Ms. Lieberman Case Paper

ICU to the floor. She has essentially stabilized. Again, she is having some type of

3. At this point, you are ready to begin the lab exercise. Click on the “Information” button on the blood

29. If all the 280 million molecules of hemoglobin contained in RBCs were free in the plasma,

My main priority would be to dehydrate the patient with a normal saline IV, then administer drugs for her pain, the dilaudid that the physician ordered for her. Then I would administer 5 ml’s of Vancomycin to treat the C. Diff.

Pulse oximeter used to check his oxygen saturation level, which was 98% on air with no central or peripheral cyanosis. Since Mr Devi, does not seem to have any sign of abnormal respiration. The next assessment is circulation, where there are many physical signs to look for. The colour of the hand and digits, are they blue, pink, pale or mottled. Also need to measure for capillary refill time (CRT) by applying cutaneous pressure for 5 Sec on a fingertip held at heart level of Mr. Devi. The normal value of CRT is usually less than 2 second prolonged CRT suggests poor peripheral perfusion. Measure his Blood Pressure (B/P), count pulse rate by listening to the heart with a stethoscope or palpate peripheral and central pulses, assessing for the presence, rate, quality, regularity and equality. All of this assessment indicates the cardiovascular system in the patient is within the normal range or is there any emergency measures should take (Resus.org.uk 2016). However, Mr Devi’s circulation is a concern because his HR was 110bpm which is higher than normal range, the normal heart beat for adults ranges from 60-100bpm. Also his BP was 190/99mmhg with mean arterial pressure (MAP) of

Breathing Rate 2.6 2.9 3 2.8 TV(L) 2.9 3 2.9 2.9 Resting Values ERV(L) IRV(L) 3.9 4.3 4.3 4.2 5.5 5.9 5.9 5.8 RV(L) 3.4 3.6 3.7 3.6 Breathing Rate 2.2 2.3 2.3 2.3 TV(L) 4 4.3 4.4 4.2 Exercising Values ERV(L) IRV(L) 5.6 5.9 6 5.8 6.2 5.3 6.7 6.1 RV(L) 42.2 50.2 49.5 47.3

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

Lisa Sherman worked for Verizon for many years. While there she never revealed her sexual orientation .Then one fated day, there was a diversification workshop with her fellow managers. The outcome of this was that her coworkers were bigoted towards homosexuality. Lisa Sherman had a tough decision to make, whether to stay or to leave. The following analysis shows a suggested solution.

An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared confused this could be associated with poor cardiac output. The nurse recorded the patient’s blood pressure using a dinamap it was measured at 88/50, it was then rechecked manually to ensure accuracy. The pulse was checked manually for rate and rhythm it was recorded as 98 beats per minute. Capillary refill was checked, was found to be normal.

Based on the information presented in the case of 39 year-old Douglas Murrow, he has been charged with criminal infractions consisting of breaking and entering his parent’s home in the middle of the night, as well as physically assaulting them. Murrow constantly theorizes about a conspiracy plot against him and has consistently displayed episodes of paranoid, delusional behavior. Murrow’s erratic behavior is marked by the belief that “his parents” are “conspiring with his doctor” to force him to take psychopharmaceuticals. The delusional ideation is amplified by Murrow’s insistence that his parents are entering into “his apartment at night” to torture “him” while he is asleep (Laureate Education, Inc., 2017).

ECG- normal sinus rhythm, with heart rate of 82, normal axis, normal P wave with no new ST-T wave changes, Normal PR, QTc.

I have gained full consent to use this lady as my patient in my care study. Consent is important as you must always gain permission from the patient in regards to their care plan and keep them fully informed. ‘It is vital that the person consents before any treatment, care, examination or assessment’ (Brooker et al., 2007, p.157). ‘Confidentiality is a fundamental part of professional practice that protects human rights’ (NMC, 2008). To maintain my patient’s confidentiality throughout my care study I am going to call her Annie. Annie is a 72 year old lady whose care I have been involved with on placement. Annie’s medical history included; previous left hip replacement, osteoporosis, high blood pressure, high cholesterol and

She feels fine on exam today. Blood pressure for the nurse 144/68, repeat for me was 140/70.

Ensuring that the patient was relaxed and comfortable I began to take her pulse, using my three middle finger tips to locate the pulse. I did so for 15 second and timed by fore for the next 15 seconds I measured her respiration rate and timed by 4. I did not explain to my patient that I was taking her respirations as looking at her chest may have made her feel uncomfortable and increase her respirations. Her pulse rate ending up being 85 beats per minute and respirations were 15 breaths per minute. These results were within normal range, as her pulse rate was between 80 and 120 bpm and respirations were between 12 and 20 (Tollefson, 2010). The change in pulse and respiration rate can increase during excercise. If a pulse is recorded below 50 bpm the patient can be at risk of a heart attach. A fast pulse exceeding 100 bpm can be a sign of infection or dehydration. This can be detected quickly and appropriate action taken to prevent negative affects on the patient’s well being.