Hewson was admitted to the med-surg unit two days ago for pneumonia. She is a 78 year old female with a past medical history of diabetes mellitus…

Question Answered step-by-step Mrs. Hewson was admitted to the med-surg unit two days ago for pneumonia.She is a 78 year old female with a past medical history of diabetes mellitus (DM), peripheral vascular disease, hypothyroidism, and osteoarthritis. She is also in the beginning stages of dementia. After getting report from the previous shift, you check her vital signs and get the following results:   Temperature 96.5◦ F Blood Pressure 104/72 Heart Rate 126 Respiratory Rate 24 Oxygen saturation 94% on 3L via NC Pain level 0  After noting the elevated heart rate, you look back at the client’s last set of vital signs from 4 hours ago and see the following values:  Temperature 97.1◦ F Blood Pressure 110/74 Heart Rate 106 Respiratory Rate 28 Oxygen saturation 94% on 3L via NC Pain level 0  There are many possible reasons for an increase in heart rate. One of those is fever, which would be likely given that she has pneumonia. However, her temperature is normal. It could also be due to medications. So you check her MAR and see the following: 1.   Which of these medications might contribute to her increased heart rate?  2.    Should you report this increased heart rate to the provider? A few hours later, you check on your patient again and note she seems more lethargic. You check her vital signs and get the below results:  Temperature 95.8◦ F – rectal Blood Pressure 78/44 Heart Rate 138 Respiratory Rate 28 Oxygen saturation 91% on 3L via NC Pain level 0  3.   What is your next step?   4.   What is going on with your patient (medical diagnosis)? While waiting for the rapid response team to arrive, you start to get some things ready in anticipation for new orders from the RRT team. 5.   What new orders would you expect? (name at least 2 diagnostic and 2 treatment orders) The RRT arrives and the provider orders a 2 liter bolus of 0.9% NS for this client.  6.   What is the reasoning for this? What is the goal? How will you know this therapy is working? Use your own words.  7.   What side effect could we see and how would you monitor for it?  After administering the bolus, the provider orders a repeat lactic acid level.  8.   Why is a repeat lactic acid (lactate) level ordered?  Your repeat vital signs after the fluid bolus are below: Blood Pressure 84/54 Heart Rate 128 Respiratory Rate 26 Oxygen saturation 95% on 6L via simple mask  Based on the new vital signs, you receive new orders: •      Norepinephrine •      0.5 mcg/kg/min•      Titrate q 5 minutes for SBP of at least 90•      Titrate rate: 0.1 mcg/kg/hr•      Max dose: 3 mcg/kg/min•      Mrs. Hewson weighs 65 kg. •      On hand is the premixed bag below.9.   How many mL’s per hour should the pump be set to? Round to the nearest tenth  10. What is the goal of the norepinephrine and what should we watch for?   Two days later the ICU nurse notes the following during the assessment:  11. What may have caused this injury? What kind of injury is this?   12. How could this have been prevented? Health Science Science Nursing NSG 206 Share QuestionEmailCopy link Comments (0)