Question

At 1400 hrs. on Tuesday, Mr. Adebo Ikeme, an 83 year oldBlack male was admitted to your floor with complaints of significant SOB when taking the stairs to his 3rd floor walkup in Brooklyn. He is 5’10” tall and weighs 145 lbs. He has a 15 yearhistory of HTN but has not been seen for follow-up in several years. He states that the breathing problem started about a year ago but got worse this week. His LE evidence 3+Edema to the middle of his shins. Mr. Ikeme states that he gets up several times a night to use the bathroom – but only has “a little bit of pee” each time. As he speaks to you, you note that his pupils are bilaterally cloudy and his dark brown irises have a distinct pale blue ring around the perimeter. Admission vital signs: BP 169/102, Pulse 88, Resp 18 & temp. 96.8°F.

Identify Key Findings/Significance & NURSING Implications
1
2
3
4

MD Orders	Describe the Nursing Response
Captopril 50mg/Day
HCTZ 25 mg BID
Cardiac diet c no added NA
VS q 4 hours
Activity as tolerated
Cardiac monitoring
Saline Lock
12 lead ECG
O2 Sat √s q 8 hours
Chem panel (SMAC 20) & troponin x 3
Schedule for nuclear stress test in AM

Answer 1

Key findings, significance, and nursing implications:-

1. History of hypertension since 15yrs. It is important because it tell us that Mr.Ikeme's kidney can be effected with long standing hypertension.
2. Bi-pedal oedema. It is important because it is associated with many diseases of heart and kidney and it gives us a idea about diagnosis.
3. Pale blue ring around iris because of cholesterol deposits which is of white or yellow colour but appear blue. It signifies that amount of cholesterol in body is higher and should be controlled.
4. Shortness of breath The first symptom of pulmonary hypertension is usually shortness of breath with everyday activities, such as climbing stairs.

Nursing implications that Mr. Ikeme may be suffering from kidney disease like chronic kidney disease.