CARDIAC CASE STUDY NGN WITH QUESTIONS AND WELL VERIFIED ANSWERS [GRADED A+] ACTUAL EXAM 100%

CARDIAC CASE STUDY NGN WITH QUESTIONS AND WELL VERIFIED ANSWERS [GRADED A+] ACTUAL EXAM 100% A 49-year-old client is seen in clinic for a follow-up visit since starting enalapril for primary hypertension at her last visit 1 month ago. She reports nausea and diarrhea for the past few weeks and is not sure what is causing these symptoms because she has implemented various lifestyle changes. She has a medical history significant for dyslipidemia, which is treated with simvastatin, and type 2 diabetes mellitus, which is managed with insulin. Since her last visit, she has increased exercise, uses potassium supplements instead of sodium when cooking, and has eliminated alcohol. Vital signs are temperature of 98.6°F (37°C), heart rate of 80 beats per minute, respiratory rate of 20 breaths per minute, blood pressure of 126/78, and pulse oximetry reading of 97%. - ANS---Laboratory Value Today's Result Result From 1 Month Ago Reference Range Alanine aminotransferase (ALT) 17 U/L 19 U/L 4 to 36 U/L Aspartate aminotransferase (AST) 20 U/L 21 U/L 0 to 35 U/L Serum creatinine (Scr) 0.9 mg/dL 1.0 mg/dL 0.5 to 1.1 mg/dL Potassium 5.2 mEq/L 4.9 mEq/L 3.5 to 5.0 mEq/L The patient developed HYPERKALEMIA - ANS---As evidence by change in POTASSIUM Rationale - ANS---Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril, may cause hyperkalemia or elevated potassium levels secondary to suppression of aldosterone release. This client has developed hyperkalemia, as noted by the increase in the client's potassium level (i.e., from 4.9 mEq/L to 5.2 mEq/L), which is now above the upper limit of normal (i.e., 5.0 mEq/L). Additionally, the client has reported nausea and diarrhea, symptoms suggestive of hyperkalemia, within the time frame of initiating enalapril and lifestyle changes. Notably, the client reports using potassium supplements instead of sodium for cooking as a means of reducing her sodium intake. Clients who are started on ACE inhibitors should be advised to avoid salt substitutes that contain potassium in order to reduce the risk for hyperkalemia. In addition to her current symptoms, hyperkalemia may cause cardiovascular effects, such as abnormal heart rhythms, which can potentially be fatal. The client does not have evidence of liver dysfunction because her AST and ALT values are within normal limits. The client also does not have evidence of renal impairment. Her serum creatinine remains within the normal range. The client does not have uncontrolled hypertension because her blood pressure reading is not elevated according to the various evidence-based blood pressure goals. Patient 2 Glucose Today: 89 mg/dL Last: 84 mg/dL GOAL: 74 to 106 mg/dL Serum creatinine (Scr) 1.0 mg/dL 1.1 mg/dL 0.5 to 1.1 mg/dL Potassium 4.4 mEq/L 4.2 mEq/L 3.5 to 5.0 mEq/L - ANS---A client returns for a follow-up visit after the initiation of metoprolol tartrate 25 mg PO BID at his last visit 4 weeks ago. The client reports some sleep disturbances but denies any other symptoms. He has brought his home blood pressure and heart rate readings from this last week. Current vital signs are temperature of 97.6°F (36.4°C), heart rate of 56 beats p