Assignment 1:Nephropathy in Diabetes Mellitus Type II, Unfolding Case Study
Stage I
Mrs. Smith is a 73 years old female living with her husband at an apartment in the twin cities.
She has been diagnoses with type 2 diabetes 25 years ago. She takes scheduled Novolog 10 units
and sliding scales. She presented to the clinic with increased weakness. Upon assessment, vital
signs respiration 24, t.99.0, blood pressure 146/98, p. 89, p. 78 and o2 sat 92 RA. Current weight
was 190, an increase of 4 lb from her base line. A nurse noted + 2 pitting edema. The physician
ordered a stat lab for kidney function. Lab result shows BUN 60, creatinine 0.9 and GFR 45,
hemoglobin 8.7, fasting blood glucose 11, and HA1c 6.8.
Physician Order: Iron supplement, rest, activity as tolerated and set up a follow up
appointment.
1.
2.
3.
4.
5.
6.
What are some of the complications of her diabetes?
What additional assessments are needed?
Why did she begin to have an increase in weight?
Why is her BUN elevated?
What do you think are some teachings that the nurse should provide
Why did the provider prescribe Iron?
Stage II
Mrs. Smith did not regain her strength. She increasingly begins to experience shortness of
breath. She can’t walk for a long distance. The iron she is taking causes constipation. Her
extremities are swollen. She feels dehydrated. She has been taking fluids water and orange juice
lately. She came to a clinic. Her vitals are: t.98.3, r.24, b/p 148/78, p. 80, o2 89 in RA and fasting
blood glucose 128. The nurse placed the patient on 2L NC. Her current weight is 195 lb. Her
abnormal labs are as follows:
Potassium
5.4
Hmg
10.0
Creatinine
1.4
BUN
64
GFR
40
Calcium
7.8
Hemoglobin A1c
6.8
Physician Orders: Lasix 20 mg once a day. Continue iron. Polythelglycol once a day.
1. What caused the abnormal electrolytes?
2. What diet or fluid restriction is required?
3. What is happening to Mrs. Smith?
4. What are some teachings you need to provide?
5. Why did not her iron level increase despite medication supplement?
5. What do we monitor for this patient?
Stage III
In the middle of the night, she woke up with increased shortness of breath. Her husband noticed
that she had a puffy face, and was breathing heavily. She did not void for 2 days. He drove her to
the nearby clinic. Her abnormal lab results shows the following
Potassium
5.6
Hmg
10.0
Creatinine
3.8
BUN
64
GFR
30
Calcium
7.4
Hemoglobin
7.1
A1c
1.
2.
3.
4.
What is happening with Mrs. Smith?
What do you think will the doctor order?
What are some nursing interventions for this patient?
What will happen if there is no intervention?
Assignment 2: Unfolding Case Study, Foot Damage, Nerve & Decrease Blood Flow
Stage I
Alice is a 72-year-old female with a history of Type II diabetes, congestive heart failure, and
obesity. She lives alone and takes pride in her independence. She is in to see the provider for her annual
Diabetic Wellness check-up. Alice states that she has be doing well managing her blood glucose levels
with medications and diet. She has a history of diabetic nerve damage in both feet that may cause various
foot complications. Today, Alice complains that she has been noticing a small amount of yellow drainage
on the bottom of her right sock when she removes it at night. Because of her with weight, it is difficult
for her to see underneath her right foot.
1. What activities of daily living are a part of Alice’s functional ability in the home setting?
2. What aspects of health are included in part I? How are these aspects related to patient-centered care?
3. What type of assessments are important for the provider and nurse to perform on diabetic patients?
Stage II
Alice states that she has been noticing the drainages for a least 1 month. She states that she “Is
not worried because she does not have any discomfort”. After informing the provider about Alice’s
complaint, you perform an assessment of Alice’s skin and her right foot. You notice an open wound
located to the bottom heel of the right foot.
1. What interventions will the nurse have to perform on the wound?
2. How is the ability to perform activities of daily living (ADL’s) related to safety?
3. How is the ability to perform a self-skin assessment, related to wound prevention?
Stage III
Alice is feeling upset about the wound to her right heel. She disappointed that she waited so long
before she came in to see her provider. Alice will be able to return home. A diabetic public health nurse
will visit with her at her home 3 days a week to assess her wound.
1. What information about skin assessment is important to share with Alice?
2. What information about foot damage in relation to nerve damage would you share with Alice?
3. Do you feel the care and treatment you provided for Alice was patient-centered? Is this important?
Why or why not?
Assignment 3: Fluid Deficit
Complete the following table, comparing the 3 major conditions related to fluid deficit
Vomiting
Diarrhea
Draining Wounds
Clinical
manifestation
(S&S)
Possible causes
Nursing
interventions
(independent
actions)
Pharmacological
management
Assignment 4: Care of Patients in Disaster
Your supervisor asks you to extend your shift due to unexpected influx of patients with flu like
symptoms. The number of patients is rapidly increasing, and their symptoms are progressing into
severe respiratory diseases. Your supervisor tells you that there are an increased number of
relatively young people with no previous health problems are getting sick. The health care
providers are not sure what is the cause and what exactly is going on.
1. Describe how you might feel about being asked to work under such circumstances and/or
expose yourself (and your family) to potentially serious communicable disease.
2. What are some things that you should /could do (or ask) that would prepare you to
face this situation?
3. Identify at least 5 nursing responsibilities in case of a disaster.
Assignment 5: Peripheral Vascular Disease
Ms. Andrews is in a clinic with complaints that she has noticed leg cramps after walking just a
couple of blocks. The pain stops when she stops walking. Ms. Andrew reports that she is a
secretary and has worked for an engineering company for over 25 years. She has gained several
pounds over the holidays and has started walking to try to lose weight. The health care provider
tells her that she may have a mild arterial insufficiency that can be treated with exercise and
possible medications if her symptoms worsen.
1. What questions would you ask her to determine risk factors for arterial insufficiency?
(List at least 3)
2. List 5 signs and symptoms that would indicate diminished arterial blood flow in the
peripheral vessels.
3. What are the 5 P’s that should be assessed for a patient with suspected vascular
insufficiency?
4. The health care provider tells that Ms. Andrews has cloudifications. You explain to her
that intermittent cloudification is characterized by
_________________________________________________________________
5. What are the major nursing goals for patient like Ms. Andrews? (list 2)
6. List 5 self-care measures that could be taught Ms. Andrews to help her with impaired
peripheral circulation.
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