Evelyn Hansen Case Study: Assessment Answer

Nursing Case Study Assignment Help:

Date: 13.8.2018 Time: 0930 hrs

PATIENT: Evelyn Hansen, 64 year old female

Obese woman: Height: 155cm, Weight: 102 kg

BACKGROUND: Patient was brought in by ambulance two days ago with decreased level of consciousness. Blood glucose taken via blood sample was 44.2 mmol/L.

VITAL SIGNS ON ADMISSION TO ICU:

RR 36 breaths/min SpO

2

88% RA – 92% 2L O

2

NP HR 110 beats/min BP 92/58 mmHg Temp 37.8 ?C orally

PMHx Diabetes Mellitus type 2 diagnosed 10 years ago. Osteoarthritis Depression Obesity Hypertension Leg ulcer on right lower leg

MEDICATIONS: Metformin hydrochloride 1g BD Tritace 5mg mane Ceftriaxone 1g IV BD Heparin 5000i.u. BD

ALLERGIES: NKA

SOCIAL: Married – lives with husband 3 daughters and 2 sons

Integrated Nursing Practice: Spring session University of Technology Sydney

INVESTIGATIONS CONDUCTED DURING ICU ADMISSION:

CXR – NAD ECG – Sinus tachycardia

Blood Pathology (normal values in parentheses)

Glycosylated Haemoglobin (HbA1

c)

11% (6.5% - 7.0%) Full Blood Count (FBC) Haemoglobin (Hb) 138 g/L (115 – 160 ?, 130 –180 ?) White cell count (WCC) 9.8 x 109/L (4.0 – 11.0) Platelet count 170 x 109/L (150 - 400)

Urea Electrolyes Creatinine (UEC) Creatinine 205 umol/L (70 – 150) Na+ 165 mmol/L (135 -145) K+ 3.0 mmol/L (3.5 -5.0) Blood Urea Nitrogen (BUN) 8.5 mmol/L (2.9 - 8.2)

Serum osmolality 336 mOsmol/kg (280 - 295) HCO

3

21.6 mmol/L (22 – 26)

Urine analysis (U/A):

Specific Gravity (SG) 1.035 (1.005 to 1.025) pH 6.2 (4.5 – 7.2) Glucose ++++, Ketones –ve Leucocytes ++

DIAGNOSIS: Hyperosmolar Hyperglycaemic Syndrome (HHS) due to UTI

TREATMENT IN ICU:

Fluid replacement Insulin Infusion Heparin IV antibiotics

ONGOING TREATMENT REQUIRED:

Admission to medical surgical unit Continue IVT, IVAB, S/C Heparin Monitor BGL and administer insulin as charted Diabetes education Wound CNC consult - leg ulcer on right lower leg