Type II Diabetes Mellitus The patient has a history of alcohol abuse.

His Hypertension
family history includes his mother having
Increased glucose diabetes, his father having heart disease, his
Metformin, PO, 1,000 mg. Decreases Hypertension causes too Amlodipine, PO, 10 mg
levels in vessels sister having heart disease and diabetes, and his
hepatic glucose production and intestinal much pressure to be daily. Inhibits calcium ion
leads to an brother having cancer, diabetes, and heart
absorption of glucose and improves exerted on arteries and influx across cardiac and
insulin sensitivity (increases peripheral increase in fatty disease (all deceased). The patient also has a
medical history of CAD, HTN, hyperlipidemia, causes small tears. The smooth-muscle cells,
glucose uptake and use (Drug Handbook, deposits or clots in
p. 911). and type II diabetes. body then tries to heal the dilates coronaries arteries
the blood vessel tears with scar tissue, and arterioles, and
Glyburide, PO, 5 mg. Action unknown.
Probably stimulates insulin release from walls, which can which traps substances decreases blood pressure
beta cells, reduces output by the liver, and narrow or block that make up plaque and and myocardial oxygen
increases peripheral sensitivity to insulin vessels in the brain J.W., 78 can lead to blockages,
(Drug Handbook, p. 688). demand (Drug Handbook,
and the neck. Transient blood clots, and hardened,
Humalog, injection, sliding scale dose. p. 124).
Increases glucose transport across muscle
Ischemic Attack weakened arteries.
and fat cell membranes to reduce glucose
level (Drug Handbook, p. 756-757).
Sudden blockage of a cerebral artery by a Heparin, subcutaneous injection, 5,000
thrombus or embolus produces ischemia in the units. Acclerates formation of
Patient didnt have facial droop but did have antithrombin III-thrombin complex and
weakness in his right arm and right leg. He wasnt territory served by the artery. Insufficient
deactivates thrombin, preventing
able to bear weight on his right for very long. His left blood flow to brain tissue results in oxygen conversion of fibrinogen to fibrin
hand also had weakness in his left hand but could still deprivation and rapid cerebral deterioration. In (Drug Handbook, p. 697-698).
use it, although I did have to help him use his urinal. some cases, the obstructing clot is efficiently
All cranial nerves appeared to be intact and he wasnt lysed by the endogenous fibrinolytic system
experiencing any confusion or difficulty with speech before permanent tissue damage occurs. If the The patient was really frustrated at his lack of
or swallowing. associated neurologic deficits completely mobility, especially since he had never had
Priority Nursing Diagnosis (3 parts) resolve, the episode is called a transient problems with weakness until the previous
Impaired physical mobility related to neuromuscular involvement as ischemic attack (Banasik and Copstead, p. weekend. He got emotional when we were
evidenced by decreased muscle strength and control (Doenges, p. 244). 913). talking about his two dogs and I could tell he
Measurable outcome w/ timeframe: Client will demonstrate techniques and
behaviors that enable resumption of activities of daily living before really missed them. He was also upset that he
This patient would benefit from learning and his wife had to miss their vacation to
discharge. about how to modify his diet and lifestyle,
Nursing interventions you used with rationales: Emerald Isle next week. He liked having
sine he does have several conditions that company in his room so I tried to go in and
1) Assessed functional ability and extent of impairment initially and on a
can lead to cerebral vascular attack. He check on him/talk to him as much as I could. I
regular basis. This identifies strengths and deficiencies and may provide
information regarding recovery (Doenges, p. 244). would also benefit from the importance of was also mindful to reassure him when he got
2) Observed affected side for color, edema, or other signs of compromised compliance with his medications and upset and to encourage him about physical and
circulation. Edematous tissue is more easily traumatized and heals more recognizing signs and symptoms of stroke
occupational therapy.
slowly (Doenges, p. 245). or myocardial infarction, since he is at risk
3) Inspected skin regularly, particularly over bony prominences. Pressure for both. He also mentioned that he takes a
points over bony prominences are most at risk for decreased perfusion and pill for erectile dysfunction, so it would be On 10/5, the patients triglyeride level
ischemia (Doenges, p. 245). important for him to know that certain ED
Evaluation: Goal partially met. The client was able to feed himself with his was elevated at 505, cholesterol was
drugs can cause severe orthostatic elevated at 237, cholesterol/HDL ratio
left hand (which is normally not his dominant hand) that afternoon, but he hypotension when taken with
still wasnt able to use his urinal by himself or wash himself up. was elevated at 5.6, LDL was elevated at
hypertension medications. 1
147, and hemoglobin A1C was elevated
at 6.8.
 Guide for Reflection
Guide for Reflection Using Tanners (2006) Clinical Judgment Model

Program Thread: Communication and Collaboration

This week, I was able to observe while one of my patients had an endoscopy echocardiogram done. I was so
excited to get to observe because while Ive been able to watch wound care and a few other procedures that nurses have
done on our unit(s), I havent had the opportunity to observe a procedure done by a doctor. The team that did the procedure
(which consisted of a doctor, an RN, and a tech) was amazing and they were so nice to me while I was there. The RN
especially took time to explain to me what they were doing and why. I noticed also that while the three of them seemed to
move through the procedure in sync with each other, communication was also essential between them. The RN had to
communicate to the doctor if the patients BP was elevating or dropping, or if his heart rate was getting too high or too low,
and if his oxygen saturation was dropping. The doctor also had to communicate to the tech when to capture the images of
the patients heart so they had a lot of different pictures with which they could work. It was so fun to watch this procedure,
to be there with my patient while he was having it, and to learn from all of them while I was there.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment
Model. Journal of Nursing Education, 46(11), p. 513-516.

List two goals for the next practicum experience:

1. To administer medications safely, confidently, and efficiently.
2. Do an EKG if we have the opportunity.