Comprehensive Assessment of Sally Green: Diagnostic Findings, Nursing Priorities, and Medication Considerations

QUESTION

Sally Green is a 68-year-old retired female administrative assistant. She is married with 5 adult children that live out of state and had a total hysterectomy after the birth of her last child. She is also a former smoker and a frequent social drinker, with a history of COPD, hypertension, and atrial fibrillation. She has presented to the emergency center with complaint of fatigue, shortness of breath which is worse going up stairs, and substernal heaviness. She is currently taking the following medications:

• Salmeterol (Serevent Diskus)
• Albuterol (Proventil)
• Tiotropium (Spiriva)
• Enalapril (Vasotec)
• Hydrochlorothiazide
• Lanoxin
• Warfarin
• Atorvastatin

When she is assessed at the emergency center, she exhibits a heart rate of 98, blood pressure of 182/88, a respiratory rate of 32 and her temperature is 36⁰C. She also has a pulse oximetry of 88% with a weight of 280 lbs. Her physical examination shows the following results:

• Lungs: diminished all lobes and expiratory wheezes
• Heart: S1S2 irregularly irregular
• Apical/Radial Pulse: Irregular
• Skin: bruising is generalized areas with multiple stages of healing

Her laboratory diagnostic results are as follows:

• Potassium 3.2
• Sodium 130
• Glucose 100 (fasting)
• Creatine 2.4
• Bun 25
• INR 3.5
• H/H 10/30
• HDL 45
• LDL 280
• Triglycerides 350

1. Discuss the diagnostic lab findings and the relationship to the medications.
2. State the three priority nursing problems and the rationale for each.
3. What is the priority nursing action? Explain your rationale.
4. What medications do you anticipate the emergency room provider will order? Explain your rationale.

ANSWER

 Comprehensive Assessment of Sally Green: Diagnostic Findings, Nursing Priorities, and Medication Considerations

Introduction

This essay presents a comprehensive assessment of Sally Green, a 68-year-old retired female with multiple comorbidities who presented to the emergency center with symptoms of fatigue, shortness of breath, and substernal heaviness. The focus is on analyzing the diagnostic laboratory findings, identifying priority nursing problems, determining the priority nursing action, and anticipating the medications that the emergency room provider may order based on the patient’s clinical presentation and history.

Diagnostic Lab Findings and Relationship to Medications

The diagnostic laboratory findings provide valuable insights into Sally Green’s health status and the relationship to her medications. Notable results include low potassium (3.2), low sodium (130), elevated creatinine (2.4), elevated BUN (25), elevated INR (3.5), and low H/H (10/30). These findings indicate potential electrolyte imbalances, impaired renal function, and coagulation abnormalities. The medications she is currently taking, such as diuretics (hydrochlorothiazide), anticoagulant (warfarin), and antiarrhythmic (lanoxin), can contribute to these laboratory abnormalities.

Priority Nursing Problems and Rationale

Inadequate oxygenation: Sally’s low pulse oximetry reading (88%) and expiratory wheezes on lung examination suggest impaired oxygenation. This can be attributed to her history of COPD, which warrants close monitoring and interventions to improve respiratory function and oxygenation.

Potential fluid and electrolyte imbalance: Sally’s low potassium and sodium levels, along with elevated BUN and creatinine, indicate the possibility of fluid and electrolyte imbalances. The use of diuretics (hydrochlorothiazide) can contribute to these imbalances, which require prompt assessment, monitoring, and appropriate interventions.

Coagulation abnormalities: The elevated INR suggests potential alterations in Sally’s coagulation system, possibly related to the use of anticoagulant therapy (warfarin). This poses a risk for bleeding or thrombotic complications, necessitating careful monitoring and implementation of appropriate nursing interventions.

Priority Nursing Action and Rationale

The priority nursing action for Sally Green is to ensure adequate oxygenation and respiratory support. Given her symptoms of shortness of breath and diminished lung sounds, immediate administration of supplemental oxygen should be initiated. This action aims to improve oxygenation, alleviate respiratory distress, and stabilize her condition. Maintaining adequate oxygenation is essential to support cellular function and prevent further complications associated with hypoxia.

Anticipated Medications and Rationale

The emergency room provider is likely to order the following medications based on Sally’s clinical presentation and laboratory findings:
Bronchodilators: Considering Sally’s history of COPD and symptoms of wheezing and shortness of breath, additional bronchodilators such as nebulized or intravenous medications (e.g., albuterol) may be prescribed to improve her airway function and alleviate bronchospasms.

Potassium replacement: Given Sally’s low potassium level and the potential risk of cardiac complications, potassium supplementation (oral or intravenous) may be prescribed to restore normal potassium levels and maintain cardiac stability.

Fluid and electrolyte management: With the presence of electrolyte imbalances and potential renal impairment, intravenous fluids and electrolyte solutions may be administered to restore balance and support renal function.

Conclusion

The comprehensive assessment of Sally Green reveals significant diagnostic findings, including laboratory abnormalities and clinical manifestations. The priority nursing problems identified are inadequate oxygenation, potential fluid and electrolyte imbalance, and coagulation abnormalities. Prompt nursing action to ensure adequate oxygenation is crucial, and anticipated medication orders may include bronchodilators, potassium replacement, and fluid and electrolyte management. By addressing these nursing priorities and providing appropriate interventions, the healthcare team can optimize Sally’s care, stabilize her condition, and improve her overall health outcomes.