19TH CASE SCENARIO. (NURSING)RIGHT FOOT DIABETIC ULCERS/INFECTION.

Age 74years female.

Admitted Date: 01/24/2015.Location 5NorthEast.Full code.

Attending doctor: Dr. Don’t Hate.

Diagnosis: Right foot Diabetic/Infected wound.

Secondary Dx: HLD/DM/CVA no deficit/HTN.Right foot wound required amputation. Depression.

Allergy: NKDA

Consultation: General surgery.

Dr.Not Nice.

Infection Disease doctor: Dr. John Wooden.

Right BKA amputation in am.

CHG bath done.

Consent signed after the surgery doctor and anesthesiologist spoke with patient regarding surgical intervention.

NPO after Midnight for surgery in am.

Blood sugar Q6hours while NPO.

Medications:

D51/2NS at 50ml/hour IV Right forearm.

Zosyn 3.375gm IV Q8hrs.

Ambien 1tablet at bedtime prn.

Norco 5/325mg1tablet to 2 tablets po Q4hours prn pain.

Laboratory results.

K =4.0mEqkcl

NA = 140mEqkcl

WBC = 11.3mm3

H/ H = 11.5g/dl

36.8%.

PLAN:

Physical therapy for evaluation and treatment. Patient will be discharge to SNF when medically stable. Case manager and social worker consulted.

Questions :

(1) The doctor orders blood sugar check every Q6hours. Since patient is NPO after midnight. Which of the following reason is blood sugar Q6hours?.

Answer:

(A)Because patient is NPO ,so whenever patient is NPO blood sugar changes to Q6hours instead of Qac+ qhs.

(B )Because that is what it is.

(C) All of the above.

(D) None of the above.

Correct answer: A.

(2)The doctor placed patient on D5NS,which has glucose in it.Why is the placed on dextrose?.

(A)The doctor worry that patient is brittle diabetic, so he is worry that blood sugar might go down.

B The doctor is use to ordering dextrose.

(C )It doesn’t matter.

(D) All of the above.

Correct answer A.

A 65years old female with diagnosis of AKI,Dehydration, secondary diagnosis Dm,HTN,Hypothyroidism, Appendectomy, Right Great toe amputation.

Full code, 5ft 8inches, weighs 170lbs. Admitted to Medical Surgical floor. Admitting doctor. Dr. Nosmile,D.F.Syncope and dizziness during shower.

Allergy: NKDA.

Blood sugar check QAC + QHS.

Diet: Carb Control cardiac diet.

Labs CBC with differential, Chem 7 in am.

(3) What is the full meaning of AKI?.

(A )AKI stands for Acute Kidney injury.

(B) Accurate Knowledge information.

(C )A and B.

(D )All of the above.

Correct answer A.

(4) The doctor orders carb control cardiac diet. What does the nurse understands about this?.

(A )The patient is diabetic and Hypertension, so the doctor considers the patient condition when ordering diet.

(B)Carb control cardiac diet is the same as regular diet.

(C )This is the same as keto diet.

(D) All of the above.

Correct answer A.

(5) List three comorbidities for this patient.

Why did the doctor consult case manager and social worker?.