Reference no: EM133845999

Question

Marcus Jeffries is a 65-year-old electrician with a history of heart failure and diabetes mellitus type 2, who has been in the hospital for two days due to an exacerbation of COPD. The patient stopped smoking two years ago and has good blood glucose control on metformin/glipizide 500 mg/5mg PO BID. In the hospital, Mr. Jeffries has been taking prednisone 20 mg PO every morning and using an albuterol inhaler, two puffs every four hours.

Upon assessment, you note that the patient has developed 2+ edema around his ankles and his weight has increased by three pounds since yesterday. No pulmonary crackles are auscultated. You call the physician and receive an order for HCTZ 25 mg PO mg IV STAT and then daily q AM.

The nursing assistant measures the patient's blood glucose level at 236 mg/dL. Mr. Jeffries is surprised at the results, since his blood glucose levels are usually within the normal range.

Mr. Jeffries is subsequently discharged two days later with orders to continue the HCTZ and prednisone until seen by his family physician.

Ten days after discharge, Mr. Jeffries returns to the Emergency Department via ambulance, with severe nausea, vomiting, and fatigue. His blood pressure is 92/60 mmHg, heart rate is 98 bpm, and SpO2 is 93% on room air. He is lethargic but oriented to time, place, and person. His skin is pale, cool, and clammy. You also note dry mucous membranes, sunken eyeballs, and diminished breath sounds at the bases. Results of STAT laboratory tests demonstrate hyponatremia and hyperkalemia. Mr. Jeffries' wife says her husband "hates the way the prednisone makes him look and feel" and is not sure whether he was taking his medication.

1. What do you expect is causing Mr. Jeffries' symptoms?

2. What are the nursing priorities in the management of this condition?