I am new here, so please be gentle. So below me I have a case scenario, my assessment is to pick the highest priority out of 5 clinical problems. At first I was going to choose Problem #4 altered blood glucose level .
The reason , because dehydration will take a few hours to rectify, he needs more urgent treatment because he has already got paralysis, his altered BGL is the reason for all the problems listed. I feel that once that is addressed then all other problems will be like a domino effect.
As you can see from below I have changed my intervention to addressing dehydration instead. I had queried this with other uni students and most seem to think that dehydration is it!!
They said I was diagnosing the fact that he may have HHNS when he may be on his way to that state but isnt yet.
The question is to justify my reasoning of why dehydration is of the highest priority, I guess I'm just reaching out for a second opinion, after all if I can justify with a decent rationale then I'm sweet.
Cheers Sian
CASE SCENARIO
Mr George Brown, a 45-year-old male, has been admitted to a ward and has undergone a limb revascularization procedure following experiencing severe leg pain on his anterior right lower leg. The following data were obtained on admission: Subjective data: (reported by Mr Brown's friend) - Diagnosed with type 2 diabetes mellitus 2 years ago - Diagnosed with peripheral arterial disease (PAD) 1 year ago - 2 year history of hypertension - 10 year history of smoking - Taking oral hypoglycaemic medications and anti-hypertensive medications Reported by Mr Brown: - Feeling 'weak' with nausea and vomiting 2 days prior to admission (don't know what has caused him to feel like this) - Extremely thirsty (caused by the dehydration which in turn caused by vomiting and also hyperglycaemia would be aggravating his fluid loss)
- Foot and leg ache continually -( better at rest) (Dehydration causing hypotension which decreases blood flow to the periphery, aggravating the effects of his PAD)Objective data: - Drowsy but can be roused (dehydration) - Dry mouth (dehydration) - Skin dry and warm with decreased turgor (dehydration) - Weight 132 kgs - Height 170 cms - Blood glucose level 21mmol/L (will be increased due to reduced volume of water in his blood - hence increased concentration of all elements in the blood) - Serum potassium level 6mmol/L (as above) normal range 3.5-5.0 mmol/l - Lipid profile: total 253 mg/dl; LDL 91 mg/dl; HDL 25 mg/dl; triglycerides 423 mg/dl (as above) - Diminished peripheral pulses (aggravated with hypotension which accompanies severe dehydration) - Ankle-Brachial Index 0.4 (severe PAD) normal 0.90-1.30, decreased peripheral blood flow due to severe hypotension in a patient with PAD.Previous hospital admission for: - Hyperosmolar Hyperglycaemic Nonketotic Syndrome (State) 2 months ago (>34mmol/l) - ST-segment elevation myocardial infarction 12 months ago Social: - has 3 children visiting, who live with ex-wife - has been working as a real estate agent 20hrs/wk ASSESSMENT Mr Brown presents with multiple clinical problems. Five of Mr Brown's problems are: 1. Altered serum potassium level 2. Dehydration 3. Decreased level of consciousness 4. Altered blood glucose level 5. Paraesthesia (abnormal feelings i.e. pins and needles) and paralysis (loss of ability to move one or all limbs)
