Reference no: EM133297052

Case: Ms. Debbie Anderson is at your facility today. She is 65 years old and is brought in by the rescue squad for confusion and disorientation that has been ongoing for the past 5 days. Her appetite has decreased and she has become more irritable. She had fallen yesterday and dislocated her right hip. The report from the nursing home shows that she has lost 2kg in the last week and her daily bp averages 140s-170s. When you examine her, she complains of being very thirsty although the nursing notes show that she is drinking at least 1.5L a day. She also admits to bone pain that has worsened over the last month and a "gritty feeling in my eyes that feels like sand". You also notice that she is very irritable. Her past medical history : 1. Congestive heart failure, diastolic 2. Hypertension 3. Anemia 4. History of CVA 5. Hyperlipidemia On arrival to your facility, her temp is 100F, bp171/79, pulse 89, resp 21, her pulse ox showed 93% and she is on room air with normal work of breathing. She has an indwelling foley catheter has a foul smell and is small amounts of white discharge at her vaginal orifice. The catheter has 300ml urine output in the last 24hrs. She weights 65kg. Renal ultrasound shows 2 masses in the left and right kidney that was not present before and chest xray was unremarkable. Her labs on arrival are these WBC 16k HGB 12.9 MCH 95 MCV 30.4 RDW 14.6 % Platelet 146 Electrolytes Potassium 2.8meq Sodium 134meq Calcium 16mq. BUN 44 PTH 350 Cholesterol 195 HDL 30mg/dl LDL 120mg/dl Creatinine 4.2mg (baseline 1.6mg/dl ) A1C 5.5% After several hours her urine studies come and they show cloudy urine color with 2+ protein, positive for urine nitrites, blood and leukocyte esterase. Her corona virus labs are pending and free kappa light chains and free lambda light chains and ratio are all elevated. Her records indicate that her son is a lawyer and has traveled out of town however he is involved in her care. Your physical exam shows pressure ulcers at the heel(that you determined to be stage 2) and purple localized area and discolored yet intact skin on her buttocks. The rest of your physical exam shows: Constitutional No Acute Distress, Alert and anorexic, alert but disoriented and irritable Conjunctiva- Normal Neck Supple, Non-Tender, No Lymphadenopathy Dialysis Access no dialysis access ENT Moist Mucosa, Trachea Midline, macroglossia Respiratory Bilat. Clear to Ausculate Cardiovascular -Normal rate, Regular rhythm, ()S1 - ()S2, No pedal edema, No JVD Gastrointestinal Normal BS all Four Quads, Soft, Tender, Non-Distended, flank pain Musculoskeletal NL Strength & Symmetrical, limited ROM, Normal Pulses Skin Normal Color, Warm/Dry, No Cyanosis, No Lesion

Question 1. What disease you suspect this patient to have? Why? Explain with rationales from the case.

Question 2. What are the diagnostic test for your disease you have chosen?

Question 3. Name 4 nursing interventions and education for the patient?

Question 4. What medications (specific) are going to be used for this patient ? What are the nursing teaching for those medications?

Question 5. Does the patient have a good prognosis? Why or why not?

Question 6. Describe stage 2 pressure ulcer? How is it managed and what your nursing intervention for preventing other ulcers in this patient?