Case Study Oral and Parenteral Medication Administration, Skills & Reasoning, Jerry Williams, 62 years old, (Latest 2021) Correct Study Guide, Download to Score A

History of Present Problem: Jerry Williams is a 62-year old obese (BMI 35.2) Caucasian male with a history of diastolic heart failure and type II diabetes. Last evening, he began having difficulty breathing with activity. He thought he might be getting a cold because he had a runny nose. He reports more swelling in his lower legs the past couple days. He woke up this morning with increased difficulty breathing when he woke up and his wife called 911. Paramedics report that his initial VS: HR:92 RR: 28 BP: 172/88 O2 sat: 80% on room air with scattered expiratory wheezing bilat. He was placed on oxygen by facemask and albuterol nebulizer administered with some improvement in his breathing. His RR is now 24 upon arrival to the emergency department ED). His initial labs have resulted; creatinine of 2.5 (last adm. 1.8), K+ 3.5 (last adm. 3.7) and BNP 944 (last adm. 322). Jerry is given furosemide 40 mg IV in the ED and had 800 mL urine output in the last hour. He is admitted to cardiac telemetry, and you are the nurse responsible for his care. What data from the present problem do you NOTICE as RELEVANT and why is it clinically significant? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT Data: Clinical Significance: What is the RELATIONSHIP of his past medical history and current medications? Why is your patient receiving these medications? (Which medication treats which condition? Draw lines to connect) Past Medical History (PMH): Home Medications: Hyperlipidemia Hypothyroidism Type II diabetes Diastolic heart failure Chronic kidney disease stage III Furosemide 20 mg PO every morning Atorvastatin 40 mg PO at bedtime Metoprolol 50 mg PO BID Levothyroxine 112 mcg PO daily Exenatide microspheres 2 mg subq. weekly Nursing Assessment Begins: Current VS: Most Recent in ED: P-Q-R-S-T Pain Assessment: T: 98.2 F/36.8 C (oral) T: 98.8 F/37.1 C (oral) Provoking/Palliative: P: 88 (reg) P: 92 (reg) Quality: Denies R: 24 (reg) R: 24 (reg) Region/Radiation: BP: 142/76 BP: 148/80 Severity: O2 sat: 93% 4 liters n/c O2 sat: 94% 4 liters n/c Timing: 1. obese, type II diabetes, Diastolic heart failure ness of breath with activity/ increased difficulty breathing when he woke up swelling in his lower legs 4. High RR and BP and low O2 sat 5. high creatine and BNP labs 1. shows that patient was not in the best health before these problems began that there is something going on with his gas exchange 3. could be a problem with purfusion, possible DVT 4. proves that hes is having difficulty breathing and his heart is trying to pick up the slack 5. increase risk for kidney and heart failure