2610305 RNSG2535 DB1 Assignment 1 Metabolism by Bj84Hy8l

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									RNSG 2535 Integrated Client Care Management




DB 1 Assignment Metabolism
The patient is a 63-year-old hair stylist who lives in a rural area with her retired husband and two dogs.
She is the mother of two sons, both of whom live in other states but visit at least annually. The patient
plans to retire within the next year and is looking forward to pursuing her sewing and gardening hobbies
on a full-time basis.

The patient is diagnosed with type II (non-insulin-dependent) diabetes mellitus five years ago. She
maintained her diet and daily insulin injections with few difficulties until recently. Approximately three
weeks ago she contracted influenza from one of her clients, which primarily manifested as a chronic
productive cough and shortness of breath. Assuming that she would recover in a few days, the patient
stayed home from work, but had difficulty eating or drinking due to loss of appetite and throat soreness
related to coughing. At the insistence of her husband, she visited her family physician who
subsequently admitted her to the hospital for treatment of pneumonia.

Currently the patient is receiving intravenous antibiotics and steroids, and her lungs are beginning to
clear. Her cough is diminishing but remains productive.

The patient is oriented to person and place but is lethargic and has difficulty answering your questions.
When she does respond, she reports being nauseated. Her skin is warm, dry, and flushed. Her pulse is
112 beats per minutes (bpm), her blood pressure is 106/72, her oral temperature is 99.4 degrees
Fahrenheit, and her respirations are 30 breaths per minute. Her intake and output record indicates that
she voided 850 mL of urine since 0600 (it is now 1000), and she has taken in 700 mL of fluid. The
glucometer indicates that her serum glucose is too high to register; therefore, it is at least 400 mg/dL.

The patient’s fasting glucose is 230 mg/dL

Instructions
Read the scenario. Complete the following discussion and post in the discussion board by the original
post due date. Be sure to attach your rubric. You will then respond to a minimum of two additional
students. Answer the following questions. Support your answers and being very specific in your
responses. Your answers must integrate nursing knowledge and science with practical application to
patient care Include appropriate citations and references where necessary. (There are hints in the
parentheses that will help you be more thorough)


   1. What data is most relevant to determining the priority nursing diagnoses for the patient?
      (Group data into physiological and psychosocial categories. Prioritize data groups according to
      Maslow’s needs, life preservation criteria, or prioritizing criteria. Identify the nursing diagnosis
      that is most appropriate for the data groups.)

   2. On the basis of the laboratory data and your assessment findings, what conclusions can you
      draw about the patient?
      (Separate the patient’s data into normal and abnormal categories.

2011 Lamar State College, Port Arthur                                                          Page 1 of 3
RNSG 2535 Integrated Client Care Management


       Discuss clinical manifestations of hyperglycemia, hyperosmolar nonketotic coma (HNKC), and
       diabetic ketoacidosis (DKA). Correlate the patient’s assessment data with common clinical
       manifestations of conditions that complicate type II diabetes mellitus.
       Discuss serious risks from this condition).

   3. What other data are essential to substantiate your suspicions?
      (Review diagnostic indicators for diabetes mellitus and its complications.
      Discuss the appropriateness of diagnostic tests for validating the presence or absence of
      complications.
      Consider the patient’s last dose and type of insulin, the amount of food she ate at breakfast, and
      the nurse’s response to her early morning fasting blood glucose).

   4. What is the relationship between non-insulin-dependent diabetes mellitus (NIDDM) and
      (HNKC)?
      (Review the pathophysiology of NIDDM as well as conditions and factors that may result in
      HNKC.
      Diagram the process of glucose alteration that results in HNKC, indicating normal and abnormal
      processes.
      Discuss the importance of regulating the blood sugar rapidly by treating the patient with insulin,
      potassium, and sodium.
      Review the necessity of replacing potassium while lowering the blood sugar).

   5. How would your assessment findings differ if the patient was experiencing DKA?
      (Review the pathophysiology of DKA and HNKC. List common assessment findings for each
      condition.
      Compare the patient’s assessment data with both conditions. Discuss how the patient’s
      assessment findings would have differed if she was experiencing DKA instead of HNKC.
      Speculate about the early symptoms of DKA versus late-onset symptoms).

   6. What impact does the patient’s pneumonia have on her diabetes mellitus?
      (Identify problems that can develop from pneumonia that may adversely affect diabetes mellitus,
      for example, decreased appetite or reduced intake with same insulin dose; increased metabolic
      needs of the body when fighting an infection; and a reduction in normal activities, thus reducing
      the use of insulin, decreasing oxygenation, and minimizing the cells’ ability to function normally).

   7. Why must you consider the patient’s current medications when evaluating her present situation?
      (Analyze the patient’s current medications. Decide if any of her medications are contributing to
      her increased blood glucose, for example, glucocorticoids are known to cause hyperglycemia.
      Investigate common antibiotics, such as penicillins and cephalosporins, to determine if they alter
      blood glucose levels).

   8. To which other groups of patients can you generalize the care of the patient?
      (Consider other conditions that can result in hyperosmolar coma, such as patients receiving
      hyperalimentation, patients who have severe burns, or patients undergoing renal dialysis.
      Compare these conditions to diabetes mellitus in regard to pathophysiological changes they
      produce that result in HNKC.
      List clinical manifestations that will be similar for all patients experiencing the problem).




2011 Lamar State College, Port Arthur                                                         Page 2 of 3
RNSG 2535 Integrated Client Care Management
                                                                 Lamar State College-Port Arthur
                                                                Upward Mobility Nursing Program
                                                          RNSG 2535 Unit I Discussion Board Grading Rubric

Student _________________________________________________ Date ___________________Instructor ________________________________________
Submit assignment following APA format guidelines using paragraph format with each section appropriately identified
                          20                                                                                                       10-0                         Points Earned
 Submitted scholarly original post with answers to                                                          Original post is not scholarly and answers to
 questions that integrate nursing knowledge and                                                             questions do not integrate nursing knowledge
 science with practical application to patient care.                                                        and science with practical application to patient
 Attached grading rubric as instructed.                                                                     care and/or grading rubric is not attached as
                                                                                                            instructed.
 Correct grammar, spelling, complete sentences,                                                             More than 2 errors in APA format and/or >2
 and APA format with in-text citations throughout                                                           spelling or grammar errors.
 and for references.
                          30                                                   29 - 10                                             9-0
 Thorough and appropriate response to two              Less than thorough response or did not include       Vague response and/or did not include
 student’s original case study responses providing     additional information or included inappropriate     additional information and/or included
 additional information including a minimum of         response to one student’s original case study        inappropriate response to one student’s
 one appropriate reference.                            response or did not include at least one             original case study response and/or did not
                                                       appropriate reference                                include at least one appropriate reference.
 Answered all questions of the case study              Answered all but one case study questions or did     Explanation vague, did not answer two or more
 thoroughly. Explanations integrate                    not answer one of the questions thoroughly or        of the questions thoroughly and did not
 pathophysiological and psychological knowledge        specifically or did not integrate pathological and   integrate pathological and psychological
 into answers.                                         psychological knowledge into answers.                knowledge into answers.

                                                       Comments:
 Late Penalty:
                                                                                                                                        Total points earned
 Up to 24 hours = 25 points.                                                                                             (Possible to earn up to 100 points)
 After 24 hours = a grade of zero posted                                                                    Deduction for late submission


                                                                                                            Failure to submit discussion appropriately
                                                                                                            within the RNSG 2535 Classroom Discussion
                                                                                                            Board
                                                                                                            (maximum of 10 points)
                                                                                                                                                  Final Score




2011 Lamar State College, Port Arthur                                                                         Page 3 of 3

								
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