Brief Patient History
Ms. S is a 72-year-old woman with a history of hypertension treated with an angiotensin-converting enzyme (ACE) inhibitor and thiazide diuretics. She has a past 100 pack-year history of tobacco abuse but quit smoking 2 years ago. Ms. S lives independently in a senior apartment. Friends bring Ms. S to the hospital because of a fall. Ms. S states that she has a severe headache but cannot recall whether she hit her head during the fall. Ms. S is also having difficulty recalling recent events.
Clinical Assessment
Ms. S is admitted to the intensive care unit from the emergency department because of nonspecific electrocardiogram (ECG) changes suggestive of inferior wall ischemia and electrolyte abnormalities.
She is awake, alert, oriented to person, time, and place, and unable to recall the events leading to her hospitalization. She states that her headache is severe and feels like someone is hitting her head with a hammer. Her skin is warm and dry. Ms. S’s gait is visibly unsteady.
Diagnostic Procedures
Ms. S’s vital signs include the following: BP, 180/92; HR, 100 (sinus rhythm); RR, 24; T, 98.8 F.
Ms. S reports that her headache is a 10 on the Wong-Baker FACES scale.
Laboratory findings include the following: sodium, 116 mmol/L; potassium, 3.3 mmol/L; chloride, 88 mmol/L; carbon dioxide, 22 mEq/L; magnesium, 1.8 mg/dL; urinary sodium level, 30 mmol/L; urine osmolality, 118 mOsm/L.
Troponin I on admission is negative.
ECG: normal sinus rhythm; T-wave inversion in leads II, III, and AVF; change from prior ECG suggesting inferior wall ischemia.
Chest x-ray study indicates the presence of a mass in the right upper lobe, strongly suggestive of neoplasm.
Medical Diagnosis
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is diagnosed.
1. What major outcomes do you expect to achieve for this patient?
2. What problems or risks must be managed to achieve these outcomes?
3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
5. What possible learning needs would you anticipate for this patient?
6. What cultural and age-related factors might have a bearing on the patient’s plan of care?
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