History of heart failure and diabetes mellitus

Assignment Help Science

Reference no: EM133852411

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.

Since the patient in the hospital has been taking albuterol, this could potentially be the reason that his glucose is elevated. The medication should be used with caution in patients that have cardiac disease and diabetes as the medication may induce hyperglycemia.

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?

Reference no: EM133852411

Questions Cloud

Discuss the anxiolytic actions of benzodiazepines : Discuss the anxiolytic actions of benzodiazepines. For this discussion, focus on their actions in the brain and receptor sites.

Occupational safety and health administration : It is essential for healthcare workers to understand OSHA's roles and its purpose in the healthcare setting.

Community acquired pneumonia : All of these points relate to community acquired pneumonia in an elderly female with hypertension and stage 2 kidney disease

Concerned because nose keeps bleeding : Mr. Sherwood is concerned because his nose keeps bleeding. He asks the nurse, Can you tell me again what I can do to keep my nose from bleeding?

History of heart failure and diabetes mellitus : Marcus Jeffries is a 65-year-old electrician with a history of heart failure and diabetes mellitus type 2,

Describe strategies for implementing teaching plan : Explain the concepts of the teaching plan and of learning goals and objectives. Describe strategies for implementing a teaching plan

How poor hygiene can cause illness-complications and deaths : Discuss and elaborate on how poor hygiene can cause illness, complications, and deaths.

Do you have any experience with shared decision making : Do you have any experience with shared decision making? Have you witnessed shared decision making in the clinical environment?

Considering physiological-pathological-psychosocial changes : Discuss these stereotypes about the elderly, considering physiological, pathological and psychosocial changes

User Account

All Pages