Question

Mr. H is a 64 year old male with a history of COPD, HTN, and Type 2 DM. he just arrived this morning from the ED with a diagnosis of uncontrolled HTN (admitting BP 220/110), and chest pain. The symptoms that brought him into the ED were severe morning H/A with occasional vomiting x3 days, SOB, and chest pain. When you examine him you notice a large bruise on his right elbow and hip. He relays history of a fall recently. He complains of dysphasia which he attributes to a sore throat from vomiting. He is slightly disoriented and drowsy, but received a dose of Zofran for vomiting before he was brought up to your unit. His HA has returned but he feels he cannot take anything PO because of his earlier vomiting.

Labs: Na: 145, K: 3.7, Cl: 100, CO2: 28, BUN: 22, Creatinine: 1.5, Blood Glucose: 210, HgB: 12.7, WBC: 10.3, PLTS: 110.
CK enzymes negative
Chest X-ray: no effusions, pneumonia but emysematous changes noted.
Current BP: 156/98 HR: 78 reg. RR: 24 on 4L O2

1) What could be happening to Mr. H? (hint: Is all his symptoms related to HTN?)
2) What symptoms are related to the severe HTN?
3) What symptoms are related to the COPD?
4) what symptoms are related to the Type 2 DM?
5) Based on his history and labs what is probably responsible for the bruising?
6) List all abnormal lab values, possible causes, in a significance of the abnormal lab values in Mr. H plan of care?
7) What does emysematous changes on the CXR mean? What disease process is this related to?
8) What are your top 3 nursing priority concepts (in order of priority) would you use for Mr. H? What nursing interventions would you include for Mr. H?

Answer 1

1)Mr H is having uncontrolled htn Or hypertensive crisis.

2) Severe chest pain.Severe headache, accompanied by confusion and blurred vision.Nausea and vomiting.Severe anxiety.Shortness of breath.Seizures.Unresponsiveness, these are all symptoms of severe htn Or Hypertensive crisis

3) Shortness of breath, especially during physical activities. Wheezing. Chest tightness. A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish. Frequent respiratory infections. Lack of energy. Unintended weight loss (in later stages) Swelling in ankles, feet or legs.

4) Symptoms include increased thirst, frequent urination, hunger, fatigue and blurred vision.Diabetes is called as 3P disease because of Polydepsia, polyuria and Polyphagia

5) Low platelet count or Thrombocytopenia (signs and symptoms may include: Easy or excessive bruising ) and history of fall contributes to bruise

6) high BUN value( can mean kidney injury or disease is present. Kidney damage can be caused by diabetes or high blood pressure ). Platelet count is low , blood sugar level high due to insulin resistance or diabetes,

7)  emphysema, the inner walls of the lungs' air sacs (alveoli) are damaged, causing them to eventually rupture. This creates one larger air space instead of many small ones and reduces the surface area available for gas exchange. that causes shortness of breath. This disease process is related to mainly smoking

8) SOB, high blood pressure,pt safety from falls

Intervention for sob. .. . . The propped up position, oxygen administration, plenty of fluids, persed lip respiration

Intervention for high blood pressure.. . . Low sodium diet , compliance to medication , fluid restrictions, rest periods

Intervention for risk of injury .. .. . Provide safety precautions like side railing , assisst pt at every step, before getting out of bed dangle your legs to avoid othostatic hypotention