Clinical Makeup Case Study (complete)

.docx

School

Community College of Baltimore County *

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Course

160

Subject

Nursing

Date

Apr 29, 2024

Type

docx

Pages

Uploaded by patrickcook1896 on coursehero.com

UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Introduction Sepsis Suggested Answer Guidelines In this unfolding case study, you will assume the role of a nurse in the acute care setting, beginning in the emergency department and ending in the critical care unit. You will use a holistic approach to provide safe care by making correct clinical judgments for a patient with suspected sepsis. You will need to apply essential knowledge to notice and interpret the most critical assessment findings and lab values to properly establish care priorities and recognize the potential for developing complications Preparation for Care Activity Recognizing Clinical Relationships Review the medical history and home medications of this patient. For each home medication, identify the pharm. classification and expected outcome for this patient, its most common side effect (SE). Finally, draw a line to determine which medication treats what condition. Medical History Home Medications Pharm. Classification Expected Outcome Common SE  Parkinson's Disease  COPD  CHF  HTN  Depression  Stage IV decubitus ulcer  Furosemide 40 mg PO BID  Prednisone 5 mg PO every other day  Potassium 20 mEQ Po daily  Carbidopa/Levodopa  Albuterol inhaler  Metoprolol  Silver sulfadizine topical ointment - Loop Diuretic - Corticosteroid - Electrolyte Supplement - Decarboxylase Inhibitor - Beta2 Adrenergic Receptor Agonist - Beta Blocker - Sulfa Antibiotics - Increased urine output - Decreased inflammation - Increased potassium levels - Increased availability of levodopa - Bronchodilati on - Decreased blood pressure - Treatment of infection - Hyponatremi a, hypokalemia , N/V, dizziness, headache - Sweating, insomnia, indigestion, impaired wound healing - Throat and gastrointesti nal discomfort, weakness - Ataxia, sleepiness, confusion, agitation, anxiety - Bronchospas m, dry cough, hypotension,

UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Part I: Developing Noticing and Interpreting Skills 1. Which findings from the present problem are most important and noticed by the nurse as clinically significant? Most Important Findings Clinical Significance - Stage IV Ulcer - Low level of consciousness - Hypotension w/ Hx of HTN - Parkinson - COPD - Stage IV ulcers are possibly fatal and a risk of infection - Patient is barely responsive, indicating an emergency - Hypotension can fatally reduce cardiac output - Parkinson’s could affect LOC - COPD presents a risk of constricted airways which could dangerously reduce body’s O2 levels and pH - 2. Which data from the social history is most important and noticed by the nurse as clinically significant? Most Important Findings Clinical Significance - Daughter is DPOA - Estranged from family - Heavy Smoker - Not DNR but requested - Bedbound - Daughter will play a significant role in medical decisions - Family is unavailable to provide much information on the patient or be there to advocate for patient - Smoking will impact his physical condition and likely is the cause of COPD Dx - Bedbound status likely contributed to formation of Stage IV ulcer and will impact plan of care to treat this ulcer and prevent another - Patient clearly voiced desire to change code status, indicating need to revisit code status w/ DPOA 3. To provide compassionate, holistic care for this patient, answer the following questions. What is the patient likely experiencing/feeling right now in this situation? - Pain - Loneliness - Helplessness - Confusion What can you do to engage yourself with this patient's experience and show that they matter to you as a person? - Take appropriate steps for pain management - Reach out to daughter for any info possible on how to provide comfort - Use physical stimulus and responses to assess needs related to comfort and pain management 4. Which findings from the contextual factors are most important and noticed by the nurse as clinically significant?

UNFOLDING Reasoning Simulation © 2023 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN Patient Care Begins 5. Which current vital sign findings are most important and noticed by the nurse as clinically signif icant? Most Important Data Clinical Significance - Hypotensive - Pyrexia - Tachycardia - Tachypnea - Low blood pressure on a patient who normally runs high means low cardiac output which dangerously impairs perfusion - Temperature of 101.4 could indicate infection which could be the result of stage 4 Ulcer - Tachycardia indicates the heart is struggling to provide adequate supply of oxygen to the body - Tachypnea in this case could be a sign of sepsis, acidosis, or constricted airways from COPD 7. What assessment data needs to be noticed as most important? Interpret its clinical significance. Most Important Data Clinical Significance - Verbally unresponsive - Pale and cool to touch - Tachypneic - Abdominal distension - Tea-colored urine w/ little output - Stage 4 ulcer w/ purulent drainage and foul odor - Lack of responsiveness could indicate low oxygen supply to brain - Cool pale skin indicated inadequate perfusion - Tachypnea could indicate sepsis, COPD exacerbation, or acidosis - Abdominal distension could indicate Heart Failure - Dark urine w/ little output could indicate inadequate blood flow to kidneys. Presence of edema suggests it isn’t dehydration - Stage 4 Ulcer could be fatal and the odor and drainage are signs of infection Auscultate Posterior Breath Sounds Place a circle on the chest where the nurse would place the stethoscope to auscultate the right lower lobe. Click this link to listen. Identify what type of breath sounds are heard, and interpret their clinical significance. Breath Sounds Clinical Significance Crackles - Indicates presence of fluid in the lungs, which could be from HF or COPD exacerbation. Could also be a sign of pneumonia