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.

Answer 1

No these results are not acceptable. Other vital signs are ok as per resting condition.But the heart rate is immense high. 140/90 is considered to be hypertension. He is having 174/108 which is way to high. Either his medications for hypertension are not working anymore or he is just skipping the medicines. Even he has been finding leftover bp pills at the end of the week which confuses him. He might be suffering from some mental issues after his wife died. He is forgetting what he has done. He should be treated for psychological issues.