NU371 HESI Case Study: Suicide, A Sentinel Event

NU371 HESI Case Study: Suicide, A Sentinel Event Client Overview The client has a 45-year history of smoking a pack of cigarettes daily. He reports having a productive cough, hoarseness, and difficulty breathing, which he attributes to his age. He states that he wakes up three to four times each night due to coughing and breathing issues. The client also mentions weight loss but thinks it is due to a decreased appetite. He expresses feeling unusually fatigued lately, at times lacking the energy to move from the bedroom to the kitchen. To compensate, he drinks nutritional shakes for meals because they are convenient and palatable. The client has a medical history of insulin dependent type II diabetes mellitus and is particularly concerned about his inability to concentrate, describing it as "brain fog." Assessment Questions As the nurse documents the client's assessment, which activities related to the client’s type II diabetes should be questioned? (Select all that apply. One, some, or all options may be correct.) - a) Frequency of blood glucose monitoring. - b) Daily intake of Ensure nutritional shakes. - c) Reasons for the client’s lack of appetite. - d) Daily fluid intake, including water. - e) The last recorded blood glucose result. Correct answers: - a) Frequency of blood glucose monitoring. - b) Daily intake of Ensure nutritional shakes. - c) Reasons for the client’s lack of appetite. - d) Daily fluid intake, including water. Emotional Well-Being The client shares feelings of sadness since his wife passed away a year ago and states that his children live far away and visit infrequently. The nurse recognizes that the greatest risk factor for major depression is: - a) Retiring from the military. - b) Coming to terms with aging. - c) Inability to regularly attend church. - d) Recent widowhood within the past year. Correct answer: - d) Recent widowhood within the past year. The combination of grief, loneliness, and hopelessness can lead to social withdrawal, placing older adults at a higher risk for major depression. Physical Assessment Findings On assessment, the client is alert and oriented to time and place but appears pale and thin, with shallow breathing. He shows nasal flaring, mild intercostal retractions, and has a productive cough. He adopts a tripod position and upon auscultation, wheezing is noted on the right side while breath sounds are diminished on the left. His heart rate is slightly elevated. Visual inspection reveals a barrel chest, mild finger clubbing, and cyanosis in the nail beds. The client’s skin is warm and dry, exhibiting decreased turgor, and he has a stage II decubitus ulcer in the sacral area, scoring 14 on the Braden scale. There is mild swelling in the feet, and the client reports limited mobility due to weakness. He has no known allergies to medication or food and does not report any pain. Additionally, he does not have advance directives. Vital Signs - Temperature: 101.5°F (38.6°C) - Heart Rate: 110 beats/min - Respiratory Rate: 20 breaths/min - Blood Pressure: 150/90 mmHg - Blood Glucose: 200 mg/dL - Oxygen Saturation: 88% on room air Medications - Albuterol and ipratropium bromide (metered-dose inhalers) - Diltiazem - Furosemide - Aspirin 81 mg - Metformin - Regular insulin (sliding scale) - Enoxaparin sodium Prescriptions The nurse adheres to the healthcare provider's (HCP) prescription for managing the exacerbation of chronic obstructive pulmonary disease (COPD): - Obtain arterial blood gas (ABG), CBC with differential, chemistry panel (Chem 7), blood cultures, and urinalysis (UA). - Perform PA and lateral chest x-ray. - Consult PT/OT for wound care. - Initiate sequential compression device (SCD). - Establish intravenous access with a saline lock. The HCP prescribes 1000 mL of dextrose 5% with normal saline 0.9% and 20 mEq/L of potassium chloride (KCl) to infuse at a rate of 100 mL/hr. Which component of this infusion should the nurse question? - a) Normal saline (NS) and potassium chloride (KCl). - b) Normal saline (NS). - c) Dextrose (D5). - d) Potassium chloride (KCl). Correct answer: - c) Dextrose (D5). Dextrose-containing solutions are not recommended for clients with diabetes as they can elevate insulin levels and decrease blood potassium levels. It’s critical for the nurse to clarify any prescribing uncertainties with the HCP. Infusion Calculation The HCP prescribes 1000 mL of normal saline (0.45%) with 20 mEq/L of potassium chloride (KCl) at a rate of 125 mL/hr. How many hours will the infusion take to complete? (Enter numeric value only. If rounding is needed, round to the nearest whole number.) Calculation: 1 hr/125 mL × 1000 mL = 1000/125 = 8 hours. Initial Intervention for Fever The client is exhibiting a fever with a temperature of 101.5°F (38.6°C). What should be the first intervention the nurse implements? - a) Contact the lab for blood cultures to be drawn. - b) Administer acetaminophen according to hospital protocol. - c) Contact the HCP for an antibiotic prescription. - d) Retake the temperature using a tympanic thermometer. Correct answer: - a) Contact the lab for blood cultures to be drawn. Blood cultures must be obtained prior to administering acetaminophen or starting antibiotic therapy, as antibiotics can interfere with the growth of organisms in the lab. IV Medication Administration Calculation The HCP prescribes clindamycin 900 mg in 100 mL to be infused over 30 minutes. With an IV tubing drop factor of 15 gtt/mL, what should the nurse set the IV to deliver in drops per minute? (Enter numeric value only. If rounding is needed, round to the nearest whole number.) Calculation: 100 mL/30 min = 3.33 mL/min 3.33 mL/min × 15 gtt/mL = 50 gtt/min. Pre-Procedure for ABG Drawing Before drawing arterial blood gases, which interventions are essential? (Select all that apply. One, some, or all options may be correct.)