Student Copy Since her divorce, she has not paid taxes and there have been mounting financial bills with the Internal Revenue Service. As a result, her wages are being garnished (money is withheld from her paycheck and sent to a creditor). She reports, "On the outside I appear bright and upbeat but on the inside I am so lonely and sad and just don't want to go on anymore." She wonders how she will pay for her medical care now. "I had not planned on the poison not working and needing dialysis. I bet dialysis is expensive." Questions On admission, Ms. Jimenez's creatinine was 1.4 mg/dL and her BUN was 25 mg/dL. Ms. Jimenez has repeat creatinine and BUN labs drawn two days after admission. The results are a creatinine of 4.7 mg/dL and a BUN of 24 mg/dL. A day later her creatinine is 8.5 mg/dL with a BUN of 57 mg/dL. 1. Are these results getting better or worse since admission? Discuss why. The following potassium values are reported: on admission, 3.6 mEq/L; forty-eight hours after admission, 4.0 mEq/L; and seventy-two hours afteradmission, 4.2 mEq/L. 2. What potential cardiovascular change is of greatest concern to the nurse? 3. Identify five priority nursing diagnoses that are appropriate to include in Ms. Jimenez's plan of care. Case Presentation Ms. Jimenez is a 56-year-old woman who has been having financial difficulties since her divorce five yea ago. She was recently involved in a motor vehicle crash (MVC) in which she drove over a curb and hi telephone pole. She did not sustain any significant injuries in the MVC. Two days ago, Ms. Jimenez daughter Maria returned home at 8:00 p.m. to find Ms. Jimenez sitting on the floor with a decreased lev of consciousness. Maria was able to shake her mother awake. With slurred speech, Ms. Jimenez told h daughter that she drank three large glasses of antifreeze (ethylene glycol) at around 7:00 p.m. Maria call 999 and emergency medical services transported Ms. Jimenez to the local emergency department. Case Progress It is forty-eight hours after her arrival in the emergency department. Ms. Jimenez has undergo twelve hours of emergency dialysis, has been extubated, and is medically stable for transfer to a medic. surgical nursing unit. A safety sitter remains in Ms. Jimenez's room at all times. Ms. Jimenez is alert a oriented but has a flat affect. She is not remorseful for her actions and states, "I had hoped I would be successful this time." psychiatrist sees Ms. Jimenez for a consultation. The psychiatric assessment reveals that she has be planning the poisoning for a few weeks. She states, "I was hoping I would die quickly and it would lo like an accident." Ms. Jimenez states that she has made attempts in the past to overdose on medication She did not seek care at the hospital when these suicide attempts were not successful. She has be depressed since divorcing her husband five years ago. Case Based Learning – Human Anatomy and Physiology