I want answer question from 9 to 14 D.H., a 54-year-old, has had multiple chronic medical...

I want answer question from 9 to 14
D.H., a 54-year-old, has had multiple chronic medical problems, including type 2 diabetes mellitus (DM) for 25 years, which has progressed to insulin-dependent DM for the past 10 years; a kidney transplant 5 years ago with no signs of rejection at last biopsy; hypertension (HTN); and remote peptic ulcer disease (PUD). His medications include insulin, immunosuppressive agents, and two antihypertensive drugs.
He visited his local physician with complaints of left ear, mastoid, and sinus pain. He was diagnosed with sinusitis and Candida albicans infection (thrush); cephalexin (Keflex) and nystatin were prescribed.
Later that evening he developed nausea, hematemesis, and weakness and was taken to the emergency department. He was admitted and started on IV antibiotics, but his condition worsened throughout the night; his dyspnea increased and he developed difficulty speaking. He was flown to your tertiary referral center and was intubated en route. On arrival, D.H. had decreased level of consciousness (LOC) with periods of total unresponsiveness, weakness, and cranial nerve deficits. D.H. has continued fever and leukocytosis despite aggressive antibiotic therapy. The physician plan to do Lumber Puncture (LP) for the patient.
Diagnosis: Meningitis complicated by an aspiration pneumonia and atrial fibrillation
1. Why was D.H. at particular risk for infection?
2. Describe bacterial meningitis.
3. What is the probable route of entry of bacteria into D.H.'s brain?
4. When D.H. was admitted, the nurse charted that he could not extend his legs without complaining of extreme pain. This sign of meningitis could have been charted as a positive:
a. Kernig's sign
b. Trousseau's sign
c. Babinski's sign
5. How do you think D.H. might have developed aspiration pneumonia?
6. What factors influenced the physician's decision to transport D.H. from a smaller hospital to a tertiary referral center?
7. What is the significance of using Lumber Puncture (LP) for a patient meningitis?
8. What type of transmission-based precautions need to be instituted for D.H.? (Select all that apply.)
a. Placing D.H. in a private room if possible
b. Wearing a gown for all patient contacts
c. Wearing a respirator each time upon entering the room
d. Placing D.H. in a room with negative airflow pressure
e. Wearing a surgical mask each time upon entering the room
f. Wearing gloves during contact with oral secretions
Medication Administration Record
NPH insulin 20 units bid
NovoLog per sliding scale ac/hs
Digoxin 0.125 mg IVP daily
Sucralfate (Carafate) 1 g PO q6h
Azathioprine (Imuran) 100 mg daily IVPB in 150 mL D5W
Imipenem–cilastatin sodium (Primaxin) 1 g IVPB q8h in 100 mL 0.9% NaCl
Metronidazole (Flagyl) 500 mg IVPB q6h in 75 mL 0.9% NaCl
Methylprednisolone (Solu-Medrol) 125 mg IVP q8h in 75 mL 0.9% NaCl
9. Indicate the expected outcome for D.H. that is associated with thefollowing medications: Azathioprine, Imipenem–cilastatin sodium, Methylprednisolone, and Sucralfate?
10. The nurse inform you that NAP insulin reports shows that D.H. has a glucose result of 450 mg/dL. Identify two factors that could contribute to D.H.'s elevated glucose level.
11. What should you do regarding the elevated glucose level, and why?
12. Outline the nursing management of D.H.'s current problems related to his risks for infection, seizures, increased intracranial pressure, hypovolemia, and acute pain.
13. List six interventions to perform to prevent complications.
14. What health teaching can be given to D.H.'s family?

Homework Answers

Answer #1

1) The patient is a chronic diabetic and kidney transplant individual. He is taking immunosuppressants also. So, his immunity would be very low and therefore easily susceptible to infections.

2) Bacterial meningitis is the inflammation of brain and spinal cord membranes caused by the bacterial infection. The organism that is most commonly implicated is Streptococcus pneumoniae.

3) The most probable route of infection in this case could be through ear as the patient has complained of ear pain.

4) Extension of legs puts pressure on the meninges which are already inflammed resulting in severe pain. This is an example of positive kernigs sign.

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