Reference no: EM133564330
A 75 year old female admitted to Kaiser San Diego with history of T-cell lymphocytic leukemia, rheumatoid arthritis on chronic, low-dose, prednisone, hypothyroidism, hypertension, type two diabetes mellitus, diabetic, chronic kidney disease stage, four with baseline, creatinine 2.1 to 2.3, proximal atrial fibrillation, atherosclerosis, diabetic peripheral neuropathy, history of lesser to amputation of the right, aortic stenosis, and diabetic dyslipidemia who presents with acute left hand, numbness and weakness associated with lightheadedness. The onset of symptoms occurred at 11 a.m. The patient noticed her hand numbness and weakness when she attempted to grab a GR and could not. Upon admission to the ER, the patient's symptoms resolved. Presentation is concerning for TIA. Emergency department evaluation revealed a negative head CT and mildly elevated high-sensitivity troponin without chest pain symptoms or acute EKG alterations. The emergency department physician discussed the case with neurology and recommended a stroke workup.
The patient reports living alone and having trouble getting to her appointments. She is aware that she has a heart monitor at home to determine the frequency of atrial fibrillation, but she has not yet figured out how to use it. She notes that she has had discussions with her primary care physician and cardiology regarding anticoagulation in atrial fibrillation to prevent acute stroke. Still, she has declined full anticoagulation due to a worry of bruising and bleeding. She is unsure whether she has atrial fibrillation episodes, so she wanted a heart monitor.
Principal discharge diagnosis with brief review:
A 75-year-old female was admitted on 8/31/2023 with TRANSIENT CEREBRAL ISCHEMIA. Given her history of Afib, the patient started on the anticoagulant Eliquis upon admission. She was evaluated by physical therapy/occupational therapy and did reasonably well, but she was recommended to be discharged to SNF rehabilitation. The patient was cooperative.
PMH:
RHEUMATOID ARTHRITIS
DM 2 PERIPHERAL NEUROPATHY
ESSENTIAL HYPERTENSION
DM 2 W CKD STAGE 3 (GFR 30-59), UNSPECIFIED
DM 2 W PERIPHERAL VASCULAR DISEASE
OSTEOPENIA
ATRIAL FIBRILLATION, PAROXYSMAL
DEPRESSION, MAJOR, RECURRENT. IN COMPLETE REMISSION
DM 2 W DYSLIPIDEMIA
ATHEROSCLEROSIS AORTA
AORTIC VALVE STENOSIS
MITRAL VALVE DISORDER
HYPOTHYROIDISM
HX OF DIABETIC FOOT ULCER
DM 2
LONG TERM METHOTREXATE THERAPY
LONG TERM SYSTEMIC STEROID THERAPY
HX OF MRSA
ALLERGIC RHINITIS
NONTOXIC UNINODULAR THYROID GOITER
PAST SURGICAL HISTORY:
AMPUTATION OF TOE
INCISION AND DRAINAGE WOUND FOOT
AMPUTATION, COMPLETE OR PARTIAL, FIRST RAY
AMPUTATION, COMPLETE OR PARTIAL, FIRST RAY
The patient is currently in skilled nursing rehab, mostly for PT/OT
She lives by herself. The goal is for her to manage herself, especially with ADLs. She has RA
She cannot fully extend her fingers. She is on insulin therapy, regular 30 units aside from sliding scale. Her BP is consistently high, ranging from 165/88 to 190/98, especially before medication. She has hypertension and other comorbidities.
QUESTIONS:
1)What is the primary nursing priority (answer should identify only 1 priority)? Provide the rationale for your priority.
2) What disciplines would you collaborate with to improve or stabilize the client's current condition? What disciplines would you collaborate with to prepare the client for discharge? Include the rationale regarding why these disciplines would be helpful for your client.
3) What are 2 complications of hypertension that does not include death that the patient could develop and how you as a nurse could prevent it? (what interventions would you initiate)