Hypothesis Appropriate for the Situation
The first hypothesis is based on empirical inquiry: the patient could suffer from COPD (chronic obstructive pulmonary disease), peripheral vascular disease in diabetes mellitus type 1, and DKA (diabetic ketoacidosis). The hypothesis that she could be ailing from COPD is rooted in the reported chief complaint of apparent labored breathing, the personal social history of chronic smoking, and the objective saturation data of 84%, which is low. Chronic smoking has resulted in severe airway obstruction, thus desaturation at 84%, with labored breathing. The patient is also ailing from peripheral neuropathy, as evidenced by the right foot open wound and her past medical history of type one diabetes. DKA is possible due to the history of known type 1 diabetes, dizziness, nausea, vomiting, and confusion, with potential triggers including stress from her husband’s hospitalization and high blood pressure as recorded.
The second hypothesis is based on ethical inquiry mode: the patient and staff violate the code of conduct in the ER (emergency room) by smoking, and no staff member intervenes. The strong cigarette smoke smell might indicate that the patient has been smoking while in the ER, and no one warns about the danger of smoking in the hospital arena.
The third hypothesis is established in the sociopolitical inquiry mode in that she is experiencing poor financial and social support. The patient is reported to only benefit from Medicaid health insurance, a government-based program for low-income earning individuals. The patient’s husband is also ailing from Alzheimer’s disease, suggesting a constraint to the already low income and no extra source of income.
The Priority Hypothesis
The priority hypothesis is the one made from the empirical mode of inquiry. This answer is supported by the patient’s assessment data, including presenting complaints of vomiting, dizziness, labored breathing, and desaturation at 84% on room air. This data suggests that the healthcare’s priority should be to stabilize the patient via various interventions such as medications and supportive management, including oxygen supplementation.
Solutions for the Priority Hypothesis
The priority hypothesis, empirical, suggests that the patient has COPD (chronic obstructive pulmonary disease), peripheral vascular disease in diabetes mellitus type 1, and DKA (diabetic ketoacidosis). The three impressions can be managed through various solutions.
- Chronic obstructive pulmonary disease: The aim is to relieve the symptoms, including labored breathing and desaturation, and prevent complications. The goal can be achieved via supportive and pharmacological interventions. Supportive therapy includes bed rest, oxygen supplementation, and patient education on smoking cessation. According to Widysanto & Mathew (2022), there are four pharmacological approaches to chronic bronchitis management, including bronchodilators such as albuterol, glucocorticoids, antibiotics, and phosphodiesterase-4 inhibitors. In this scenario, bronchodilation will be the priority to open the airway, thus relieving the patient of labored breathing and promoting oxygen circulation in the blood. Inhaled corticosteroids such as mometasone can also help reduce airway inflammation and promote oxygen saturation.
- Diabetes Ketoacidosis is a complication of diabetes mellitus that is precipitated by various factors, including poor medication adherence, infections, and other comorbidities (Lucier & Weinstock, 2023). DKA is solved via serial fluid administration to rehydrate the patient, correction of hyperglycemia via insulin administration, and correction of electrolyte imbalances, including potassium, bicarbonate, and sodium levels. Evaluations and investigations such as urinalysis and blood sugar monitoring are essential in solving the DKA and monitoring improvements such as resolving labored breathing and confusion.
- Peripheral vascular disease in diabetes mellitus type 1: According to Lucier & Weinstock (2023), type 1 diabetes mellitus is an autoimmune condition resulting from destroying the pancreas’s beta cells responsible for insulin production. Therefore, the mainstay approach to this patient’s management is insulin administration. It is also important to evaluate her blood sugar levels before and after insulin administration to avoid acute complications, including hypoglycemia. Patient education on glycemic control, wound care, and dressing should also be initiated to prevent further infection.
Potential Complications with their Solutions
The possible complications from the case scenario include hemodynamic instability and lung collapse. Hemodynamic instability can result from severe dehydration from DKA, vomiting, and hematemesis. The hemodynamic instability can present in the form of hypovolemic shock, which is life-threatening and results in death if not promptly addressed. According to Taghavi et al. (2022), hypovolemia can be solved via fluid resuscitation, with crystalloids preferred to colloids. In hemorrhagic hypovolemic shock, transfusion with whole blood is an essential first-aid solution with urgent grouping and cross-matching. Hemoglobin monitoring will also be critical in this case. Lung collapse can be prevented via prompt diagnosis and first aid management of COPD with bronchodilators, corticosteroids, or phosphodiesterase-4 inhibitors. The patient should also be advised on the importance of smoking cessation to prevent further lung damage. Constant evaluation of lung function tests can also help monitor the effectiveness of bronchodilator use and the need for adjustments.
References
Lucier, J., & Weinstock, R. S. (2023). Diabetes Mellitus Type 1. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507713/
Taghavi, S., Askari, R., & Nassar, A. (2022). Hypovolemic Shock. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513297/
Widysanto, A., & Mathew, G. (2022, November 28). Chronic Bronchitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482437/#:~:text=Chronic%20bronchitis%20is%20a%20type
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