Mrs. Giammo

Mrs. Giammo is a 59-year-old woman who was brought to the emergency department.

by her husband. Mr. Giammo noticed that suddenly, his wife “was slurring her speech and her face was drooping on one side.” Mrs. Giammo told her husband that she felt some numbness on the right side of her face and in her right arm. Mr. Giammo was afraid his wife was having a stroke, so he brought her to the hospital.

Case Study

In the emergency department, Mrs. Giammo is alert and oriented.

Her vital signs are temperature 98.28F (36.78C), blood pressure 148/97, pulse 81, and respiratory rate 14.

Mrs Giammo has a history of Rheumatoid Arthritis and GERD. She is 5’4” tall and weighs 175lbs. She had her gall bladder out 15 years ago. She has never smoked but enjoys a glass of wine with dinner.

Mrs. Giammo is still complaining of “numbness” of the right side of her face and down her right arm. Her mouth is noted to divert to the right side with a slight facial droop when she smiles. Her speech is clear. She can move all her extremities and follow commands. Her pupils are round, equal, and reactive to light (4 mm to 2 mm) and accommodation. There is no nystagmus noted. Her right-hand grasp is weaker than her left. Mrs. Giammo does not have a headache and denies any nausea, vomiting, chest pain, diaphoresis, or visual complaints. She is not experiencing any significant weakness, has a steady gait, and is able to swallow without difficulty.

Diagnostic Tests

A head computed tomography (CT) scan is done which shows no acute intracranial change and a magnetic resonance imagery (MRI) is within normal limits.

An electrocardiogram (ECG, EKG) monitor shows a normal sinus rhythm.

Laboratory blood test results are as follows:

White blood cell (WBC) 8,000 cells/mm3,

hemoglobin (Hgb) 14 g/dL,

hematocrit (Hct) 44%, platelets = 294,000 mm3,

erythrocyte sedimentation rate (ESR) 15 mm/hr,

prothrombin time (PT) 12.9 seconds,

international normalized ratio (INR) 1.10,

sodium (Na2+) 149 mEq/L,

potassium (K+) 4.5 mEq/L,

glucose 105 mg/dL,

calcium (Ca2+) 9.5 mg/dL,

blood urea nitrogen (BUN) 15 mg/dL, and creatinine (creat) 0.8 mg/dL.

Mrs. Giammo is scheduled for admission to have a neurology evaluation, magnetic resonance angiography (MRA) of the brain, a fasting serum cholesterol, and blood pressure monitoring.

Homework Questions

Mrs. Giammo’s cholesterol lab work reveals the following:

total cholesterol 242 mg/dL,

low-density lipoprotein (LDL) 165 mg/dL,

high-density lipoprotein (HDL) 30 mg/dL.

Mrs. Giammo is started on an intravenous heparin drip of 25,000 units in 500 cc of D5W at 18 mL per hour (900 units per hour).

Mrs. Giammo reports that she takes atenolol at home. She also takes Metformin and Gabapentin.

Atorvastatin 10 mg PO per day is prescribed for Mrs. Giammo.

Mrs. Giammo is also prescribed Tylenol 650mg prn pain Q 6 hours, Tramadol 50mg PRN pain Q6, and Ativan 2mg at bedtime.

Question 1.

Identify six Nursing Diagnoses appropriate for Mrs. Giammo and list them in order of priority. Pick one nursing diagnosis and fill out the template with all the data (goal, outcome criteria, interventions, etc.)

Expert Solution