M. J. is a 76-year-old woman who lives on the side of a very steep mountain. The home health nurse has visited her once a week for the last year. She has running water, electricity, and a coal stove with back-up oil heat for very cold winter nights. She uses the telephone for communication. She has diabetes mellitus, hypertension, hypothyroidism, and is in atrial fibrillation. She has never been in the hospital before.
Her current medications include metformin (250 mg twice a day), losartan (50 mg/day), levothyroxine sodium (Synthroid) (50 mcg/day), digoxin (0.125 mg/day), furosemide (Lasix) (10 mg/day), aspirin (81 mg/day), simvastatin (20 mg/day), and warfarin (Coumadin) (4 mg/day, with 6 mg on Sundays). Allergies are to penicillin (hives) and to metoprolol (hypotension and dizziness). M. J. stopped smoking 5 years ago, but until then she smoked one-half pack a day.
Last laboratory test results (1 week ago) were: hemoglobin A1C (Hgb A1C) 8.3, international normalized ratio (INR) 1.7, sodium 129, potassium 5.8, chloride 102, CO2 20, blood urea nitrogen (BUN) 45, creatinine 1.5, glucose 289, white blood cell (WBC) count 6.8, Hgb 10.1, hematocrit 30.2, platelets 215,000.
The home health nurse calls you from the patient’s house, where she notes that the patient had a 5-minute spell of visual loss in her right eye. It has not recurred. During this period, M. J. noted that her left hand and left leg felt “funny,” and her left foot and leg were so weak that she could not walk.
M. J. has a heart murmur, described by the home health nurse as loudest over the right sternal border and more prominent in the systolic phase. Furthermore, the home health nurse tells you that she hears bruits on both sides of the neck, with the right being louder than the left. The blood pressure in the right arm is 135/72 mm Hg and 110/66 mm Hg in the left arm. Heart rate is irregular at 75 to 90 beats per minute. The left hand and fingers have always been cooler than the right. Lungs are remarkable for wheezes. The patient has no fever. Oxygen saturations at room temperature are 90% to 92%, which has been her baseline.
1. What concerns do you have regarding M. J. at this point?
2. Do you need to see M. J. fairly soon, or can she come to see you at her regularly scheduled appointment in 3 weeks?
3. If you were to see M. J. in the next 24 hours, what additional tests would you perform?
4. Based on the laboratory results given, what changes would you make in her medication profile?
5. Which arm will you use for blood pressure recordings in the future?
6. What systolic blood pressure range would you order for M. J., as a general target?
7. If M. J. has a repeat episode of right eye blindness, lasting 30 minutes this time, what would you do? Get Nursing Help Today
At Myrestlab.com, we always work diligently to provide our customers with high-quality nursing assignment help services. We ensure that all papers by our writers possess 100% originality. We also guarantee all students of 100% privacy and confidentiality when working with us.
At Myrestlab.com, our mission is to provide quality services to all students. We, therefore, guarantee money-backs for the rare occasions of satisfaction. Your satisfaction is our goal.Read more
All our nursing assignment help services are 100% original. Each of our professional writers develops custom papers from scratch to reduce the chances of plagiarism. In addition to this, we always run completed papers through advanced anti-plagiarism checkers for 100% originality.Read more
Our free revision guarantee is a courtesy service by Myrestlab.com to ensure that we achieve 100% customer satisfaction rates. In case you feel unsatisfied with the outcome of your paper, you can always request for free unlimited revisions. We recommend a revision request within 14 days after the delivery date for short papers and 30 for dissertations.Read more
Myrestlab.com also guarantee 100 privacy and confidentiality. We do not share any of our customers’ personal details with third parties. We have also fitted our websites with security features to ensure secure connections. Our security features also prevent damages that might occur through attacks by outsiders.Read more
By ordering a paper through My Rest Lab, you agree to receive nursing assignment help services offered by our nursing assignment writers. Our assignment help experts will always endear to provide quality services as promised. We always expect maximum cooperation from our students to help us achieve our mission and vision.Read more