Question

Hormonal Regulation Unfolding Case Study

A 62-year-old patient is being seen for admission at their home by the home health nurse. The patient was released from the hospital today after a 6-day inpatient stay for new onset Type II diabetes and dehydration. The patient is crying and states that they are feeling overwhelmed by all their new medications and discharge instructions. The patient states that they are having trouble seeing and doesn’t think they can give themselves an insulin injection. The patient has a health history of morbid obesity, congestive heart failure, hyperthyroidism, celiac disease, osteoarthritis, depression, and breast cancer. The nurse assessed the patient’s discharge medication list to include Humulin 70/30 40 units su bcut q AM and 20 units sub cut q PM, Lantus 10 units sub cut q AM, furosemide 40 mg one PO BID, potassium chloride 40 mEq one PO daily, tamoxifen 5 mg PO daily, Colace 100 mg one po daily, celecoxib 100 mg one PO BID, aspirin 81 mg one PO daily and duloxetine 30 mg one PO BID. Vital signs are BP 150/90, P 108, R 26, T 97.4 °F. The patient states they feel nervous and weak. Skin is cool and diaphoretic. Blood glucose reads 48 mg/dL on the glucometer. The patient asks for the nurse’s help to find her glasses.
1. Which of the following patient assessment findings require immediate follow-up? (Select all that apply.)
1. History of morbid obesity
2. BP 150/90
3. Furosemide 40 mg one PO BID
4. "feels nervous and weak"
5. Blood glucose 48 mg/dL
6. Skin is cool and diaphoretic
7. Pulse of 108
8. Humulin 70/30 40 units subcut q AM

Answer 1

Immediate medical follow-up is required for the patient's symptoms of feeling nervous and weak, blood glucose level of 48 mg/dL, cool and diaphoretic skin, and an elevated pulse rate of 108, indicating possible hypoglycemia.

Step-by-step explanation:

The following patient assessment findings require immediate follow-up:

• "feels nervous and weak" - These are symptoms that could indicate a serious underlying condition and warrant further investigation.
• Blood glucose 48 mg/dL - This is considered hypoglycemic and could be a medical emergency if not treated promptly.
• Skin is cool and diaphoretic - Cool, clammy skin can be a sign of shock or other serious conditions, especially in the context of hypoglycemia.
• Pulse of 108 - Tachycardia could be an indicator of dehydration, stress, or other health issues.

The patient’s reported symptoms of feeling nervous and weak, in combination with a low blood glucose level, tachycardia, and cool, diaphoretic skin suggest that she might be experiencing hypoglycemia, which can occur during insulin therapy. Considering these signs and symptoms, the administration of Humulin 70/30 needs to be reassessed immediately.