Nursing Question (11)

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University of Nairobi School of Physical Sciences *

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Nursing

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Nov 24, 2024

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1 56 y/o Caucasia Male Student's Name Institutional Affiliation Course Number November 7, 2022

2 56 y/o Caucasia Male 1. What are the pertinent positive and negative findings in this patient assessment? (more than 4) The patient history of a 56-year-old Caucasian male reveals several pertinent positives: i. dizziness and nausea for four days, ii. increased urination and thirst, iii. a history of cerebral vascular accident (CVA) in two separate episodes, iv. chronic fatigue, and v. a family history of diabetes, hypertension, and coronary artery disease. The pertinent negatives include: i. Absence of headaches ii. A normal respiratory rate of 20 iii. Normothermic w/ body temperature of 98.5 degrees iv. No blurry vision. 2. Create a list of differentials with rationales for this patient? Blood sugar levels are elevated at 405 mg/dL, blood pressure is 190/101 mmHg, and the patient's heart rate is 102 beats per minute, all of which are consistent with hyperglycemia, hypertension, and tachycardia, as determined by the physical examination. Hyperglycemia: Symptoms of hyperglycemia don't typically present themselves until the blood sugar (glucose) levels are extremely elevated, which is defined as being greater than 180 to 200 milligrams per deciliter (mg/dL) or 10 to 11.1 millimoles per liter (mmol/L) (Brufsky, 2020).

3 However, the patient has reported increased thirst and frequent urination, symptoms common with hyperglycemia. Hypertension: Dizziness and nausea are common symptoms of high blood pressure. In addition, fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors are all symptoms that can be caused by severe hypertension (Mills et al., 2020). Tachycardia: Symptoms related to high blood pressure could lead to tachycardia. The signs and symptoms of tachycardia include the sensation of a racing, pounding heart, fainting, rapid pulse rate, and shortness of breath (Fedorowski, 2018). 3. Discuss a medication regimen for this patient considering his financial status? Even though he has been unable to use metformin and Lantus due to a lack of medicine refills, the treatment goal of increasing his blood sugar has been achieved. This is even though he has been experiencing certain symptoms, such as dizziness and nausea, due to not being able to use these medications. 4. What is the priority concern for this patient? Dizziness and weakness are the primary concerns for the patient. In addition, the patient hasn't taken his meds, increasing stroke risk. Stroke causes dizziness and weakness. Dizziness occurs when the brain doesn't get enough blood or oxygen. Low blood sugar, altitude, heart failure, dehydration, and medicines can produce dizziness. Dizziness and weakness may suggest a more serious condition that requires quick medical intervention. Stroke or TIA symptoms include sudden, one-sided weakness and dizziness.

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4 5. How does this patient's comorbid diagnosis impact his current symptoms? The current patient's symptoms are exacerbated by the presence of the patient's concurrent diagnoses of diabetes, hypertension, and coronary artery disease. In addition, for his body to make better use of insulin, he stopped taking metformin, a medicine that had previously increased the sensitivity of his tissues to insulin. These symptoms, however, have been brought on by low levels of insulin in the body, which the elimination of the transformational medication has brought on. 6. Discuss how the patient's health beliefs, culture, and behaviors impact the potential outcomes for the patient. Their lifestyle choices and cultural beliefs largely influence the patient's condition. HHS can be brought on in adults by conditions such as diabetes type 1 and 2, viral illnesses, and problems of the respiratory, circulatory, and genitourinary systems. An increase in the prevalence of HHS has been linked to obesity and the chronic drinking of beverages high in sugar and other simple carbohydrates. Correction of fluid and electrolyte imbalances and insulin prescriptions are common treatments for DKA and HHS (Shahin et al., 2019). Medical nutrition therapy (MNT), physical activity, weight loss, smoking cessation counseling, and psychological support are all essential components of diabetes care and are commonly provided as part of diabetes self-management education and support (DSMES). Symptoms of severe hyperglycemia include an increased need to urinate, increased thirst, impaired vision, extreme weariness, and a heightened susceptibility to infections.

5 References Brufsky, A. (2020). Hyperglycemia, hydroxychloroquine, and the COVID‐19 pandemic. Journal of Medical Virology , 92 (7), 770–775. https://doi.org/10.1002/jmv.25887 Fedorowski, A. (2018). Postural orthostatic tachycardia syndrome: clinical presentation, etiology, and management. Journal of Internal Medicine , 285 (4), 352–366. https://doi.org/10.1111/joim.12852 Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology , 16 (4), 223–237. https://doi.org/10.1038/s41581-019- 0244-2 Shahin, W., Kennedy, G. A., & Stupans, I. (2019). <p>The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review</p> Patient Preference and Adherence , Volume 13 , 1019–1035. https://doi.org/10.2147/ppa.s212046

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