Question

A 78-year-old man was admitted with pneumonia hyponatremia. Plasma Na concentration was initially 129 meq/L, decreasing within 3 days to 118-120 meq/L despite fluid restriction to 1 liter/day. A chest CT scan revealed a right 2.8 x 1.6 cm infrahilar mass and post obstructive pneumonia. The patient was active smoker. Past medical history was notable for laryngeal carcinoma treated 15-yearsprior with radiation therapy, renal carcinoma, peripheral vascular disease, and hypothyroidism. On review of system, he denied headache, nausea and vomiting. He had chronic hip pain, managed with acetaminophen. Other medications include cilostasol, amoxicillin, digoxin, diltiazem, and thyroxine. He was euvolemic on examination, with no lymphadenopathy and a normal chest examination.

Laboratory Results:

Na-120

TSH-2.6

K-4.3

Uric acid-2.7 mg/dl

cl-89

Bun-8

Crea-1.0

Glucose-93

Mg-2.0

Phos-2.8

Ca-8.9

Alb-31

The patient was treated with furosemide 20 mg PO BID and salt tablets. The plasma Na concentration increased to Na meq/L with this therapy: How ever the patient developed orthostatic hypotension and dizziness. He was stated on demeclocycline, 600 mg PO in the morning and 300 mg in the evening, just before discharge from hospital. Plasma concentration increase to140 meq/L with Bun of 23 and crea of 1.4 at which point demeclocycline was reduced to300 mg POBID. Bronchoscopic biopsy eventually showed small lung cancer. The patient declined chemotherapy and was discharged.

Create a conceptual map using the case scenarios as guide. Conceptual map should include pathophysiology, medical diagnosis, signs and symptoms, and risk factors, if any. Nursing diagnosis, nursing interventions, medical management (medication and procedures), expected outcomes.

Answer 1