Question

Sodium-135-145 Potassium - 3,5-5 Chloride - 97-107 Calcium 8.5 - 10 Magnesium 1.5-2.5 Phosphorus 3.4 -4.5 Case Study A 55-year-old African-American with PMH of DM-Type 2 and HTN who presents to the ED with an elevated blood pressure of 230/120 mm Hg: pulse 60 beats/minute. Pt. current wt is 275 lbs and height is 6'1. Hematocrit was 38%, serum sodium, 140 mEq/L; and serum potassium, 2.7 mEq/L. His medications included propranolol and hydrochlorothiazide. Two-part: at risk (related to/due to) Three-part: they have already developed the problem (as evidenced by)

Answer 1

Diabetes Mellitus:

It is medical disorder characterised by high blood sugar level due to an inability to produce or inability to metabolize sufficient quantities of the hormone insulin .

Hypertension:

The disease or disorder of abnormally high blood pressure is called Hypertension. The normal blood pressure is 120 / 80 mm of Hg.

Two part Nursing Diagnosis / Risk diagnosis / Potential problem for patient:

1. Risk for decreased cardiac output related to increased vascular resistance/  ventricular hypertrophy

2. Risk for unstable blood glucose related to inadequate blood glucose monitoring or lack of adherence to diabetes management.

3. Risk for infection related to high glucose levels.

4. Risk for injury related to muscle weekness

( Hypokalema or decreased Potassium ion concentration in blood may result in muscle weekness).

Three part Nursing Diagnosis/ Actual problem of the patient :

1. Electrolyte imbalance (Hypokalema) related to treatment related side effects such as diuretics as evidenced by decreased potassium level ( 2.7 mEq/ L in the lab report.

( Diuretic, Hydrochlorothiazide causes increased urine output along with the excess loss of electrolytes from the body . This can result in decreased potassium concentration in the blood)

In the above case study there are no symptoms given except high BP and hypokalema.

( Usually Hypertension patient may have symptoms like head ache, Activity intolerance etc. In that case the Actual nursing Diagnosis are:

* Acute pain related to increased cerebrovascular pressure as evidenced by verbal reports of throbbing pain located in occipital and temporal region.  

* Activity intolerance related to generalised weekness as evidenced by verbal report of fatigue and weekness. )