brain

Case Study - Endocrine

Mr. Joel Miller is a 53 year old Caucasian male who has arrived at the emergency department at 0745 following a fall. He has a three inch laceration on his right forehead. He complains of abdominal pain (7/10 and dizziness. Mr. Miller tells you that he is a Jehovah’s Witness.

General data:

Allergies: Sulfa (angioedema), Penicillin (rash)

Height: 5’11” Weight: 112 kg

Vital signs: T-98.8 oral, HR-74, BP-146/78, RR-20

Past medical history:

History of hypertension, coronary artery disease, bipolar disorder

Smokes one pack of cigarettes per day

Denies alcohol or drug use

Past surgical history:

Tonsillectomy (as child)

Cholecystectomy (2001)

Right knee arthroplasty (2018)

Assessment:

Neurological – Drowsy and oriented x4, full range of motion all extremities, pain at laceration site, complains of dizziness

Respiratory – Lungs clear, mild shortness of breath, equal chest expansion

Cardiac – Heart rate regular, denies chest pain or pressure

Gastrointestinal – Abdomen is soft, non-tender, non-distended, bowel sounds present all quads

Genitourinary – Voids clear yellow urine via urinal without difficulty

Mr. Miller is admitted for observation with the following orders:

Vital Signs: Every 4 hours

Diet: Cardiac

Activity: Out of bed with assist

Labs: CBC, Metabolic Profile, Urinalysis

IV Fluids: 0.9 NaCl at 75 mL/hour

Daily wound care: Cleanse with normal saline, apply gauze dressing

Medications:

Multivitamin 1 tablet PO daily

Lisinopril 10 mg PO daily

Simvastatin 40 mg PO daily

Lithium 600 mg PO BID

Upon arrival to the medical-Surgical unit the nurse obtains the following data:

Vital Signs: T-38.8 Oral, HR-102, BP-148/52, RR-22, 92% on room air

Intake and Output

Time	Intake	Output
0800	800	1600
1200	500	1200

Serum Laboratory Data

Glucose	Osmolality	Potassium	Sodium	Magnesium	Phosphorus	Anion gap	Blood Glucose
98 mg/dL	320 mOsm/L	3.0 mEq/L	135 mEq/L	2.0 Mg/dL	3.8 Mg/dL	12	586

Urine Laboratory Data

Urine Osmolality	Urine ketones
584 mOsm/L	positive

Questions

1. What data will be reported to the healthcare provide (HCP)?

2. What does the data suggest might be happening with Mr. Miller?

3. Describe the pathophysiology of the endocrine disorder in question?

4. What clinical manifestations are expected?

5. What other diagnostic test might be ordered? Explain nursing considerations with additional diagnostic tests.

6. What will the physician order for the treatment of this endocrine disorder?

7. What nursing interventions will be included in the plan of care for this client as related to the endocrine disorder?

8. What complications will the nurse monitor for?

9. What client education is needed?

03/2020 SMM