. Calcium build and maintain the bones and Vitamin D helps in effective absorption of calcium.

Nightingale answered 2 years ago

Mrs. Jacks is a 78-year-old woman who is a resident of a long term care home....

Mrs. Jacks is a 78-year-old woman who is a resident of a long term care home. When you are administering Mrs. Jacks her medication at 0830am she states, “I feel like I need to go to the bathroom constantly and it hurts when I go.” Mrs. Jacks’ urine is cloudy and has a foul odor. Her temperature is 38.1 degrees Celsius. You call the physician and she orders a specimen for C&S and you advise Mrs. Jacks to increase her...

Walter is a resident in the same nursing home with Elva. He is a 78-year-old widower...

Walter is a resident in the same nursing home with Elva. He is a 78-year-old widower who has been taking antidepressants since the sudden death of his wife 5 years ago. He, too, is visited often by his daughter. The staff of the nursing home inadvertently threw out his dentures with the sheets while making his bed. He had a habit of leaving them on the bed, and although the staff usually noticed them, a new employee failed to do...

Mrs. Toms, 72 years old, fell at home and was admitted to the hospital with a...

Mrs. Toms, 72 years old, fell at home and was admitted to the hospital with a fracture of the right hip. She was alert and oriented on admission. After the initial work-up she was taken to surgery for an open reduction with internal fixation (ORIF) of her right hip. On her first post-op day, her right hip dressing has a small amount of dried dark red drainage. She has an IV of D5/0.45 NS at 75 mL/hr, O2 at 2L/NC,...

C.S. is a 78 year old PT admitted to the nursing home unit with a diagnosis...

C.S. is a 78 year old PT admitted to the nursing home unit with a diagnosis of dehydration. C.S. has been ordered to increase their PO intake to 2500cc/day. When offering her a glass of water she pushes away your hand and says, “I hate water and don’t drink it much.” You note that after one and a half days she has dry mucous membrane and poor skin turgor. 1.What could be the problem? 2.What should you assess? 3.What should...

Mrs Brown, a 78 year-old female, was admitted to the Emergency Department at 6am after waking...

Mrs Brown, a 78 year-old female, was admitted to the Emergency Department at 6am after waking up with severe breathlessness. Her family informed you that the patient has a history of heart failure that had been diagnosed two years ago. On admission to the Emergency Department the clinical manifestations were: Severe dyspnoea Respiratory rate of 24 breaths/minute SpO2 85%, on room air BP 170/95mmHg Pulse rate of 120 beats/minute, in atrial fibrillation Auscultation of lungs identifies bilateral basal crackles A...

Bertha is an 86-year-old resident of the dementia unit in a nursing home facility. Her speech...

Bertha is an 86-year-old resident of the dementia unit in a nursing home facility. Her speech consists of irrational sentence fragments unrelated to any conversation directed to her. Her usual activity is ambulating down the corridor with her walker, going in and out of rooms at random. For the past 2 days, Bertha has resisted getting out of bed. She has been less responsive with few verbal utterances. Today the nurse finds her crying and restless. She has developed a...

If a regular diet is an issue for a resident in a nursing home, what are...

If a regular diet is an issue for a resident in a nursing home, what are some things the facility staff can do aside changing the diet to mechanical soft to minimize both facility liability and to minimize the resident's personal risks ?

Mrs. A, 78 years old, reports to her health care provider (HCP) that she has been...

Mrs. A, 78 years old, reports to her health care provider (HCP) that she has been waking up in the middle of the night feeling like she was going to suffocate. She has also noticed that her legs are tight, and it takes every bit of energy she has to walk to the mailbox. What additional information would be helpful?

A patient in a nursing home complains to her nurse that she is not feeling well....

A patient in a nursing home complains to her nurse that she is not feeling well. When asked to describe how she feels, the patient states that she really is not hungry anymore and seems to have indigestion a lot. The nurse checks the patient’s chart and finds that her vital signs are normal, but that she has lost weight over the past 2 months. She also notes that there is a history of gastric cancer in the patient’s family....

Mrs Leece is 81 years old and is currently in hospital recovering from a fractured hip...

Mrs Leece is 81 years old and is currently in hospital recovering from a fractured hip (fractured neck of femur), which occurred when she was trying to mobilise outside to get the mail. She reports that she had noticed that she had been getting ‘weaker’ in the legs and had not been able to shop regularly, or cook for herself for a while. She says that her appetite has been reduced also and that she has noticed that her clothes...