315 NGN CASE STUDY RESPIRATORY EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE

315 NGN CASE STUDY RESPIRATORY EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE A 63-year-old male client comes to the clinic today for a routine follow-up. The client recently adopted a small dog for companionship since losing his wife and reports experiencing rhinorrhea and sneezing over the last couple of weeks. He has not tried any medications to relieve the symptoms. The client also reports trouble sleeping, frequent headaches, and overeating since the death of his spouse. He has a medical history significant for hypertension treated with lisinopril and benign prostatic hyperplasia (BPH) treated with tamsulosin and dutasteride. Vital signs Temperature: 98.6° F (37° C) Heart rate: 80 beats per minute Respiratory rate: 20 breaths per minute Blood pressure: 124/70 mmHg Pulse oximetry reading of 98% Laboratory Value Today's Result Result from 4 Weeks Ago Reference Range Glucose 88 mg/dL 82 mg/dL 74-106 mg/dL Potassium 4.9 mEq/L 4.8 mEq/L 3.5-5.0 mEq/L Serum creatinine (Scr) 0.9 mg/dL 0.8 m The healthcare provider recommends the use of "as-needed" diphenhydramine to treat the client's symptoms of allergic rhinitis and insomnia. The nurse alerts the healthcare provider about the client's findings and suggests the need for alternative therapy. Drag one condition and one client finding to complete the sentence(s). The client is at risk for developing -Urinary retention , from diphenhydramine, a e/b --hx of BPH, and -home/intake output log Patient 1 Rationale Rationale: Antihistamines, such as diphenhydramine, work by competing with histamine for receptor sites, thereby blocking the effects of histamine. They are first-line drugs for mild to moderate allergic rhinitis. They are able to relieve sneezing, rhinorrhea, and nasal itching. Nasal congestion, however, is not relieved with antihistamine therapy. Because these drugs exert anticholinergic effects, urinary retention is a possible adverse effect with therapy. Benign prostatic hyperplasia (BPH) is a condition in which the prostate enlarges and compresses the urethra, making urinating difficult. Anticholinergics can worsen urinary retention in clients with BPH and should ideally be avoided in this population. This client clearly has a history of BPH, and his home intake/output log suggests reduced urinary output, which could be worsened with diphenhydramine. Diphenhydramine does not affect potassium levels, nor does it increase the risk for hyperkalemia. Similarly, diphenhydramine does not affect glucose levels, nor does it increase the risk for hyperglycemia. Renal impairment and changes to serum creatinine are not expected with diphenhydramine. The client's blood pressure appears to be controlled, and diphenhydramine does not pose a concern for uncontrolled hypertension. The client's home blood pressure log is beneficial for assessing control of his blood pressure and does not provide insight about the potential effects of diphenhydramine. The client's insomnia might actually improve with diphenhydramine; however, because of BPH, this therapy is not appropriate. Reports of frequent headaches and overeating are important to address; however, they are not a concern in relation to diphenhydramine therapy.