Question

P.W. Is a 40-year old disabled man who recently lost his wife to metastatic breast cancer. His brother has taken him into his home. P.W. has a 22-year history of insulin-dependent diabetes mellitus (Type-1). Until recently, he has taken responsibility for the management of his disease and has been actively involved in the local chapter of the American Diabetic Association. PMH includes 2 amputated toes on his R foot, retinopathy and visual impairment in both eyes, and angina on exertion from coronary artery disease that severely restricts his activity. Since he began treatment with an Ace-inhibitor 2 years ago, his blood pressure has gone from 182/128 to 126/78 mm Hg. Currently, he is 71” tall and weighs 135 lb. P.W.’s sister-in-law, who is an LPN says P.W. has lost about 12 lbs in the past 3 weeks. Over the past few years, P.W. has been administering a multidose (3 injections) regimen of regular Humulin insulin to himself before meals and at night. Recently his BG levels have been increasingly inconsistent and labile, and he has been labeled “noncompliant.” It is Monday. You are the home care nurse assigned to visit P.W. 3 times per week for teaching and evaluation. P.W.’s brother and sister-in-law express concern that P.W. seems to be indifferent about his nutritional and pharmacologic regimens. P.W.’s resting vital signs are: BP 174/108, HR 82, RR 20, Temp: 98.4F (oral). Are these results acceptable? If not, indicate which ones are not and what you think is happening. You ask P.W if he has been taking all his medications. He says “yes” but adds that he discovers “extra” blood pressure pills left over at the end of each week. He seems to be confused about the reason for the “leftover” pills. You decide to do a glucose stick. He registers 348 mg/dl.

Please only answer the following questions:

1) Based on all the above information, what other 2 assessments will you want to perform on P.W.?

2) You decide to call P.W.’s health provider. Specifically, what information are you going to give him/her?

Answer 1

1. Assessments

HbA1c test tells the average level of blood sugar over the past 2 to 3 months. Because P.W registers 348 mg/ dl and P.W seems to be indifferent about his nutritions.

Electrocardiogram ( ECG ) because of P.W's increased blood pressure ( BP 174/108 ) and has angina on excertion from coronary artery disease.

2. About increased blood pressure ( BP 174/108 ) .P.W is not taking the medicines regularly ( left over blood pressure pills ).

About increased blood glucose level 348 mg / dl.

About the findings in ECG and in HbA1c test .