Neurologic Case Study

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus
• Medications: Lisinopril, Metformin
• Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

Which condition is the patient most likely experiencing?

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus, Atrial Fibrillation
• Medication History: Lisinopril, Metformin, Apixaban

Presenting Complaint:

• The patient was admitted to the hospital with shortness of breath, fatigue, and swelling in his legs. He reported a weight gain of 5 pounds over the past week.

Vital Signs on Admission:

• Blood Pressure: 160/95 mmHg
• Heart Rate: 110 bpm (tachycardia)
• Respiratory Rate: 24 breaths/min (tachypnea)
• Temperature: 98.6°F (37°C)
• Oxygen Saturation: 86% on room air

Physical Examination:

• General: Appears anxious and fatigued.
• Cardiovascular: Irregular heart rhythm
• Respiratory: Diminished breath sounds, crackles in lung bases bilaterally
• Abdomen: Soft, non-tender, no distension
• Extremities: Bilateral pitting edema (2+)

Diagnostic Tests:

1. Echocardiogram: Confirmed reduced ejection fraction (EF of 35%)
2. Chest X-ray: Showed cardiomegaly and bilateral pleural effusions
3. Electrocardiogram (ECG): Atrial fibrillation noted
4. B-type Natriuretic Peptide (BNP): 800 pg/mL
5. Arterial Blood Gas (ABG): pH 7.35, PaCO₂ 45 mmHg

Which of the following prescribed interventions would the nurse complete first?

Patient Profile:

• Name: Mr. John Smith
• Age: 68 years
• Medical History: Osteoarthritis of the hip, Type 2 diabetes, hypertension, and atrial fibrillation
• Current Medications: Lisinopril, Metformin, Warfarin
• Surgical Procedure: Total hip replacement (THR) due to severe pain and limited mobility.

Preoperative Care:

• The nurse conducts a comprehensive assessment, including a physical examination, vital signs, and a review of Mr. Smith's medical history.
• Preoperative labs are ordered with the following abnormal values noted:
  • Complete Blood Count (CBC):
    1. Hemoglobin: 12.0 g/dL (normal range: 13.5-17.5 g/dL)
    2. Hematocrit: 36% (normal range: 38.8-50%)
  • Basic Metabolic Panel (BMP):
    1. Serum Creatinine: 3 mg/dL (normal range: 0.6-1.2 mg/dL)
    2. Blood Urea Nitrogen (BUN): 24 mg/dL (normal range: 7-20 mg/dL)

• • Coagulation Studies:
    1. INR: 5 (normal range: 0.8-1.1)

Intraoperative Care:

• The scrub nurse assists in positioning Mr. Smith on the operating table.
• The surgical team completes the time-out procedure.
• The surgeon states the estimated blood loss at 300 ml.
• The anesthesiologist reports a stable blood pressure of 120/64.

Postoperative Care:

• Mr. Smith is transferred to the Post Anesthesia Care Unit (PACU) for close monitoring of his recovery from anesthesia.
• Once fully recovered from surgery, Mr. Smith is transferred to the orthopedic unit where the orthopedic unit nurse starts the ordered morphine PCA.

Which medication should be held before surgery? Select all that apply.