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Karen is a 66-year-old grandmother of five. She worked in an office as a legal secretary for many years before recently retiring. Due to her job and busy lifestyle, she often skipped breakfast and relied on coffee to see her through to lunch, which she usually bought from one of the food trucks outside her office building. Her favorite lunch was a sliced pork sandwich and pickle from the deli meat truck. She continued drinking coffee into the afternoon, and then sometimes at home after dinner. Despite her retirement, her dietary practices remain essentially the same, except that she buys meats from the grocery store and makes her own sandwiches now. Karen rarely ever drinks plain water, herbal tea, juice, or milk-black coffee and red wine are her only sources of hydration. For many years, Karen has battled kidney stones, high blood pressure, headaches, and chronic fatigue. How have Karen's dietary habits contributed to her health issues and what changes should she make to her routine? Although Karen drinks a moderate amount of fluid each day, all of it (except the wine) contains caffeine—a diuretic that stimulates the body to urinate. Assuming that Karen is getting enough fluid to offset coffee's diuretic effect, what potential conditions related to chronically low fluid intake levels (dehydration) might she need to be aware of? a. glaucoma, cataracts, and night blindness b. gallstones, urinary tract infections, and diabetes c. atherosclerosis, hypotension, and migraines d. kidney stones, hypertension, and constipation e. heart attack, stroke, and diabetes
Rupsa S.
A 21-year-old female (A.M.) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she's been ill and unable to keep any food down. She's only tolerated sips of water and juices. Since she's also been unable to eat, she hasn't taken any insulin as directed. While helping A.M. from the lobby to the examining room, you note that she's unsteady, her skin is warm and flushed, and that she's drowsy. You also note that she's breathing rapidly and smell a slight sweet/fruity odor. A.M. has difficulty answering questions but keeps asking for water to drink. You get more information from A.M. and learn: - She had some readings on her glucometer which were reading 'high'. - She vomits almost every time she takes in fluid. - She hasn't voided for a day but voided a great deal the day before. - She's been sleeping long hours and finally woke up this morning and decided to seek care. Current labs and vital signs: What is the pathophysiology for the condition you believe A.M. has? Relate the etiology and clinical manifestations for the condition you identified for A.M. The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders these items: - 1000 ml Lactated Ringer's (LR) IV stat - 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now - CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air - 1800 calorie, carbohydrate-controlled diet - Bed rest - Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN - Furosemide (Lasix) 60 mg IV push now - Urinary output every hour - VS every shift The orders above -- which are questionable related to her condition and which are appropriate? What are the expected treatments for this condition? Instructions: Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition. Use two evidence-based articles from peer-reviewed journals or scholarly sources to support your findings. Be sure to cite your sources in-text.
Madhur L.
HLSC 102 Fall 2016 Case Study #4 - Family Divided A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only "yes" and "no," and his responses are inconsistent. The attending physician is convinced that the patient has lost decisional capacity, while two family members are equally convinced that he has decisional capacity. The patient's wife and two other children are ambivalent about his competency to make decisions. The prognosis for recovery of safe swallowing and speech approaches zero due to the dense damage to the cerebral cortex visible on brain imaging. Two neurological consultants have verified that recovery is likely to be minimal and that permanent severe disability will be the outcome. The patient does not have an advance directive. The patient's wife says that they never discussed his preferences about life-sustaining treatment. She is convinced that he would not want to live in this disabled condition but is uncertain whether to request the placement of a feeding tube. The patient's four adult children are strongly opposed to the tube placement, while the other two insist that not to do so would be "killing our father." The patient's wife is torn between these positions but finally requests that the tube be placed. The attending physician and the rest of the treatment team are opposed to placing the feeding tube. Their argument is that the patient has "minimal consciousness" and will not improve. They define this as a futile situation with no reasonable expectation for recovery. Furthermore, nurses claim that during previous hospitalizations for cardiovascular events, the patient told them he would not want to be sustained by artificial means such as mechanical ventilation, dialysis, or tube feeding. It is their position that the patient has expressed his preference not to be kept alive in a futile situation. The family requests an ethics consultation. See page for questions:
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