Case Study: Elderly Patient with Diabetes, Hypertension, and Breast Cancer

Case Study: Elderly Patient with Diabetes, Hypertension, and Breast Cancer

Mrs. Adams, a 68-year-old widow who was referred to case management upon discharge from the hospital based on her physician’s recommendation that she is not able to care for herself independently. Her diagnosis is diabetes, hypertension, and breast cancer. She is 5 days’ post-op from a right sided mastectomy. Mrs. Adams apartment is located in a low income area of the city where crime is prevalent. Upon assessment by the Community Health Nurse, Mrs. Adams apartment was in disorder with minimal airflow or light. Her cloths appeared unchanged and she had no food in the apartment. The small apartment also housed 3 cats and a small dog who Mrs. Adams considers family since the death of her husband 1 year ago. Mrs. Adams complains of pain and draining from her surgical site and a broken air conditioner.

• Using Nightingales Environmental Theory, what actions would the nurse take upon the first assessment? What are the five essential components?
• What would be an appropriate plan of care be for Mrs. Adams? How would you prioritize the care plan?
• Apply Nightingale’s Environmental Theory to an area of your nursing practice? What patient population would benefit from this approach? Support this practice change with at least one evidenced-based article.

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Elderly Patient with Diabetes, Hypertension, and Breast Cancer

Introduction

The elderly patient with diabetes, hypertension, and breast cancer presents a diagnostic dilemma. The clinical manifestations of these conditions may be similar, but their underlying mechanisms are quite distinct.

History

History of Present Illness

The patient is a 76-year-old female with a history of diabetes and hypertension. She was diagnosed with breast cancer 10 years ago, but her current symptoms began three months ago with chest pain, shortness of breath and fatigue. She has not experienced any other serious illnesses or injuries in the past that could be related to her current condition. She denies any history of trauma or surgery in the past month that may have caused this problem.

Section:

• Blood pressure, pulse rate, and temperature

• Pulse oximetry

• Abdominal examination

• Skin examination

• Liver evaluation (if indicated)

Subsection: Present Illness

Your doctor will ask about your present illness:

• History of present illness. The first thing your doctor wants to know is how long you’ve had the current condition, including any exacerbation episodes (a sudden worsening in symptoms). This can be difficult to remember because you’re likely experiencing many other symptoms besides those related specifically to your diabetes and hypertension, such as fatigue or thirstiness. Your physician will also want to know if there is a family history of cancer or heart disease; if so, he or she may order additional tests—such as an electrocardiogram (EKG) or chest x-ray—to determine whether there are any risks associated with these illnesses.

• Past medical history including all current medications taken regularly since age 18; any surgeries performed on yourself or others (including hernias); and all allergies known by you that may affect treatment decisions

Physical Examination and Diagnostic Studies

The physical examination is the first step in your diagnosis. Your doctor will examine you and ask about your health history, making sure that you are not suffering from any medical conditions that might cause or contribute to diabetes or hypertension (high blood pressure). He or she may also look at your eyes, ears, nose and throat for signs of cancers such as breast cancer.

Conclusion

The physical examination revealed a history of diabetes, hypertension and breast cancer. A chest x-ray was performed and the patient was found to have bilateral pleural effusions as well as an enlarged heart size in the left atrium. The patient had a hemoglobin level of 13 g/dL (normal range: 12-15 g/dL), an echocardiogram confirmed this finding by showing a mild left ventricle wall motion abnormality with no significant stenosis or regurgitation. An ultrasound revealed atrial enlargement with ectopic beats and a mass near the right carotid artery that appears to be benign based on echocardiographic findings, but needs to be further evaluated by magnetic resonance imaging (MRI).