85-year-old female presents with confusion and weakness. Per the patient’s family she has “not been acting right” for the last several days, occasionally saying things that “do not make sense”. Today, initially when visiting, the family could not find their mother and then finally found her wondering around in her basement. They found groceries sitting out on the counter. When questioned what she was doing, the patient was confused and did not know where she was. When obtaining the patient’s initial health history, she is unable to recall her PMH and is confused why she is being asked so many questions. Patient oriented to self only and easily distracted during conversation and interactions with others. The patient’s daughter is at her bedside. Per the daughter, she has noticed her mom lately becoming easily fatigued when performing simple house hold tasks and sleeping more. The daughter is able to provide a list of her mothers’ PMH and current medication list. It is uncertain whether or not the patient has been taking her medications routinely or as ordered. The patient’s skin is cool to touch.
Past Medical History:
Hypertension
Osteoarthritis
Coronary Artery Disease
COPD
Diabetes
Overactive Bladder
Urinary Incontinence
Depression
Medication List
Aspirin 81mg Daily PO
Lisinopril 10mg Daily PO
Metoprolol 25mg ER Daily PO
Metformin 500mg bid PO
Tolterodine 2mg bid PO
Celecoxib 200mg Daily PO
Citalopram 20mg Daily PO
Atorvastatin 10mg Daily PO
Upon admission labs and a urine specimen were obtained. UA results are still pending. When sending the UA, you note the urine is concentrated, dark amber and cloudy. Patient only voiding 100ml at this time. Patient states “feeling dizzy” when walking back from the bathroom. You note the patient becomes easily fatigued with dyspnea on exertion when helping the patient back into bed.
Some of the patient’s lab results were as followed:
WBC 14
RBC 5.0
Hemoglobin 12
Hematocrit 49
Glucose 70
Sodium 150
Chloride 110
Potassium 3.8
BUN 30
Creatinine 1.1
Calcium 9.0
Vitals on Admission
BP: 100/50
Pulse: 112
RR: 24
SPO2: 92% on Room Air
Temp: 99.8
Pain: 6/10 pain in lower back and legs
Based on previous patient information answer the following questions.
- After reviewing the previous clinical scenario, the patient’s past medical history, the patient’s presenting labs and vital signs, identify significant data which require immediate follow-up. (Identify at least 5 and explain the significance of each for this patient)
- Upon recognizing these cues, what is your patient at risk for and why? (Provide supporting detail and evidence to back your response. Provide at least 3-5 sentences.)
- For each finding what nursing interventions are necessary for the appropriate care of the patient?
| Nursing Interventions |
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- For each finding what would you need to assess to know if the outcome is effective?
- What would you need to assess to know if the patient is improving or declining?
- Review the patient’s medications and complete the chart below
| Patient’s Medication | Indication for Medication Use | Priority Nursing Considerations | Education to Reinforce with your patient |
| Aspirin |
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| Lisinopril |
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| Metoprolol |
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| Metformin |
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| Tolterodine |
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| Celecoxib |
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| Citalopram |
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| Atorvastatin |
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- Review the following lab results and complete the table below.
| Lab | Normal or Abnormal? |
What may an abnormal result mean? What may cause an abnormal result?
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| WBC 14 |
1.
2.
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| Hemoglobin 12 |
1.
2.
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| Hematocrit 49 |
1.
2.
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| Platelets 300 |
1.
2. |
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| Sodium 150 |
1.
2.
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| Potassium 3.8 |
1.
2.
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| BUN 30 |
1.
2.
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| Creatinine 1.1 |
1.
2.
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- Review the following past medical history and complete the table below
| Past medical history | Priority nursing assessment |
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Hypertension
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COPD
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Diabetes
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Depression
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- You are preparing to speak with the provider regarding the priority findings. What orders to you anticipate?
