Nursing Case Studies

I was well versed with the patient’s medical history and current treatment, as I was the Long Call IM PGY – II Resident who supervised the medical intern when this patient was being downgraded from the ICU to the medical floor on 5/20/17 (and even suggested to the medical intern to add in her notes that the patient would benefit from statins, ACE inhibition and Spironolactone given CAD, CVA and HFrEF (LVEF < 35%.) The medical team subsequently started the patient on Atorvastatin 40 MG PO QHS, Lisinopril 10 MG PO QD and Spironolactone 12.5 MG PO QD.

BH reports that he takes his medications as prescribed and reports he has tried to adjust his diet in order to decrease his glucose, triglycerides, and cholesterol. He continues to consume

The patient is a 75-year-old female who did see a new pulmonologist (Daniel Kim, DO) as Elvira Aguila, MD left this area. She did have a CT scan done of her lungs. She was told to hold her metformin and had blood work done because of IV contrast. Her creatinine did go up to a high of 1.5, but then on repeat came back to 1.37 with a BUN of 14. I did have her decrease her dose of metformin from 1000 mg b.i.d. to 500 mg b.i.d. She did have a BUN and creatinine done in December of 2014, which showed creatinine of 1.46, BUN of 35. Repeat in March of 2015 showed creatinine of 1.1 with a BUN of 49. The patient has also been found to have proteinuria with a urine microalbuminuria/creatinine

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

The very first and easily the most important problem for this patient are the medications. Both the Lasix and Lanoxin have been doubled as these are new medications written by the hospital physician and he

Patient lives with his wife in a suburban area and has great support system through his friend and family.

The doctor would then focus on decreasing the progression of the chronic renal failure. He would be

Glaucoma is a common and important health problem. It is one of the leading causes of blindness in Western Society (Hoskins & Kass, 1989). It is responsible for ten percent of all blindness in the United States and continues to be the second or third most common cause of blindness in the world (Bunce, Fraser, & Wormald, 1999). It is estimated that two million people in the United States have been diagnosed as having glaucoma. Glaucoma is known to affect about two percent of Caucasians beginning at the age of 40 with an increasing risk for those over the age of 60. This risk is especially high if a member of the family has glaucoma or diabetes. Further, there is a higher risk of a glaucoma diagnosis for African Americans

Observations were fine when he came to us here at the ward, but now his blood pressure and respiratory rates have increased.

The patient is a 70-year-old gentleman who presented to the ED with the complaint of numbness, noticeable changes mental status and is also noted glucose of 43. His medical history is significant for long-standing history of insulin-dependent diabetes mellitus, chronic alcoholism, chronic pancreatitis, paroxysmal atrial fibrillation, he is on no coagulation because of a history frequent falls, coronary artery disease, past history of a CVA, as well as COPD. Review of the chart and discussion with the patient reveals that he attends a daycare center five days a week. He lives alone, his sister and his niece do his food shopping for him. He prepares his own meals and he gives himself his insulin on the weekend otherwise it’s given to him

At that time, his hemoglobin was 11.6. Most recently his hemoglobin has dropped to approximately 9 grams. He is on oral iron. This patient also had a colonoscopy in 09/2014 noting diverticulosis. He also reports to me having had a normal endoscopy at UNC Chapel Hill at or near the time of his cardiac valve replacement, although that information is not

Family history of glaucoma—having a family history of glaucoma increases the risk of developing glaucoma.

The excessive dispersion of pigment during exercise or activity is known as pigmentary storm, which also we lead to an increase in the patient’s IOPs [7-8, 17-18]. Pilocarpine would work by directly stimulating the cholinergic receptors of the parasympathetic pathway, which then causes contraction of the ciliary muscle causing increased tension on the scleral spur and opening the trabecular meshwork to facilitate outflow of aqueous humor and diminish outflow resistance to lower IOP [19]. This would allow the patient’s IOPs to be reduced to be within normal limits and helping treat the patient’s elevated IOPs. As mentioned previously, the patient was administered latanoprost for the treatment of his PG. Latanoprost works in a similar fashion by overall increasing the outflow of aqueous and reducing outflow resistance, however, its side effects include potential reddening of the eyes, increased eyelashes, iris pigmentation, and even intraocular inflammation [20]. In the case that IOPs did not improve various laser treatments are suggested to the patient, possibly SLT or laser iridotomy

Demographic risk factors for POAG are Africandescent14, 15,16 and older age (>70 years).14-22 In thepopulation-based Baltimore Eye Survey in the USA, African-Americans were four times more likely tohave glaucoma than white people.14 White people and African-Americans aged 70 years or older were 3•5 and7•4 times more likely to have glaucoma than whitepeople and African-Americans

Glaucoma is the name given to a group of eye diseases that causes damage to the optic nerve fibers and can lead to progressive vision loss or blindness if left untreated. The damage is primarily a result of the buildup of intraocular pressure, which results when an imbalance occurs in the production and drainage of aqueous humour. However, some glaucoma is not distinguished by high intraocular pressure, but as optic nerve damage. In the human eye the ciliary body constantly creates aqueous humour to provide sustenance for surrounding tissues. To maintain a healthy balance as new fluid is produced, older fluid must leave the eye through the meshwork drainage system along the periphery of the iris. If too much aqueous humour is produced or the drainage system is not working properly, consequently intraocular pressure builds, causing optic nerve fiber damage and deterioration of vision.