nursing question

Case Study

NSF, 74-year-old, Native American male, arrived to the office, accompanied by his wife, she explained NSF has been complaining about weakness, confusion, getting up to use the bathroom multiple times at night, and intermittent blurred vision when he is reading the newspaper for the past couple of weeks. NSF states, I feel thirsty & hungry but I am too tired to

get up to get a glass of water. My mouth is dry.

Mrs. NSF states they are usually active, riding bikes, hiking, gardening & traveling. But the past 2-3 weeks NSF has not felt like exercising or going anywhere. Approximately 6 weeks ago, NSF was hospitalized for pneumonia.

General Overview: Obese male in no acute distress, alert & oriented with complaints of weakness & feeling tired, thirst, dry mouth, nocturia, blurred vision with reading.

Vitals reported by MA: BP 160/86, P 88, RR 16, HT 5’7”, WT 208lbs

Allergies: Penicillin

Current Medications: Tumeric, IBP 800mg / onset of Great toe pain

Past Medical History includes: Pneumonia, Cholecystectomy, & Gout. Vaccinations up to date. 2 doses Pfizer for COVID, 2021.

FH: mother deceased due to stroke, father deceased due to MI, 2 children no health issues, 4

siblings. 2 sibling MI, 1 surgery for stents, 1 sibling pancreatitis, 1 sibling gout.

SH: Retired computer programmer, married, 2-3 beers weekly, smoked cigarettes for about 5 years in 20’s, no illicit drug use.

Physical Exam -

HEENT: normocephalic, thinning hair. Bilateral eyes, sclera white, prescription reading glassing. Bilateral Tympanic membranes gray & intact. No tenderness tragus & pinna. Bilateral nares no exudate. Neck supple. No lymphadenopathy. Thyroid midline, small & firm, no palpable masses.

Cardiovascular: S1 & S2 RRR, no rubs or murmurs. Respiratory: bilaterally clear to auscultations.

Abdomen: soft, round, no tenderness reported, BS x 4 quads, No bruits. + Bilateral pedal pulses, Great toes no inflammation or swelling. Diagnostics:

EKG: NSR

Laboratory Values –

UA:

pH 5.1 RBC (-) Leukocyte esterase (-) Nitrates (-) Glucose 2+ Protein: small Ketones (-) Complete Blood Count - RBC 4.2 million

HGB: 12.6 gm/dl MCV 86 fl MCHC 36 g/dl RDW 13.6% WBC: 5,600/mm3 CMP –

NA+ 140 K+ 4.2

HCT: 42%

Chloride 100 Glucose 98 BUN 12 Creatinine 1.94

GFR est non-AA 90 mL/min1.73 GFR est AA 101 mL/min/1.73 CA 9.5 Total Protein 7.8 Bilirubin total 0.6 Alkaline phosphatase 74 AST 30 ALT 28 Bun/Creatinine 10 Lipid Panel – LDL-C 138 mg/dL

HDL-C 55 mg/dL Total-C 240 mg/dL triglycerides 218 mg/dL Thyroid – Free T 40.0 TSH 2.33 HbA1c, 7.6%