CASE STUDY ON LACTIC ACIDOSIS

NAME: __________________ CLASS: __________________ DATE:
_______________
Case Study
All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not
assume information that is not provided. Please print or write clearly. For every question,
please support your answer using reference to a source (i.e.: textbook), including in-text
citations and a reference page in APA format.
Scenario
Mrs. Jones is a 69-year old female coming in for her annual check-up visit
with her primary care provider, Dr. Spencer. She is accompanied by her
daughter. The nurse takes the following measurements on Mrs. Jones
before bringing her into the patient room.
Height: 5’1”
Weight: 150 lbs.
Pain: 0/10
Blood Pressure: 170/102
O2Sa: 92%
Respirations: 20 rpm
Pulse: 78 bpm
Temperature: 98.9 F
As the nurse reviews Mrs. Jones’s chart, she notes the following pre-existing
diagnoses:
Type II diabetes mellitus (DM) for 11 years
Chronic obstructive pulmonary disorder (COPD) for 17 years
Hypertension (HTN)
Atrial fibrillation
Hypothyroidism for 32 years
Osteoporosis
Depression for 2 years
The following are assessment findings by the nurse:
Extremities:
2+ pitting edema in lower extremities bilaterally
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Abdomen:
Liver palpable 3 cm below right costal margin
Non-tender to palpation
Bowel sounds present x4 quadrants
Respiratory:
Wheezing
SOB upon exertion, none at rest
CVS:
No jugular distention
Normal S1/S2
Cap refill <3 seconds
No clubbing
Skin cool to touch
Neuro:
No localized or sensory deficits
Patient appears sad, with trouble sleeping
Acting holistically, the nurse recognizes the importance of taking a thorough
patient history:
Mrs. Jones has smoked 1ppd for over 25 years. She occasionally has an
alcoholic beverage like red wine 2-3 times per week in social settings. She
tells the nurse that she tries to go on walks, but does not like to go alone so
has only gone occasionally. Mrs. Jones had a hysterectomy at age 50, but
has no other surgical history. She states no food or medication allergies. Mrs.
Jones is a recent widow. Her husband of 47 years passed away 8 months ago
from a severe stroke. Mrs. Jones has been living alone since her husband’s
death in the house that they have owned together for the past 25 years. Her
daughter, Mrs. Nader, lives 10 minutes away and checks in on her mother
daily by phone and visits every few days to help with housework. Mrs. Jones
still has her driver’s license and is able to take trips to the store
independently. She particularly enjoys attending her Baptist Church every
Sunday and takes part in the choir. Mrs. Jones has 2 other daughters who
have recently moved to different states, and she mentions that it has been
difficult adjusting to her children moving away. Mrs. Jones says that she has
been feeling sad lately and has been having difficulty sleeping at night. She
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does not know what to do without her husband, and is still grieving the loss.
Her daughter mentions that Mrs. Jones used to play bingo with a group of
friends every Tuesday, but she is no longer attending the gatherings. The
daughter, Mrs. Nader, is concerned about her mother’s emotional and
psychological well-being.
During the admission interview, the nurse makes a list of all the
medications Mrs. Jones takes at home.
Medication List
Zestril (lisinopril) 40 mg PO qd
Combivent (ipratropium bromide and albuterol sulfate): 2 inhalations qid
Advair Diskus 250/50: 1 inhalation q2d bid
Synthroid (levothyroxine) 112 mcg PO qd
Glucophage (metformin) 500 mg PO bid
Coumadin (warfarin) 5 mg PO qd
Question:
Fill out the following table regarding Mrs. Jones’s medication list
Medication
Class
Mechanism of
action Use Side Effects
Zestril
(lisinopril)
Pharmacologi
c: ACE
inhibitors.
Therapeutic:
antihypertens
ives
Angiotensin-
converting
enzyme
(ACE)
inhibitors
block the
conversion of
angiotensin
I to the
vasoconstrict
or
angiotensin
II. ACE
inhibitors also
Lowering of
BP in
hypertensive
patients.
Increased
survival and
decreased
symptoms in
patients with
heart failure.
Increased
survival after
myocardial
infarction.
dizziness,
fatigue,
headache,
weakness,
cough,
hypotension,
chest
pain,
abdominal
pain, diarrhea,
nausea,
vomiting,
erectile
dysfunction,
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prevent the
degradation
of
bradykinin
and other
vasodilatory
prostaglandin
s. ACE
inhibitors also
increase
plasma renin
levels and
decrease
aldosterone
levels. Net
result is
systemic
vasodilation.
impaired renal
function,
rashes,
hyperkalemia,
ANGIOEDEMA.
Coumadin
(warfarin)
Therapeutic:
anticoagulant
s
Pharmacologi
c: coumarins
Interferes
with hepatic
synthesis of
vitamin K-
dependent
clotting
factors (II, VII,
IX, and X).
Prevention of
thromboemb
olic events.
cramps,
nausea,
dermal
necrosis,
BLEEDING,
fever.
Combivent Therapeutic:
allergy, cold,
and cough
remedies,
bronchodilato
rs
Pharmacologi
c:
anticholinergi
cs
Maintenance
therapy of
reversible
airway
obstruction
due to COPD,
including
chronic
bronchitis
and
emphysema
Adjunctive
management
of
bronchospas
m caused by
asthma
dizziness,
headache,
nervousness,
blurred vision,
sore throat,
epistaxis,
nasal
dryness/irritati
on,
bronchospasm
, cough,
hypotension,
palpitations,
GI irritation,
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nausea, rash,
allergic
reactions.
Advair Diskus
Therapeutic:
anti-
inflammatorie
s (steroidal)
Pharmacologi
c:
corticosteroid
s
Potent,
locally acting
anti-
inflammatory
and immune
modifier.
Decreases
frequency
and severity
of asthma
attacks.
headache,
dizziness,
dysphonia,
hoarseness,
oropharyngeal
fungal
infections,
nasal
stuffiness,
rhinorrhea,
sinusitis,
bronchospasm
, cough, upper
respiratory
tract infection,
wheezing,
diarrhea,
adrenal
suppression
(high-dose,
long-term
therapy only).
Synthroid
(levothyroxin
e)
Therapeutic:
hormones
Pharmacologi
c: thyroid
preparations
Replacement
of or
supplementat
ion to
endogenous
thyroid
hormones.
Principal
effect is
increasing
metabolic
rate of body
tissues:
Promote
gluconeogen
Replacement
in
hypothyroidi
sm to restore
normal
hormonal
balance.
Suppression
of thyroid
cancer.
Usually only
seen when
excessive
doses cause
iatrogenic
hyperthyroidis
m,
headache,
insomnia,
irritability,
angina
pectoris,
arrhythmias,
tachycardia,
abdominal
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esis, Increase
utilization
and
mobilization
of glycogen
stores,
stimulate
protein
synthesis,
Promote
cell growth
and
differentiatio
n, Aid in the
development
of the brain
and CNS.
cramps,
diarrhea,
vomiting,
sweating,
hyperthyroidis
m,
menstrual
irregularities,
heat
intolerance,
weight loss.
Glucophage
(metformin)
Therapeutic:
antidiabetics
Pharmacologi
c: biguanides
Decreases
hepatic
glucose
production.
Decreases
intestinal
glucose
absorption.
Increases
sensitivity to
insulin.
Maintenance
of blood
glucose.
abdominal
bloating,
diarrhea,
nausea,
vomiting,
unpleasant
metallic taste,
hypoglycemia,
LACTIC
ACIDOSIS,
decreased
vitamin B12
levels.
Question:
Mrs. Jones goes on to ask whether there is anything else she should do to
help with her HTN. She asks, “Do I need to lose weight?” Look up her height
and weight for her age on a body mass index chart.
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