Please help me answer the questions below. Thank you so much! Case Study #4Romina Jackobs is a 45-year-old morbidly obese French woman who moved to theUS one year ago for a job promotion. She lives alone with her two cats. She says thatshe has made a lot of friends in the apartment building that she lives in, and herneighbor has called her and let her know that she will take care of her cats. Becauseshe has only been in her new position for a year, she is worried that she will get intotrouble if she has to miss too many days. As a regional public relations manager forDelta airlines, she has to travel a lot, she is worried she will miss a lot of her reports.She presented in the ER this morning complaining about pain in her right calf. Onassessment her calf was red, edematous and hot to the touch. There was a palpablemass in the calf, so Romina was sent to ultra sound. Ultra sound revealed that therewas an encapsulated mass in the calf, and pt was sent to CT scan. CT revealed thatthere was a large abscess in Romina's calf.The admitting doctor has put in orders for admission with a diagnosis of Abscess, aconsult for surgery, wound care nurse evaluation post surgery, home health careconsult on discharge, social worker consult, wound culture. The doctor has also ordered a transesophogeal Echocardiogram.Lab values were:WBC 17, 000RBC 4.5Hbg 13HCT 35Vital signs were:HR 115BP 165/98RR 24Temp 102.3O2 98Pain 8/10In the ER she was given morphine 2mg IV for pain that managed her pain well,however, she got very nauseous after the morphine. She is allergic to Zofran so the ER doctor ordered 12.5mg Phenergan for nausea.Romina has a medical history of :Chronic Heart Failure- Lasix 40mg qd in amHypertension- Metoprolol 25mg BIDDiabetes Type 2- Humalog sliding scale insulin qhs, acBS 100-200 4 unitsBS 200-250 6 unitsBS 251-300 8 unitsBS 301-350 10 unitsBS 351+ 12 unitsAsthma- ProAir rescue inhaler 2inh PRN q 2 hrsGERD Pepcid 20mg BIDChronic Anemia- Ferrous sulfate 1000mg/day qdThe doctor has ordered Vancomycin 1gm q8hrs IV, Zosyn 3.75gm q6hr IV and Ancef1gm 30min pre-surgery. Because her anxiety has caused her asthma to becomerelentless, the doctor has also ordered solumedrol 40mg IV q8hr in an attempt to keepinflammation down systemically and relieve her asthma symptoms. Morphine 2mg IVq4hr for pain, Phenergan 12.5mg IV q 12hr for nausea.On entering Romina's room, there is a cane leaning against the wall across the roomfrom Romina's bed and Romina appears frustrated. Romina reports that she has beenneeding to use the restroom, but can't get to her cane, so she can't get up out of bedwithout it. Your assessment shows that she has fine crackles in her lower lungs andhas edema 2+ in BLE. Romina has her bed almost flat, and she is complaining ofdifficulty breathing. She states that her mattress is uncomfortable and she says she canfeel the metal frame through it, and it's hurting her tailbone and her legs, she says that she is having a hard time shifting and trying to get comfortable, because every timeshe sits the bed up, she slides down. She said it feels like there are rug burns on herback from the constant sliding up and down in the bed.Heart sounds are muffled and a pericardial rub is heard. Bowel sounds are present inall 4 quadrants. Pt reports last BM was this morning and was within normal limits. Nocomplaints of burning on urination. 1. Give your conclusions about the present situation. Words like "might be" or "could be." are helpful. A diagnosis is not necessary. (i.e., Patient’s tongue swelling might be from side effects from ACE drugs) 2. If the situation is unclear at least try to indicate what body system might be involved. 3. State how severe the problem seems to be. (Patient is having a severe chest pain from ischemia to cardiac vessels) 4. If appropriate, state the problem could be life threatening such as medication adverse effect. (Pt is experiencing Red Man Syndrome from a severe reaction to Vancomycin infused too rapidly)
Please help me answer the questions below. Thank you so much!
Case Study #4
Romina Jackobs is a 45-year-old morbidly obese French woman who moved to the
US one year ago for a job promotion. She lives alone with her two cats. She says that
she has made a lot of friends in the apartment building that she lives in, and her
neighbor has called her and let her know that she will take care of her cats. Because
she has only been in her new position for a year, she is worried that she will get into
trouble if she has to miss too many days. As a regional public relations manager for
Delta airlines, she has to travel a lot, she is worried she will miss a lot of her reports.
She presented in the ER this morning complaining about pain in her right calf. On
assessment her calf was red, edematous and hot to the touch. There was a palpable
mass in the calf, so Romina was sent to ultra sound. Ultra sound revealed that there
was an encapsulated mass in the calf, and pt was sent to CT scan. CT revealed that
there was a large abscess in Romina's calf.
The admitting doctor has put in orders for admission with a diagnosis of Abscess, a
consult for surgery, wound care nurse evaluation post surgery, home health care
consult on discharge, social worker consult, wound culture. The doctor has also ordered a transesophogeal Echocardiogram.
Lab values were:
WBC 17, 000
RBC 4.5
Hbg 13
HCT 35
Vital signs were:
HR 115
BP 165/98
RR 24
Temp 102.3
O2 98
Pain 8/10
In the ER she was given morphine 2mg IV for pain that managed her pain well,
however, she got very nauseous after the morphine. She is allergic to Zofran so the ER doctor ordered 12.5mg Phenergan for nausea.
Romina has a medical history of :
Chronic Heart Failure- Lasix 40mg qd in am
Hypertension- Metoprolol 25mg BID
Diabetes Type 2- Humalog sliding scale insulin qhs, ac
BS 100-200 4 units
BS 200-250 6 units
BS 251-300 8 units
BS 301-350 10 units
BS 351+ 12 units
Asthma- ProAir rescue inhaler 2inh PRN q 2 hrs
GERD Pepcid 20mg BID
Chronic Anemia- Ferrous sulfate 1000mg/day qd
The doctor has ordered Vancomycin 1gm q8hrs IV, Zosyn 3.75gm q6hr IV and Ancef
1gm 30min pre-surgery. Because her anxiety has caused her asthma to become
relentless, the doctor has also ordered solumedrol 40mg IV q8hr in an attempt to keep
inflammation down systemically and relieve her asthma symptoms. Morphine 2mg IV
q4hr for pain, Phenergan 12.5mg IV q 12hr for nausea.
On entering Romina's room, there is a cane leaning against the wall across the room
from Romina's bed and Romina appears frustrated. Romina reports that she has been
needing to use the restroom, but can't get to her cane, so she can't get up out of bed
without it. Your assessment shows that she has fine crackles in her lower lungs and
has edema 2+ in BLE. Romina has her bed almost flat, and she is complaining of
difficulty breathing. She states that her mattress is uncomfortable and she says she can
feel the metal frame through it, and it's hurting her tailbone and her legs, she says that she is having a hard time shifting and trying to get comfortable, because every time
she sits the bed up, she slides down. She said it feels like there are rug burns on her
back from the constant sliding up and down in the bed.
Heart sounds are muffled and a pericardial rub is heard. Bowel sounds are present in
all 4 quadrants. Pt reports last BM was this morning and was within normal limits. No
complaints of burning on urination.
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1. Give your conclusions about the present situation. Words like "might be" or "could be." are helpful. A diagnosis is not necessary. (i.e., Patient’s tongue swelling might be from side effects from ACE drugs)
|
|
2. If the situation is unclear at least try to indicate what body system might be involved.
|
|
3. State how severe the problem seems to be. (Patient is having a severe chest pain from ischemia to cardiac vessels)
|
|
4. If appropriate, state the problem could be life threatening such as medication adverse effect. (Pt is experiencing Red Man Syndrome from a severe reaction to Vancomycin infused too rapidly) |
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