Posted: May 27th, 2015

Patient case study

Patient case study
Georgina Lawson is a 55 year old IT consultant for the Adelaide City Council and has been admitted to the ward for investigation of a suspected urinary tract infection and possible renal failure. She saw her GP 3 days ago who prescribed her Trimethoprim. She presented herself to ED at midnight.
She is married and has 3 children ranging in age from 17-22. She works long hours and rarely gets home before 8 o’clock. She lives in Greenwith, has a mortgage and her husband works night duty as a cleaner since being made redundant during the global financial crisis.
Georgina was first diagnosed with type 2 diabetes mellitus when she was 40 years of age. She initially managed to control her sugar levels with diet and exercise. However in the last 12 years, when she returned to work, she has found it increasingly hard to control her glucose levels. She admits that she loves food and has trouble saying no to treats or several glasses of alcohol. Her long hours at work and busy lifestyle mean that she finds very little time for exercise. She often buys take away food or eats out at restaurants.
Discuss the following areas.
Q-1 Nursing assessment
What data will you collect as a basis for your nursing assessment of Georgina? What questions would you ask? Why? What types of information are you trying to elicit? What factors have put Georgina at risk of this disease? Why?
Q-2 Explore the aspects below in relation to Georgina’s case and discuss in detail:
Hypertension
600 ml fluid restriction
Stat glucose and insulin prescription
Deep breathing pattern O/A

Q-3 Medication management
Pharmacodynamics: What, when, how, contraindications, special nursing considerations, interactions. Pharmacokinetics—absorption, distribution, metabolism and excretion, remembering her possible diagnoses.
Georgina is prescribed Metformin 100 mg BD and Trimethoprim 200 mg nocte. Discuss the implications of giving these medications to Georgina with reference to the pharmacodynamics and pharmacokinetics of each medication.
How would Georgina’s Pharmacology be different if her BMI was 45?

Q-4 Signs and symptoms in relation to diabetes and urinary tract infection

Q-5 Are Georgina’s signs and symptoms consistent with a patient who has a urinary tract infection? List the signs and symptoms of a urinary tract infection; acute and chronic renal failure

Q-6 Chart Georgina’s vital signs on a graphic chart—does this make you respond to her symptoms differently?

Q-7 Please explain the pathophysiology in detail of one of the following as it applies to Georgina.
Acute renal failure as related to her Type 2 Diabetes Mellitus (T2DM)
Explain why you believe that she has acute or acute on chronic renal failure and explain the pathophysiology of three (3) signs and symptoms that Georgina has presented with to support your belief.
OR
Chronic renal failure as related to her Type 2 Diabetes Mellitus (T2DM)
Explain why you believe that she has chronic renal failure and explain the pathophysiology of three (3) signs and symptoms that Georgina has presented with to support your belief.

Note: the signs and symptoms must be relevant and specific to Georgina. Thus you will need to investigate how this disease/illness affects adults with type 2 diabetes mellitus, not type 1 diabetes mellitus.
How would Georgina’s pathophysiology be different if her BMI was 45?
Q-9 List the differences between acute and chronic renal failure.
Q-10 List the signs and symptoms of diabetes type 2.
Q-11 Outline focal points of connections of renal functions and the complexity of diabetes type 2.
Q- 12 Advocating for your patient

How would you present all the data you have collected to the medical team to support or negate their diagnosis, and ensure best outcomes and treatment for your patient?