HESI Review Case Studies NGN style complete solutions

HESI Review Case Studies NGN style complete solutions A 66-year-old female presents to the emergency department with fever and a cough productive of green, thick sputum for the past 3 days. She reports that she has been very fatigued and losing weight lately. When further questioned, she adds that she has had palpitations and dizziness. Physical assessment findings include tachycardia, tachypnea, and crackles detected on the right side. Medical history: Hypertension, arthritis Surgical history: Knee surgery at age 52 Medications: Ibuprofen, Hydrochlorothiazide Allergies: No known drug allergies Family history: Paternal heart disease Social history: Negative for tobacco, alcohol, or illicit drug use Vital signs: BP 142/92, HR 126, RR 28, pO2 96% on room air, temp 101.5°F (38.6°C). A 64-year-old female client admitted to the medical surgical unit for further management. Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two relevant cues and two examples of supporting objective data that would be recognized. Potential Condition: Hyperthyoidism Relevant Cue: Palpitations, Weight Loss Supporting Objective Data: Heart rate 126, TSH 0.1 μU/mL Rationale: Potential condition-This client’s symptoms are indicative of hyperthyroidism. Hyperthyroidism is an endocrine disorder characterized by an excessive amount of thyroxine in the body. It can be primary or secondary and is often accompanied by fatigue, palpitations, tachycardia, heat intolerance, sweating, weight loss, anxiety, nervousness, irritability, tremor, diarrhea, brittle skin, and thinning of hair. Heat intolerance, tremor, and nervousness do not occur as often in the older adult. This client has a normal blood sugar and no other symptoms that would indicate diabetes. There is no evidence to suggest thyroid cancer in this client. Hypothyroidism is commonly associated with fatigue, weakness, depression, dry skin, and constipation. Relevant cue-This client has both weight loss and palpitations, which are manifestations of hyperthyroidism. This client’s fever and cough are likely as a result of a respiratory infection, not hyperthyroidism. Although she reports dizziness, it is unrelated to hyperthyroidism. Supporting objective data–This client has both tachycardia and a decreased TSH consistent with hyperthyroidism. The client’s elevated blood pressure can be accounted for by her history of hypertension. The increased respiratory rate and leukocytosis are probably linked to a respiratory infection. Monday 0830 (admission to emergency department [ED]) A 66-year-old male type 2 diabetic client who has been experiencing a productive cough for the last 5 days was found to be barely arousable by spouse upon waking this morning. The spouse reports he has had fever and weight loss. The client has eyes closed but is answering questions. He reports feeling unwell and has a headache and blurred vision. Vital signs: HR: 116 bpm B/P : 150/92 mm Hg RR: 28 bpm spo2: 94% on room air T: 39°C (102.2°F) HEENT: Mucus membranes pink, dry, and cracked. Fruity odor from breath. Cardiac: Tachycardic; Respiratory: Tachypnea. Crackles detected in right lower lobe with associated dullness to percussion. Neurologic: Client is lethargic. Moving limbs spontaneously. Medical History: Diabetes, hypertension Medications: Metformin 500 mg po bid, lisinopril 5 mg po daily The nurse is reviewing the client’s history and laboratory results to develop a plan of care. Select the 4 client assessment parameters that require immediate nursing follow-up. Chest x-ray findings Creatinine Potassium level Glucose level The four client assessment parameters that require immediate follow up by the nurse include the potassium level, glucose level, chest x-ray findings, and creatinine. The potassium level indicates hyperkalemia, this can have effects on the cardiovascular system and requires management. This client’s glucose level is high, and he may be experiencing diabetic ketoacidosis, this is a serious condition that can lead to death if not treated. The chest x-ray findings suggest a pneumonia that should be treated and may be the cause of his uncontrolled diabetes. Elevated creatinine is evidence of kidney injury. While the client’s heart rate is fast, his heart rhythm is normal sinus. The increased heart rate is associated with the infection. The client’s hemoglobin levels, oxygen saturation, and chloride levels are normal. These do not require immediate nursing follow-up. The nurse is reviewing the client’s history and laboratory results to develop a plan of care. Click to highlight the laboratory results in the table consistent with a renal problem. Creatine The nurse continues to care for the client in the ED while awaiting a bed on a medically monitored floor. The client remains lethargic. An intravenous line is started in the right forearm, and normal saline is infusing at 125 mL/h. Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. The nurse determines that the client is most likely experiencing Acute renal failure as a result of Dehydration In addition, the client most likely has Pneumonia which relates to his report of Cough Rationale: The nurse determines that the client is most likely experiencing acute renal failure as a result of dehydration. Anemia would cause a decreased hemoglobin level; this client has a normal hemoglobin level. Leukocytosis, not leukopenia, would be caused by an infection. The client is currently hyperglycemic. This client is not hypotensive. The client most likely has pneumonia, which relates to his reported cough. The client does not have signs of anxiety or GERD. There is no indication that the client has cataracts. The client’s headache and blurred vision may be as a result of his hyperglycemia. Weight loss may be due to dehydration.