Question

Discussion: Week 4

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Scenario 1

A nurse is reviewing the latest lab results for a 44-year-old patient admitted with fever of unknown origin (though meningitis was ruled out). The lab slip indicates that the patient’s white blood cell count is elevated. The nurse calls the physician’s office to discuss the lab results, but the office is closed and the nurse is asked to leave a voicemail message. What should the nurse do?

Scenario 2

A student nurse is assisting in the outpatient clinic and is caring for a 30-year-old man with excessive thirst, frequent urination, and recent weight loss. The physician suspects diabetes mellitus and has ordered a fasting glucose test and a 2-hour postprandial glucose tolerance test for the next morning. The diagnostic test instructions for the patient include drinking orange juice and eating a high-carbohydrate meal after the fasting specimen is collected. The patient wants to know why he is supposed to eat sugars and starches before the second test is performed and whether this might be dangerous if he is diabetic. How should the nurse respond?

Scenario 3

A 77-year-old woman with a history of diabetes mellitus and hypertension is scheduled for an upper and lower gastrointestinal (GI) series because of persistent abdominal pain and occasionally positive Hemoccult stools. After a laxative the night before and the cleansing enema in the morning, the patient arrives in the outpatient medical imaging area for the tests scheduled for 8 am. The physician told the patient that she could have a sip of water for her diabetic and blood pressure medications before she left for the hospital. Because of scheduling difficulties, the patient’s tests are pushed back until 11 am. Around 10:30 am, the patient is found to be diaphoretic, pale, and confused, and nearly falls out of her chair in the outpatient waiting area. The patient is then transferred to the emergency department to be treated for dehydration. What is the nurse’s responsibility in preparing older patients for diagnostic tests?

Scenario 4

An 81-year-old female is brought to the emergency department by ambulance from an assisted-living facility. An hour after supper she began feeling short of breath and exhibited a short shrill sound with each inspiration. For the past couple of days she had been complaining of numbness in both hands that “seems to be getting worse.” During the assessment, the student nurse noted there was involuntary facial muscle twitching. The patient’s medications were reviewed. When the student asked if she took anything else, the patient said, “Yes, a teaspoon of baking soda in a glass of water after meals. It seems my heartburn has been getting worse and the baking soda really helps. I don’t like to take medicine.” The physician asked to review the medication list when the assessment was completed. The student wondered if baking soda was a medication and if it should be placed on the list.

Scenario 5

A 46-year-old female with a history of type 1 diabetes mellitus and asthma recently underwent abdominal surgery to remove a tumor. On the second postoperative day, she was diagnosed with postoperative pneumonia and placed on additional antibiotics and regular respiratory therapy treatments. On the third postoperative day, her NG tube remained in place because of the absence of bowel sounds. She sits up in the chair, but has been unable to ambulate fully because of her pneumonia. She is receiving hyperalimentation to provide her with parenteral nutrition and maintain her blood glucose within normal limits. The student nurse’s assessment of the patient is deep, rapid respirations at 32/min, nausea, decreased skin turgor, pulse 140 bpm and regular, blood pressure 94/52 mm Hg, and complaints of abdominal pain. The student is directed to do a stat glucose check while the physician is being notified of the patient’s condition. The glucose reading is found to be 450 mg/dL. The physician determines that the patient is experiencing signs of diabetic ketoacidosis and orders stat electrolytes, BUN, creatinine, ABGs, and urine for ketones, and to discontinue the hyperalimentation infusion and begin an insulin infusion. What are the laboratory tests likely to show? What is the probable cause of the patient’s ketoacidosis?

Answer 1

Scenario 1

The nurse should leave the voicemail message if the institution has the practice of doing thet and record it in the nurses notes.Once she gets the replay document that also in the nurses notes.

Scenario 2

The nurse should expalin the patient regarding the test and the procedure.If he has doubt like why he has to take sugars and starch,the the nurse should explain thet this post prandial glucose test is peforming to diagnose whether the patient is diabetic or not.So after the patient takes the sugar and starch the blood glucose level will rise,and according to this the pancreas will produce the insulin to maintain the blood glucose level.So the by the two hours the blood glucose level in the blood will become normal.If the sugar level is not becoming normal that means the patientis diabetic.

Tell the patient need not to be panic if he is diabetic because the food has the standard amount of sugar and it will not harm him.

Scenario 3

While preparing elderly patients for diagnostic procedures,make sure the complete history of the patient is obtained.Like the medical history whether the patient is diabetic or hypertensive or he has any other comorbidities and is he taking any medicine and what is the time and the dosage of the medicine.Also it is important to know the allergic history of the patient to avoid any unhappy events during the diagnostic procedure.Should know the cognitive ability of the patient to run the diagnostic test effeclively.Brcause the client shoud be able to follow the instructions correcly to get the accurate value of the diagnostic test.

Also has to obtain the surgical history,like any history of removal of any orhgans especially glands,placemnt of any arificial implants etc

Family history has agreat role that the nurse should know wheter is there anybody to accompany the patient before and after the diagnostic procedure,and to takecare of the patient after the procedure.

In short the a holistic preparation of the client is needed when we preapre the elderly clients for the diagnostic procedure.

Scenario 4

Baking soda(sodium bicarbonate) is not mentioned in the list as medicine but it is used to treat the heart burn because it neutrlise the gastic acid and gives relief from the heart burn.It is non toxic but should not be taken without the instruction of doctors,also caution should be taken before taking the baking soda because it has mild to severe drug interaction.

Scenario 5

The value of BUN has mild to mederate fuctuation in DKA.Electrolye is affected especially pottassium the patient can experience hypokalemia.The creatinine level can increase during DKA because of the dehydration.There will be prsence of ketone in the urine and the ABG value shows PH of less than 7.3 and low bicarbonate level that is less than 18MEq per liter.

Normaly the patient who undergo surgery has high glucose level due to the stress and anesthesia can cause release of certain hormones like cortisole and it causes the hyperglyucemia.And in post operative cases other than stress and anesthesia the main cause to occur the DKA is infections and mainly pneumonia and urinary tract infections,also dehydration plays an important role in DKA.