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CASE STUDY: STUDY THE CASE AND FILL OUT THE SECTION ON LABORATORY & DIAGNOSTIC TESTS Pathophysiology and Nursing Implications of Admitting Diagnosis (Be sure this is a nursing diagnosis not a symptom.) (10 points) Pathophysiology & Impact on the Plan of Care for Health Condition 1 Pathophysiology: This patient is a 73-year-old male Caucasian with admitting diagnosis of hypoxic respiratory failure and COVID 19 pneumonia. The pathophysiology is marked by inflammation-mediated disruptions in alveolar-capillary permeability, formation of oedema, lowered alveolar clearance and collapse/de-recruitment, lowered compliance, elevated pulmonary vascular resistance, and resultant gas exchange abnormalities due to shunting and ventilation-perfusion mismatch. The gas exchange impairment in this case was because of the consequences of the changes to alveolar structure and histology that occur due to the pathogenesis of pulmonary damage and repair in acute respiratory distress syndrome (ARDS). (Swenson et al., 2021). It is worth noting that this patient had not been vaccinated against COVID-19 and was therefore more susceptible than the general population. Also, in consideration of his Age, and secondary diagnoses of Type 2 diabetes mellitus, liver cirrhosis and chronic kidney disease (CKD) stage 3, the patient was more susceptible to both acquisition of the COVID 19 and increased severity of symptoms. Impact on the Plan of Care: The patient was on supplemental oxygen for the respiratory failure due to covid 19. His tolerance on oxygen was monitored with a view of weaning off the oxygen in preparation for discharge. The overall plan of care was complex and difficult to isolate only for a particular disease process as there were simultaneous disease processes ongoing. For instance, the patient experienced hypertension, headache, confusion, and speech abnormalities consistent with an expressive aphasia, an MRI demonstrated several subacute infarcts in multiple territories, large left sided infarct, and smaller right sided infarct. He was seen by neurology for stroke and treated with aspirin and statin. CT showed complete occlusion of the right ICS. MRI then showed extensive Ischemic changes in the left medial temporal lobe, left occipital love, left basal ganglia, and corpus callosum and right periventricular region, no hemorrhage, no brain herniation. EKG showed sinus rhythm. In the treatment course of clinical management of COVID-19, the disease process progressed to the onset of ischemic stroke, even though pneumonia might frequently occur as a complication of stroke. In this case report, I depict a 73-year-old man who was hospitalized for COVID-19 pneumonia and later diagnosed with right limb weakness and was later diagnosed with acute extensive ischemic stroke in multiple territories. The relative roles of aging process, oxidative stress, endothelial dysfunction, inflammation status, and other vascular risk factors could have contributed to the stroke however, the OVID-19 hypoxemia and inflammation could contribute to the occurrence, development, and prognosis of ischemic stroke (Zhai et al., 2020). The plan of care was to include speech therapy. occupational Therapy and the use of aspirin and statin. Pathophysiology and Impact on the Plan of Care for Health Condition 2 (10 points) Pathophysiology Studies have shown increased severity COVID-19 in patients diagnosed with diabetes mellitus moreover, COVID-19 itself has also been associated with hyperglycemia in infected individuals (Lim et al., 2021). The interaction of hyperglycemia with other risk factors, may modulate immune and inflammatory responses, resulting to increased severity of COVID-19. In cases with hyperglycemia, insulin is the recommended main approach to its control and the proper control of blood glucose through monitoring and effective management are crucial. This patient was also diagnosed with CKD and liver cirrhosis which are likely to have resulted to increased severity of COVID-19 compared to patients without CKD. The explanation for this is likely attributable to the attenuated immune system activation leading to a higher susceptibility to COVID-19 infections including severity in patients with CKD and/or malignancies. (Jdiaa et al., 2022). Impact on the Plan of Care: The patient was on monitoring of blood sugars 4 times a day, Insulin therapy for the type 2 Diabetes Mellitus (DM). Also, his diet and meals were per the diagnosis of DM as a cornerstone of therapy. To reduce microvascular complications, the treatment goal was to achieve a Hb A1C of less than 7%. For the lipid panel, the goal of therapy was an LDL-C less than 100 mg/dl, and the drug of choice is a statin for reasons that these drugs reduce cardiovascular events and related mortality (Goyal and Jialal, 2021). Other comorbidities were managed per protocols. LABORATORY & DIAGNOSTIC TESTS Explain 5 significant abnormal laboratory &/or diagnostic test results (Bloodwork, cultures, EKG, X-Rays, etc.) Include nursing implications and how you would explain the results to the patient. Test Name/ Result & Normal Range Discuss abnormal results (Provide reference(s)) GlucosePoint-of-care testing (POCT)= 190 mg/dL(High) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. Hemoglobin A1c (results are pending) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. 3.Platelets= 105× 109 /L (patient has liver cirrhosis) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. 4. Hemoglobin = 7.6g/dL (Anemia) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. 5. stool for occult blood(Rule out GI bleeding) =No occult blood Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient.
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