Mods Case Study

African- American female, 71 years old, has been admitted to the hospital from her primary care provider ten days post-op following a right below the knee amputation. Her only complaint is that of abdmonial pain. Her vitals are as follows: BP 100/70, HR 122, RR 22, Temp 101.1, and oxygen level 96% on room air. Glucose level is 563mg/dl on glucometer and the patient states that she takes a round white pill for her diabetes. She has also been diagnosed with hypertension in the past and takes a white oval pill for it. Head to toe assessment that has been completed noted a foul smell omiting from the bandage where the leg has been amputated. Clearly this patient is exhibiting clinical signs of sepsis. The initial thought is that the source of infection is the surgical wound since the foul odor is present. The next few hours are critical in initating treatment for sepsis. Multi-organ failure can result if treatment is not received in

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.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

It is applicable to obtain arterial blood gases (ABG) or pulse oximetry for patient experiencing a severe exacerbation (Booker, 2014). Chest X-ray and ECG

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia

This week, I was given the opportunity to care for two female patients – 205(1) and (2). The first patient, 205-1, was admitted with respiratory distress and had a past medical history of hypertension, schizophrenia and bipolar disorder. She was initially put on 2 L/min of oxygen and placed on oxygen titration protocol with orders to maintain O2 saturations between 88-92%. The patient was oriented to person and place, but had difficulty with time. She was also obese (BMI 30) and deemed a moderate assist with ambulation. Her care plan included total assistance with ADLs, smoking cessation and oxygen protocols, limited salt intake (3mg), and chronic pain management. The second patient, 205-2, was admitted with a right pelvic fracture and had

The patient did have black soot around his nose and mouth. Thats when first responders started manual ventilation's via BVM and 02 at 15 LPM. At this time Medic 1 assumed patient care. Medic 1 assigned first responders to obtaining vitals signs that are stated in the vital section of the report. It was at this time that Medic 1 applied a OPA after first measuring on what size to use. First responders also applied fast patches to the patients right upper chest and left midaxillary line At this time Medic 1 assigned first responders to start chest compressions a 15:2 ratio. Medic 1 at this time started a IO in the patients plateau region of the right leg. The Plateau region is inferior and lateral to the knee cap. At this time Normal Saline bolus was started with a 60 drop per ML set. Medic 1 found the patient to be in a sinus rhythm At this time miscommunication with Medic 1 and first responders happen with chest comparisons started. We then secured the patient on the cot via 4 straps and transported a code red patient to the nearest hospital. While enroute to hospital radio report was given with chief compliant and treatments listed in the appropriate category of the report. Vitals was continued to be taken every 5

What findings would indicate that the patient is ready to have the chest tube removed?

Admitted through the Emergency Room at 4 PM to a semi-private room is Maggie P., a 78-year-old retired Registered Nurse with end-stage Chronic Obstructive Pulmonary Disease (COPD). Her temperature is 98.7, B/P 130/92, heart rate 124 and respirations are labored and irregular at 37 per minute. She appears frail and weighs 89 pounds. She is pale with a bluish hue to her lips and nail beds. Oxygen at 3 liters per minute is applied via nasal cannula. She is alert and oriented to time, place, and person. She coughs intermittently, expectorating copious amount of thick gray, blood-tinged sputum. She complains of back and rib pain and 5mg of Morphine Sulfate in administered intramuscularly. On assessment the nurse lists, between

3. Continuous irrigation is fluid instilled into the body at a steady rate. Intermittent infusions are for medication administration and

194-195). The fourth nursing diagnosis that pertains to her is anxiety related her inability to breath adequately without support, the unknown outcome, her inability to speak from intubation, a change in the environment, a change in health status, and her not having insurance, and this is evidenced by restlessness, being unable to sedate her, and her uncooperative behavior(Gulanick & Myers, 2014, p. 416). The last nursing diagnosis for this patient is risk for decreased cardiac output related to her mechanical ventilation (Gulanick & Myers, 2014, p.

The Author will firstly discuss why the ‘Vital Signs’ would be; followed by both the immediate treatment that should be given and the intervention needed from more advanced medical personnel.

I would perform a peripheral vascular assessment on both upper and lower extremities. First, I would inspect and palpate her face and both her arms for color and consistent warmth. Then, I would do skin turgor and assess for capillary refill time bilaterally. Since patient also has vitamin deficiencies, I would at that point inspect her nails. I would move on to palpate her radial pulse bilaterally. Then, I would move to her lower extremities and inspect and palpate for color and consistent warmth. I would then palpate for pretibial edema and pedal pulses bilaterally. After that, I would assess for capillary refill time bilaterally. If there were abnormalities, then I would do a more comprehensive cardiovascular assessment. Patient also has Spina Bifida. I would inspect her back, then have her bend to palpate her spinal curvature. Patient is deaf on her right ear, so I would start out by inspecting and palpating both her ears. I would then do a focus neurological assessment for her ears. I would test for cranial nerve 8, which is acoustic. Since patient has hearing loss on her right ear, I would then perform a whisper test. I would also do a screening of patient’s heart and lung. I would start out by inspecting patient’s anterior chest and cardiac landmark for pulsation. Then palpate and auscultate the patient’s cardiac landmark. If there are no abnormalities I would move on to the lungs. I would note the

The primary assessment of this patient is the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. According to the ABCDE approach, it is crucial to check the airway first to see if the airway is patent. Then, check the patient’s breathing. Determining the respiratory rate, inspecting movement of the chest wall, measuring pulse oximeter and using the stethoscope to auscultate the lung sounds are the possible way to check if the breathing of the patient is sufficient (Thim et al., 2012). Next, check the circulation. Skin changes, such as check the colour and sweating, relate to the circulatory problems. Also, heart auscultation, blood pressure measuring and electrocardiography monitoring should be involved in this procedure (Thim et al., 2012). When measure the blood pressure, using the AVPU score (A for ‘alert’, V for ‘reacting to vocal stimuli’, P for ‘reacting to pain’, U for ‘unconscious’) to assess the consciousness, which is for the disability part. Moreover,