NU371 HESI Case Study: Suicide, A Sentinel Event
Client Overview
The client has a 45-year history of smoking a pack of cigarettes daily. He reports having a productive
cough, hoarseness, and difficulty breathing, which he attributes to his age. He states that he wakes up
three to four times...
NU371 HESI Case Study: Suicide, A Sentinel Event
Client Overview
The client has a 45-year history of smoking a pack of cigarettes daily. He reports having a productive
cough, hoarseness, and difficulty breathing, which he attributes to his age. He states that he wakes up
three to four times each night due to coughing and breathing issues. The client also mentions weight
loss but thinks it is due to a decreased appetite. He expresses feeling unusually fatigued lately, at times
lacking the energy to move from the bedroom to the kitchen. To compensate, he drinks nutritional
shakes for meals because they are convenient and palatable. The client has a medical history of insulin-
dependent type II diabetes mellitus and is particularly concerned about his inability to concentrate,
describing it as "brain fog."
Assessment Questions
As the nurse documents the client's assessment, which activities related to the client’s type II diabetes
should be questioned? (Select all that apply. One, some, or all options may be correct.)
- a) Frequency of blood glucose monitoring.
- b) Daily intake of Ensure nutritional shakes.
- c) Reasons for the client’s lack of appetite.
- d) Daily fluid intake, including water.
- e) The last recorded blood glucose result.
Correct answers:
- a) Frequency of blood glucose monitoring.
- b) Daily intake of Ensure nutritional shakes.
- c) Reasons for the client’s lack of appetite.
- d) Daily fluid intake, including water.
Emotional Well-Being
The client shares feelings of sadness since his wife passed away a year ago and states that his children
live far away and visit infrequently. The nurse recognizes that the greatest risk factor for major
depression is:
- a) Retiring from the military.
- b) Coming to terms with aging.
, - c) Inability to regularly attend church.
- d) Recent widowhood within the past year.
Correct answer:
- d) Recent widowhood within the past year.
The combination of grief, loneliness, and hopelessness can lead to social withdrawal, placing older
adults at a higher risk for major depression.
Physical Assessment Findings
On assessment, the client is alert and oriented to time and place but appears pale and thin, with shallow
breathing. He shows nasal flaring, mild intercostal retractions, and has a productive cough. He adopts a
tripod position and upon auscultation, wheezing is noted on the right side while breath sounds are
diminished on the left. His heart rate is slightly elevated. Visual inspection reveals a barrel chest, mild
finger clubbing, and cyanosis in the nail beds. The client’s skin is warm and dry, exhibiting decreased
turgor, and he has a stage II decubitus ulcer in the sacral area, scoring 14 on the Braden scale. There is
mild swelling in the feet, and the client reports limited mobility due to weakness. He has no known
allergies to medication or food and does not report any pain. Additionally, he does not have advance
directives.
Vital Signs
- Temperature: 101.5°F (38.6°C)
- Heart Rate: 110 beats/min
- Respiratory Rate: 20 breaths/min
- Blood Pressure: 150/90 mmHg
- Blood Glucose: 200 mg/dL
- Oxygen Saturation: 88% on room air
Medications
- Albuterol and ipratropium bromide (metered-dose inhalers)
- Diltiazem
- Furosemide
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