PH is 58 year-old male patient presents to the ER complaining about right hand spasticity and numbness of the right upper extremity and right side of the face.  Patient denies trouble swallowing.  Patient is able to talk.  He denies any weakness, numbness or tingling.  He denies trouble walking, reports mild headache off and on.

He lives with wife who loves to cook.  Patient used to be on insulin, however due to lowering his A1C in January, 2022 by 5 points, the PCP took him off of SQ insulin.  Patient has not seen any doctors since then and has not been compliant with medications and diet.  He says he feels well.

Patient seems to think that he may have had high blood pressure in the past.  Doctor prescribed antihypertensive meds however patient was laid off and he lost his medical insurance.  At times he was taking some of his wife’s medications, he thinks they were oblong shaped, green and yellow capsules.

Blood sugars ranging from 220s-350s.  Na remains 129, A1C-17.8.  Patient remains SR, RA, No acute event overnight.

Examination:

General: AOX3, pleasant, cooperative

Neuro: diminished sensation in RUE, R face.

HENT: Normocephalic and atraumatic.  No facial droop, no aphasia

Neck: No JVD

Pulmonary: On room air, Clear to auscultation bilaterally

Cardio: S1S2 heard, no murmurs

GI: soft, non-tender, non-distended, bowel sounds present

GU: voids spontaneously, no burning when urinating

Extremities: no edema, pulses intact

Musculoskeletal: normal muscle mass for age

Psych: pleasant, cooperative.  Anxious to go home to watch Superbowl. Depressed at times.   Drinks 6 bottles of bear a day.  Smokes 1 pack per day.

BP 182/102

HR 68

Resp 20

Temp 97.8F oral

SpO2-98% – RA

Weight 248lb

Height 178cm

WBC 7.3

HgB 8.1

Hct 25.1

Plt 183

Na 129

K 4.9

Cl 92

CO2-26

BUN 21

Cre 1.99

Glu 458

Ca 9.4

AST 15

ALT 16

Albumin 3.7

LDL 125

Triglycerides 134

DVT prophylaxis Heparin

0730 Humalog SQ 0-12units tid

BG <149 – no insulin

BG 150-200 – 2 units

BG 201-250 – 4 units

BG 251-300 – 6 units

BG 301-350 – 8 units

BG 351-400 – 10 units

BG >401 – 12 units and call MD

0800 Humalog SQ 6units tid

0900 Losartan 25mg bid

0900 Heparin 5,000 units/ml SQ, 5,000 units – daily

What do you think happened to the patient?  What is supporting your theory?

What data from the present problem are RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT Data from Present Problem:               Clinical Significance:

1

2

3

4

5

What medication are missing from the list and why?  Please give me the rationale behind it.

Please describe the pharm class and mechanism of action in your own words for the following medications:

Pharm class                           Mechanism of Action

Humalog

Losartan

Amlodipine

Atorvastatin

Aspirin

Lexapro

You are the ER nurse receiving this patient and you need to call the MD to give a report and get orders.  Please give us a report, using SBAR.

What lab values are abnormal, and what is the significance?

Put it all together and think like a nurse!

What’s the problem?                        What is causing the problem?  (Explain the patho in own words)

What would be the medical management and rationale in this case?

Which specific nursing assessments for this body system are most important?

Priority Nursing Assessment:          Rationale:

What is the current nursing priority and plan of care?

Nursing Priority Interventions:       Rationale:                   Expected outcome:

Case Manager is working on making arrangements for this patient for discharge.  What discharge needs do you think CM needs to focus on?

You, as a primary RN need to provide teaching to this patient (and family).  What teaching would you provide?  What would you teach?  How would you teach?

The patient spends approx 3 days in the hospital.  Who do you think will be providing care to this patient during this time and how do they contribute to the care?