Question

Need nursing dx for the following  

1. Frank’s problems included shaky hands, blurry vision, trouble focusing his vision, and fatigue. 2. Frank is overly tired, he is likely not getting enough sleep at night, resulting in sleep deprivation and his blurred vision. 3. Frank’s condition appears to be sleep deprivation, this may be due to some underlying problem causing a lack of sleep but that is unknown at the time without further testing. Part II 1. Insulin is responsible for decreasing blood glucose levels. 2. Insulin is secreted by cells in the pancreas. 3. Type 1 Type 2 Blood insulin level Low High Insulin receptor function Normal Low 4. It would appear that Frank is suffering from untreated Type 2 diabetes. 5. Yes, Type 2 diabetes has a familial link and it would therefore make sense that Frank suffers from Type 2 diabetes given that members in his family also suffer from it. Part III 1. Frank is tired and has a has a lack of appetite before going to bed, however when he wakes, he is showing signs of jaundice. 2. Frank’s eyes will show yellowing in the sclera. 3. Bilirubin is the molecule responsible for jaundice. 4. Hemoglobin  Liver  binds/found  bile duct/small intestine/lipids 5. There could be something causing an obstruction of the flow of bile to the intestine, which would result in a buildup of bilirubin causing jaundice. 6. Yes, the high levels of blood glucose could cause a problem in the pancreas which would result in a blockage of the bile duct, causing the buildup of bilirubin and therefore the jaundice. 7. Because the pancreas is involved in the Type 2 diabetes diagnosis, it is likely that it is experiencing inflammation which is causing a backup of the bile ducts and problems with the expulsion of bilirubin. 8. Would test for conjugated and unconjugated bilirubin as well as insulin levels and hematocrit. Part IV 1. Unconjugated bilirubin is lipid-soluble and found in the blood plasma from the spleen. 2. Frank’s level of unconjugated bilirubin is within normal range. 3. Conjugated bilirubin is water-soluble and is formed in the liver. 4. Frank’s conjugated bilirubin levels are higher than normal. 5. It’s possible that there is a buildup of bilirubin due to a blockage in either the pancreatic or bile duct. However, since the liver enzymes are fine, it is likely something other than the liver itself causing the issues, but more tests are needed. 6. 7. The pancreas secretes insulin. 8. The liver would be the main organ involved in creating Frank’s jaundiced appearance. 9. The pancreas and the liver are connected, they are involved in managing bilirubin and bile. 10. A lack of insulin in the pancreas or a blockage causing the bilirubin to be unable to exit could be the problem. 11. No. Part V 1. The dark blobs could be tumors. 2. The dark blobs, if tumors, could play a role in the insulin production deficiency by affecting the pancreas. 3. Similarly, these blobs, if tumors, could be affecting the liver such that conjugated bilirubin production is interrupted. 4. The large size of the pancreas could result in blocked bile and pancreatic ducts. 5. If the ducts are indeed blocked, then bilirubin would not be able to make it to the small intestine and would build up in the gall bladder and liver, and then eventually the blood. 6. No, the blocked ducts are causing the issue, the ducts are just blocked by abnormal growth.

Answer 1

Possible Nursing Diagnoses for Frank are:-

1. Sleep deprivation

2. Readiness for enhanced sleep

3. Disturbed sleep pattern

4. Risk for falls related to decreased muscle control as evidenced by shaky hands.

5. Fatigue related to lack of sleep as evidenced by overt tiredness.

6. Ineffective health maintenance related to lack of knowledge as evidenced by untreated type 2 diabetes.

7. Risk for impaired liver function related to biliary obstruction as evidenced by jaundice.

8. Risk for unstable blood glucose level related to Ineffective medication management

9. Risk for Imbalanced nutrition: less than body requirements related to decreased intake as evidenced by lack of appetite.