A nurse in an emergency department is caring for a 52-year-old male client.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Rationale:

A. They promoting renal excretion of sodium and glucose: SGLT-2 inhibitors block the sodium-glucose co-transporter in the proximal renal tubules, reducing glucose reabsorption and increasing urinary glucose excretion. This leads to lower blood glucose levels and mild natriuresis, which also contributes to blood pressure reduction.

B. They reduce hospitalizations by decreasing blood glucose levels through increasing insulin through the pancreas: SGLT-2 inhibitors do not act on the pancreas or increase insulin secretion. Their glucose-lowering effect comes from preventing renal reabsorption of glucose rather than stimulating insulin production.

C. They increase the cardiac output by strengthening heart contractions: Although SGLT-2 inhibitors have shown cardiovascular benefits, they do so through mechanisms such as osmotic diuresis and reduced cardiac workload, not by increasing cardiac output directly.

D. They decrease blood pressure by vasodilating peripheral vessels: While SGLT-2 inhibitors may lower blood pressure modestly, the mechanism is not through vasodilation. Instead, it is primarily related to osmotic diuresis and sodium loss, which reduce intravascular volume.

Rationale:

A. The patient took the prescribed metformin today: Metformin should be withheld before contrast dye procedures because it increases the risk of lactic acidosis if renal impairment occurs. This would likely lead to rescheduling the angiogram until the drug is cleared.

B. The patient's blood glucose is 128 mg/dL: A glucose level of 128 mg/dL is within an acceptable range for a diabetic patient and would not require postponing the procedure.

C. The patient's most recent A1C was 7.5%: An A1C of 7.5% shows moderately controlled diabetes, but it is not an immediate contraindication to proceeding with an angiogram.

D. The patient took the prescribed enalapril 4 hours ago: ACE inhibitors such as enalapril are commonly continued unless specifically contraindicated. This does not typically warrant delaying the procedure.