Epigastric Shock Case Studies

Client outcome: have surgical area that show evidence of healing no redness, draining, or immobility _______________________________________________________

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

After surgery, Mr. Baker is taken to a room on the medical-surgical floor. He has an IV infusing at 125 ml/hr, a PCA pump, and a nasogastric tube connected to low suction. He is receiving oxygen through a nasal cannula.

The physician performs a problem focused history and physical examination with straightforward decision making 99201

This week for clinical I was doing my first day on the surgical floor for this semester’s placement. I was able to begin to understand how the surgical floor works and how a normal day on the floor will look like.

Your white blood count (lab test) was 16.6, computed axial tomography (test) of the neck showed mild edematous (swelling) and enlargement of the right tonsil without abscess (pocket of infection). You received intravenous treatment (through the vein) fluid bolus (fast) in the amount of 2 liters, Morphine (pain medicine) for pain, Decadron (medicine that decreases swelling), Clindamycin (antibiotic) and Unasyn (antibiotic) all intravenous (through the vein) stat (immediately). Your blood cultures showed no growth. You were admitted with intravenous (through the vein) fluid at 60 an hour (rate), Zosyn (antibiotic) intravenous (through the vein) every 6 hours, Heparin (medicine to thin blood) and Tylenol. You were seen by an Infectious disease (specialist) for a consultation and continued on intravenous (through the vein) antibiotics. Based on the Interqual guideline criteria (a decision based program to determine medical need) for infection, the clinical guidelines were not met because there was no documented failed outpatient anti-infective treatment; you were not Immunocompromised (body not able to fight infection or gets infection easily) and your temperature was not greater than 99.4

for the resident who sustain the injury and the Interprofessional team involved, to progress the injury

Also, I will assist patients with scheduling appointments and provide information to help my patient understand his diagnosis and treatment options as needed. He is 60 years old, he is living on his own in the apartment; as a result I will provide him a caregiver, who has a good understanding about the different needs of my patient to keep him safe. In addition, I will refer him dietitian to improve his appetite and prevent wait loss. As a patient navigator to ensure patient can get insurance coverage and insurance continuity, I will help my patient find the best affordable insurance. I will negotiate and work with billing offices to get a discounts and payment plans to cover medical bills for my patient. Also, I will help my patient with managing and filing insurance paper works for all expensive procedures and treatments. As a patient navigator to ensure the patient receives culturally competent services, I will complete cultural assessment, religious and spiritual beliefs, values and practices to determine clear and detail needs of my patient. Culturally appropriate care will improve participation of my patient in his care. The cultural care that my patient receives will be respectful, confidential, and mindful of the patient

thoroughly examine the patient he doesn’t know the patient has a severe case of pneumonia and misdiagnosing the patient.

This is anyone who provided treatment to you or anyone who you consulted with regarding an injury (such as for a second opinion or a doctor you were required to see as a requirement from your employer

110/62, a pulse oximetry reading (Pox) of 92%. At this time Mr. B should have been placed on

Shock is a serious medical issue characterized by insufficient perfusion, which can lead to sepsis and death. A patient going into shock is something that an EMT may face in the field, therefore an EMT must be able to accurately identify and diagnose all types of shock. Although there are many specific types of shock, the most widely accepted division of shock was established by authors of “The Fundamental mechanisms of shock” Hinshaw and cox. Hinshaw and cox explain that shock can be separated into four broad pieces: hypovolemic shock, cardiogenic shock, distributive shock, and extracardiac obstructive shock (Sethi).

A complication from a MI is cardiogenic shock, it is rare but is life threatening when not treated early. Even if Mr Jones is treated for cardiogenic shock early, there is only a fifty percent survival rate (Mayo Clinic Staff, 2014). Signs and symptoms the RN should be aware of for cardiogenic shock include increased respiration rate, shortness of breath, tachycardia, weak pulse, pale skin, jugular vein distension cold hands and feet and decreased urine output. This is due to the heart being damaged and unable pump enough blood to supply the required amount oxygen to the body (Lemone et al., 2017). The RN can increase Mr jones oxygen rate to improve the amount of oxygen being delivered to organs, also maintain the high-fowlers position for

Risk for infection related to surgical wound on her left upper back and drainage tube in left lung. I chose this as the second nursing diagnosis and would also rate this high priority. The patient did not have a

During the second set of final clinical practice, I provided nursing care to the client with query sepsis and clostridium difficile as admitting diagnosis. The client had a history (Hx) of acute kidney infection (AKI) which led to dialysis. After resolving AKI, the patient went home, but soon returned to the hospital with severe diarrhea (5-6 episodes per day), confusion and symptoms of sepsis. Upon initial assessment, I found the patient oriented to name only, confused and lethargic, incontinent of urine and stool. The patient had bilateral crackles throughout the lung fields, gurgles upon exertion and tachypnea with respiratory rate 24-28. SpO2 level was within normal limits. The patient’s family reported that the current patient’s cognitive condition function was different from the baseline. The patient was difficult to arouse, with Glasgow Coma Scale (GCS) score 12-13. The heart rate was within normal limits, strong, irregular. Bilateral edema 2+ was present in lower legs, skin was warm to touch, pedal pulses palpable. The patient was on caloric count due to poor caloric intake. The family was frustrated because of recurrent hospitalization due to hospital-acquired infection and very concerned about possibility of poor outcome for the patient due to rapidly deteriorating general condition.