Please complete the Case Study

Be sure to include the following elements:

Statement of the Problem,
Solutions or Recommendations
Must include a minimum of 3 scholarly references (less than 5 years old)
Must be a minimum of 2 pages (not including title page or reference page)
Must be in APA format

Case Study Question:

Mrs. Ramirez is an 81-year-old female who arrives at the emergency department (ED) with increasing confusion, fever, lethargy, and hypotension experienced for the last three days. Her vital signs are as follows: blood pressure 80/56 mm Hg, temperature 100.0° F, heart rate 100 beats/min, and respiratory rate 28 breaths/min. Her husband tells the physician that she has a past medical history of hypertension and type 2 diabetes. Her daily medications include lisinopril/hydrochlorothiazide (Prinzide) 20 mg/25 mg, metformin (Glucophage) 1000 mg twice a day, pravastatin (Pravachol) 40 mg at night, and calcium citrate and vitamin D (Citracal) two tablets every day. She was just seen by the primary care provider last week and her blood pressure medication was increased from once a day to twice a day. You note the following results in her chart:

ECG: sinus tachycardia
Chest x-ray: lung fields without any noted infiltrates or masses; moderate degenerative changes noted to the thoracic spine
White blood cells 16,000/mm3 (4000-12,000/mm3)
Hemoglobin 18 g/dL (12-16 g/dL) / Hematocrit 50 % (36%-46%)
Sodium 130 mEq/L (135-145 mEq/L)
Potassium 2.5 mEq/L (3.5-4.5 mEq/L)
Magnesium 1.5 mEq/L (1.5-2.5 mEq/L)
Blood urea nitrogen (BUN) 30 mg/dL (8-24 mg/dL)
Creatinine 2.0 mg/dL (0.6-1.1 mg/dL)
Blood glucose 230 mg/dL
Urinalysis with positive nitrates, moderate leukocytes, and moderate proteinuria
Urine culture with moderate growth Escherichia coli present
Blood culture negative for any bacterial growth

Introduction / Statement of the Problem:

Pathophysiologically, what do you suspect is going on with this patient, given her current condition, situation and past history? What, specifically, about this geriatric patient might you want to consider when planning and anticipating her treatment course?

Solutions or Recommendations / Conclusion:

What is this patient’s anticipated acute care course? Does she need to be admitted to the hospital? What floor should she be admitted to? What might you do as the nurse to address some of her immediate health concerns? Consider her age while answering these questions.

Case analysis