Question: Janny Rumkins is a 69 yo female with hx of DM-type 2, HTN, and CHF.

Janny Rumkins is a 69 yo female with hx of DM-type 2, HTN, and CHF.

Medication List:

glyburide 2.5 mg daily with meals
captopril 6.25 mg one pill TID
metoprolol 100 mg BID
furosemide 40mg daily
ASA 81 mg
Prandin 2mg with each meal
Respond to the below questions using Headers in bold, and responses should be in bullet points and sub-bullet points as indicated.

1) What 5 assessment questions would you ask the patient, and why?

2) What focused physical assessments would you implement, and why?

3) What would you educate the patient, and why?

4) What labs would you anticipate checking, if applicable, and why?

5) List 5 NANDA nursing diagnoses with 3 interventions for each NANDA diagnosis

6) Write Medication, correct indication (cross-reference with the dx), side effects, nursing actions

DRAFT ANSWER:

1) Assessment Questions:

• Current Symptoms:

  • Ask about any new or worsening symptoms related to diabetes, hypertension, or congestive heart failure (CHF) to assess the current status of her conditions.

• Medication Adherence:

  • Inquire about her adherence to the prescribed medications and any issues or concerns she may have regarding her medication regimen.

• Diet and Nutrition:

  • Ask about her dietary habits, including portion sizes, carbohydrate intake, and sodium intake, to assess her ability to manage her diabetes, hypertension, and CHF through diet.

• Physical Activity:

  • Inquire about her level of physical activity or exercise routine to assess if she is engaging in regular physical activity, which is important for managing diabetes and heart conditions.

• Fluid Retention and Edema:

  • Ask about any signs of fluid retention, such as swelling in the ankles or legs, to evaluate the effectiveness of her diuretic (furosemide) therapy and monitor for CHF exacerbation.

2) Focused Physical Assessments:

• Vital Signs:

  • Measure blood pressure, heart rate, and respiratory rate to assess her current cardiovascular status and control of hypertension.

• Weight:

  • Weigh the patient to monitor for changes in fluid status and to assess for any significant weight gain, which can be indicative of worsening CHF.

• Cardiac Auscultation:

  • Listen to heart sounds to detect any new murmurs or irregularities that may indicate changes in cardiac function.

• Peripheral Edema:

  • Examine the extremities for signs of edema, especially in the ankles and legs, to assess for fluid retention associated with CHF.

• Blood Glucose Monitoring:

  • Check her blood glucose levels to assess glycemic control in diabetes.

3) Patient Education:

• Medication Adherence:

  • Educate the patient on the importance of taking medications as prescribed and the potential consequences of non-adherence, including uncontrolled diabetes, hypertension, or CHF exacerbation.

• Dietary Management:

  • Provide dietary guidance, emphasizing portion control, carbohydrate monitoring for diabetes, and sodium restriction for hypertension and CHF management.

• Signs of Exacerbation:

  • Teach the patient about the signs and symptoms of CHF exacerbation, such as sudden weight gain, increased shortness of breath, and worsening edema, and instruct her to seek medical attention promptly if these occur.

• Regular Monitoring:

  • Emphasize the importance of regular monitoring of blood glucose, blood pressure, and weight at home to track her conditions' progression and response to treatment.

4) Anticipated Labs:

• HbA1c: To assess long-term glycemic control in diabetes.
• Serum Creatinine and BUN: To monitor renal function, especially with the use of medications like metoprolol and furosemide.
• Electrolyte Panel: To check for electrolyte imbalances, which can be caused by furosemide.
• NT-proBNP: To assess cardiac function and detect CHF exacerbation.

5) NANDA Nursing Diagnoses and Interventions:

• Ineffective Health Management related to lack of understanding of the disease process:

  • Provide patient education on diabetes, hypertension, and CHF.
  • Develop a written care plan with clear instructions for medications, diet, and monitoring.
  • Encourage the patient to ask questions and seek clarification about her conditions.

• Risk for Medication Noncompliance related to complexity of the medication regimen:

  • Simplify the medication schedule if possible.
  • Use medication organizers or pillboxes to help with adherence.
  • Involve a family member or caregiver in medication management.

• Imbalanced Nutrition: More than Body Requirements related to overconsumption of carbohydrates:

  • Collaborate with a dietitian to develop a personalized meal plan.
  • Educate the patient on portion control and carbohydrate counting.
  • Monitor dietary intake and provide feedback.

• Impaired Physical Mobility related to fatigue and weakness:

  • Encourage and support the patient in engaging in regular physical activity.
  • Teach energy conservation techniques to reduce fatigue.
  • Monitor the patient for signs of increased weakness or difficulty moving.

• Risk for Fluid Volume Excess related to CHF and diuretic therapy:

  • Monitor daily weights and assess for signs of fluid retention.
  • Educate the patient about the importance of sodium restriction.
  • Adjust diuretic dosage as needed based on fluid status and renal function.

6) Medication Information:

• Glyburide (Indication: Diabetes):

  • Side Effects: Hypoglycemia, weight gain, dizziness.
  • Nursing Actions: Monitor blood glucose regularly, educate on signs of hypoglycemia, and emphasize the importance of meal timing.

• Captopril (Indication: Hypertension, CHF):

  • Side Effects: Hypotension, cough, elevated potassium.
  • Nursing Actions: Monitor blood pressure, assess for cough, and monitor serum potassium levels.

• Metoprolol (Indication: Hypertension, CHF):

  • Side Effects: Bradycardia, dizziness, fatigue.
  • Nursing Actions: Monitor heart rate and blood pressure, assess for signs of bradycardia, and educate on rising slowly from sitting or lying positions.

• Furosemide (Indication: CHF):

  • Side Effects: Hypokalemia, dehydration, electrolyte imbalances.
  • Nursing Actions: Monitor electrolyte levels, fluid balance, and signs of dehydration.

• ASA (Indication: Cardiovascular protection):

  • Side Effects: Gastrointestinal bleeding, bruising.
  • Nursing Actions: Educate on the risk of bleeding, advise on reporting any unusual bleeding, and consider gastroprotective measures if necessary.

• Prandin (Indication: Diabetes):

  • Side Effects: Hypoglycemia, weight gain, gastrointestinal upset.
  • Nursing Actions: Monitor blood glucose, educate on signs of hypoglycemia, and emphasize meal timing with medication administration.