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The Priority Nursing Diagnoses

The three priority nursing diagnoses are responding to client’s problem in the diagnostic label, identification of related factors causing the problem, and identification of defining characteristics.

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The initial interventions for the client are pain management, identification of pain etiology, and defining the evidence of the pain. The dependent actions are monitoring the pain scale, measuring the respiratory rate, heart rate, blood pressure, temperature, monitoring peripheral capillary oxygen saturation, and observing the alertness and orientation of the client. The dependent actions for the client are computerized axial tomography scan, lap appendectomy surgery, pain medication, and placement of the patient-controlled analgesia pump intravenous to the client.

The laboratory values to focus are pain scale, peripheral capillary oxygen saturation, alertness and orientation of the patient, the blood pressure, and urinalysis. The blood pressure of the client needs to be regulated since it has an associated with cardiovascular event rates and death of diabetic patients. All the laboratory values to consider for the client are essential because they determine the condition of the patient, such as life-threatening concerns, safety and psychological concerns of the patient.

The client uses both Beta-blocker and angiotensin-converting enzyme (ACE) inhibitor in the management of hypertension. Metoprolol is a beta-blocker that acts on adrenergic receptors while Lisinopril is an ACE inhibitor that acts on angiotensin II receptors. The Lisinopril inhibits production of angiotensin chemical that narrows the arteries while Metoprolol eases the pumping mechanism of the heart through inhibiting the effects of adrenaline. The ACE inhibitors promote peripheral vasodilation and improve insulin sensitivity and glucose uptake through a reduction of angiotensin II. The beta-blockers prevent peripheral vasodilation and reduce peripheral blood flow hence reducing cardiac output. The client requires a combination therapy because she has lower rates of blood pressure control due to past medical history of hypertension and diabetes mellitus type 1. The combination therapy helps control blood glucose and blood pressure of the client. The ACE inhibitors help prevent kidney damage for clients with diabetes while beta-blockers help in reduction of complications that have an association with long-term hypertension.

Pain management using patient-controlled analgesia (PCA) pump allows continuous infusion of pain medication that goes through intravenous injection route. The infusions of pain medication through intravenous route on the client using PCA pump result in great satisfaction, little sedation, and reduced postoperative complications. The intravenous route involves the application of initial dose, lockout interval, demand dose, and background infusion rate at the 1-hour limit.

The blood glucose of the patient is 250mg/dl even after the patient being NPO for the past 18 hours. The blood glucose is elevated due to the use of Metoprolol, a beta-blocker in the management of hypertension. The increased use of beta-blockers in the management of hypertension leads in elevation of blood sugar. Beta-blockers exhibit significant glycemic effects and result in consistently elevated fasting blood glucose levels. The beta blockers contribute to the development of hyperglycemia by impairing the release of insulin from pancreatic beta-cell.

The nursing priority for this finding is the withdrawal of beta-blockers medication from the client. The client should take an ACE inhibitor as part of the regiment since it is safe and responds to the client problem.

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The priority assessment related to this treatment protocol is the management of diabetes. The antihypertensive drugs have differences in affecting the glucose homeostasis. The client should reduce the use of Metoprolol since it has a direct effect on glucose uptake and disposal.

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