Case Study: Client with Diabetes, COPD, and Hypertension (Nursing)

by Rhonda Lawes

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    00:01 Okay, here we go. Here is another kind of long question.

    00:05 "Mr. Rosenstein has a history of Type II diabetes, COPD, and hypertension." Okay, when you get multiple diagnoses in a test question, we don't know if it's going to be the diabetes, the COPD, or the hypertension that we're dealing with.

    00:20 So just kind of file it away in your brain.

    00:22 You have a picture of what this patient's history is.

    00:25 Now, "He also has an acute bacterial infection of the right leg.

    00:30 The wound drainage is purulent.

    00:32 His vital signs and blood pressure are 142/88.

    00:36 Pulse is 97, respiration, 16, and temp is 39.4°C." Before you go on, let's go back to that sentence and break it down like we've talked about.

    00:47 So, we know that he has these chronic problems: Type II diabetes, COPD, and hypertension.

    00:53 But he also has something going on right now that's acute; a bacterial infection of his right leg.

    00:59 Now, the wound drainage is purulent, so we know that we have an infection.

    01:04 His vital signs are 142/ 88.

    01:07 Now that's a little higher than we would like it, but I'm not really alarmed.

    01:11 His pulse is 97. That's within normal.

    01:14 Respiratory rate is fine, it's 16.

    01:17 Temp is 39.4°C or 102.9° Fahrenheit.

    01:21 That's a little high.

    01:23 Now, with what I know about him, oh, he has an acute bacterial infection, his temp is high. That means his body is working at fighting that infection.

    01:32 Look at that last sentence.

    01:34 "Which of the following would you most likely anticipate seeing when his lab results are returned?" All right. I've got written A, B, C and D on my paper.

    01:46 Now when I look at the answer choices, I notice that -- I almost go cross-eyed.

    01:50 They all look the same. White blood cell, white blood cell, white blood cell.

    01:54 That's good. We see a pattern there.

    01:56 So, really, what this question is asking me is, "What would I expect to see with someone who has an acute infection," right? We had to work through a lot of stuff to get to that point, but because we spent so much time in the stem, this is going to go a lot quicker.

    02:12 So I know before I even look at these answer choices, I'm going to expect a white blood cell count that is elevated.

    02:20 So, A, I -- white blood cell count of 7, that's within normal, I can get rid of it.

    02:26 B, ooh, a white cell count of 13. Okay, that's higher than normal.

    02:31 I'm going to leave that one in, but I'm not going to stop there.

    02:35 White blood cell of 4 in option C. Oh, that's normal. We can get rid of it.

    02:40 White blood cell count of 9. That's also normal so we can get rid of it.

    02:45 Correct answer? Right. It's answer B.

    02:49 Okay. So even if you got that question, right, you're like, "Eh, I got that without eliminating answers," don't do that to yourself.

    02:56 You want to take your time and think through every question.

    03:00 Remember, when you're on the NCLEX and you're taking those questions, when you are slow and methodical, but accurate, you'll actually end up having a shorter test. It will shut off sooner, which is what everybody wants.

    03:13 When you're taking your nursing school exams, if you take your time and focus yourself, you'll also see an increase in your exam scores.

    About the Lecture

    The lecture Case Study: Client with Diabetes, COPD, and Hypertension (Nursing) by Rhonda Lawes is from the course Complete Blood Count (CBC) (Nursing).

    Author of lecture Case Study: Client with Diabetes, COPD, and Hypertension (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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