Essay On Nursing Case Study


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Nursing Case Study


D.M, a sixty year old male has been admitted with a chief complaint being dizziness and difficulty walking up the stairs. He has been lethargic for the past two weeks and falling four times during the same period. Furthermore, he has been lightheaded and even lost strength before falling. A close look at his medical history reveals that he has Type 2 Diabetes Mellitus, hypertension, hyperlipidemia, pneumonia back in 2000, Osteoarthritis of the spine and hip, and Cerebrovascular accident in 1999. In his social life, he takes four to five beers as the main alcoholic beverage.

He is a retired salesman whose wife is deceased. His family comprises of four children who live and work in other states. He does not smoke and furthermore, no known allergies to the medication administered. From the physical examination results, he has no distress with the body temperature being 98.6 Fahrenheit. He has a high blood pressure of 164/96 while sitting and 152/88 while standing. The patient weighs 172 kilograms. HEENT analysis reveals that he has pale conjunctivae and gums. Cardiovascular analysis reveals systolic ejection murmur.

The prostate gland is enlarged due to palpation with neuronal analysis indicating that he has slow response rate to questions. Peripheral vascular analysis shows that the patient has pedal edema with capillary refill. He has tachycardia with laboratory analysis conducted showing that he is hyperglycemic (189mg/dL). The levels of alanine aminotransferase are low. Aspartate Aminotransferase levels are also low with high levels of cholesterol (267 mg/dL). He has high levels of Thyroid stimulating hormone recording at 12.3 mlU/L with poor levels of Hemoglobin (7.2 g/dL). Hematocrit analysis results are below par at 24 percent. Red Cell Distribution width is very high at 17 fL.

The recommended iron studies reveal very low levels of serum iron, ferritin and high Total Iron Binding Capacity (TIBC). TIBC is higher than the recommended levels when the iron levels in the body a low. Higher than the average levels of TIBC reveals that the patient is anemic (Rolfes, Pinna, Whitney, & Rolfes, 2012). From laboratory results given and the medical profile of G.M, it is clear that the patient is anemic. Lack of energy and fainting could be due to poor transportation of oxygen in the body resulting in hypoxia (Edmunds & Mayhew, 2013). Furthermore, D.M is diabetic as shown by high levels of blood glucose.

Patients with pedal edema are inappropriately diagnosed with heart failure. It is clear that D.M has hyperlipidemia which could contribute to deep vein thrombosis (DVT) a major cause of pedal edema (Edmunds & Mayhew, 2013). Systolic ejection murmur as diagnosed for D.M arises from obstruction of blood flow or in situations when the patients suffers from anemia, hyperthyroidism or pregnancy (Anderson & McLaren, 2012).

D.M is hypertensive due to the high levels of cholesterol deposited in the arteries along with calcium forming a plaque (Anderson & McLaren, 2012). He experiences the tachycardia which means that the blood has to beat fast to pump the blood. High levels of Thyroid Stimulating Hormone indicates that the patient suffers from hyperthyroidism (Edmunds & Mayhew, 2013). Cerebrovascular accident or stroke arises from thrombosis in the coronary artery supplying oxygenated blood to the brain. D.M suffered from the stroke several years ago an indication of elevated levels of cholesterol together with other factors (Edmunds & Mayhew, 2013).

The medical profile of D.M is complicated revealing multiple conditions affecting the patient. The patient has hypercholesterolemia and hyperlipidemia that can be explained from lifestyle choices. Furthermore, he is diabetic as shown by elevated blood sugar level. In addition, blood tests reveal that he has hypochromic and microcytic anemia. The medications taken by the patient have been used for the treatment of the conditions (Edmunds & Mayhew, 2013). Glyburide is a drug taken orally for controlling blood sugar levels. Metformin is an anti-diabetic drug which unlike the sulfonylurea class of drugs such as glyburide does not increase the insulin levels in the blood. Paravachol (paravastatin) belong to statin class of drugs used in the treatment of elevated levels of lipids in the body (Rolfes, Pinna, Whitney, & Rolfes, 2012). D.M is suffering from hyperlipidemia or hypercholesterolemia. It has inhibitory effects on HMG CoA reductase, the rate controlling enzyme in the pathway leading to the generation of cholesterol.

Hydrochlorothiazide (HCTZ) acts as a thiazide diuretic used in the treatment of fluid retention. This medication finds great relevance in the case of D.M, who is both hypertensive and suffers from edema (Rolfes, Pinna, Whitney, & Rolfes, 2012). Atenolol is a beta-adrenergic blocker which has its effects on adrenaline and epinephrine. Beta-adrenergic stimulation increases heartbeat. By blocking this stimulatory pathway, the drug helps in the treatment of tachycardia thus lowering the high blood pressure.

Angina pectoris arises when the oxygen demands of the heart exceeds the supply. By lowering the rapid heart rates, the drug helps in treating chest pain. Naproxen belongs to the NSAIDS class of drugs and work by reducing the levels of prostaglandin in the blood through inhibitory effects on cyclooxygenase (Edmunds & Mayhew, 2013). D.M suffers from osteoarthritis of the lumbosacral spine and the hip the reason explaining for administration of this drug. Aspirin another NSAIDS is a pain reliever that has been administered to treat arthritis in the case of D.M.

Follow up Plan

Despite the worsening medical condition of D.M, he takes four to five beers on a daily basis. Reducing the severity of the conditions faced by the D.M would necessitate abhorring the intake of alcoholic drinks taken by D.M or even complete cessation (Edmunds & Mayhew, 2013). Studies reveal that drinking of alcohol remains to be a risk factor contributing to increased levels of cholesterol and lipids in the body. Preventing the progression of the various states experienced by D.M would require use of two approaches i.e. lifestyle modification and dietary management (Rolfes, Pinna, Whitney, & Rolfes, 2012).

Lifestyle modification

• Avoid drinking of alcohol a risk factor associated with hypercholesterolemia and cardiovascular heart disease.
• Get involved in a regular physical activity and exercise program; the rationale in this program is to increase energy expenditure and thus lower the blood sugar levels and by extension help in management of weight.

Dietary Management

• D.M should limit the use of food that is high in fat and cholesterol.
• Due to the problem of osteoarthritis, he should avoid consumption of organ meat that is high in purine and pyrimidine, red meat and dairy products rich in saturated animal fat.
• He should limit heavy intake of processed food that has high levels of salt.
• In the diet plan, he should include intake of grains, pulses, legumes, fruits, vegetables, and low-fat milk.
• The diet should be balanced and in right proportions per meal. He should eat less before going to sleep.
• To bring back the iron levels to normal he should eat food that is rich in iron. This will help in controlling anemia through dietary management. Such food includes kidney beans, lentils, fresh spinach, oatmeal, white meat such as turkey meat.

Medical management

Medical management will help in supplementing the dietary choices and lifestyle modification.
• The patient should continue using the medications as already indicated with alterations necessary in case of adverse reactions.
• In addition, the patient needs to take iron supplements to replace the low levels of iron in the blood.
• D.M should constantly monitor his health status through lipid profile and measurement of blood sugar levels among other parameters such as Blood Pressure.

References
Anderson, G. J., & McLaren, G. D. (2012). Iron physiology and pathophysiology in humans. New York: Humana Press.
Edmunds, M. W., & Mayhew, M. S. (2013). Pharmacology for the primary care provider. St. Louis, Mo: Elsevier-Mosby.
Rolfes, S. R., Pinna, K., Whitney, E. N., & Rolfes, S. R. (2012). Normal and clinical nutrition. Pacific Grove, Calif: Brooks/Cole.