John (Jake) Steeler Age: 43 Occupation: Investment Banker Social…
Question Answered step-by-step John (Jake) Steeler Age: 43 Occupation: Investment Banker Social… John (Jake) SteelerAge: 43 Occupation: Investment Banker Social History: only child of Bob and Harriet Steeler; lives in Cumberland; smokes 1 pack per day; weekend drinkerFamily History: see parental info aboveCurrent Health Problems: asthma; HTN; hyperlipidemia; obesityCurrent Medications: Advair 250/50 one inhalation Q 12 hours; Albuterol inhaler 2 puffs 4 times daily as needed; Hydrochlorothiazide 25 mg po QD; Simvastatin 40 mg QDRachel Monaghan SteelerAge: 42 Occupation: Elementary School TeacherSocial History: wife of Jake Steeler; lives in Cumberland; has two sisters who live locally, one of whom is an alcoholic Family History: both parents still living; mother had breast cancer at age 62Current Health Problems: overweight; HTNCurrent Medications: Lisinopril 20 mg po QDREMINDER: In this course, we will go by the lab values noted in Table 25-4 of your text. Jake’s presentation to the ED:Jake Steeler developed severe upper abdominal pain and became dizzy at work yesterday, and almost fainted. Brought to the Emergency Department, Jake stated he had not been feeling well for about a week. He stated he has had episodes of upper abdominal pain during the night, has occasionally been nauseated, and has noticed his stools were black. In the ED, Jake was clearly in a lot of pain, was diaphoretic, and had a BP of 90/60, HR of 110, RR of 22, Temp of 97.8, and oxygen saturation on Room Air (RA) of 96%. After examination and diagnostic testing, Jake was diagnosed with a perforated duodenal ulcer. Jake’s current health problems: see profile at the top of the pageJake’s current medications: see profile at the top of the pageTwo IVs were started with NS (Normal Saline—0.9% Saline), and Jake had labs drawn. Lab results, which came back 30 minutes after being drawn, were as follows:CBC WBC 7200 (4500-11,000 mm3) Hgb 11 (m 13-18 g/dL; f 12-16 g/dL) Hct 38 (m 42-52%; f 35-47%) Platelets 310,000 (150,000-450,000 mm3)Chem Na 140 (135-145 mEq/L) K 3.4 (3.5-5.0 mEq/L) Mg 2.4 (1.8-3.0 mg/dL) Cr 0.9 (0.7-1.4 mg/dL) Ca 9.4 (8.5-10.5 mg/dL) BUN 22 (10-20 mg/dL) From the ED, Jake is going right to the operating room.1. At this point, what questions do you have? 2. What are you worried about in this patient? What is the worst thing that could happen? Be specific. 3. What do you think nursing’s responsibilities are at this point? Explain your answers.Jake’s wife Rachel comes rushing into the ED, and Jake tells her he has an ulcer, and he needs an immediate operation. Rachel becomes very anxious and begins to cry. 4. What do you say to her (select at least 2 communication techniques you would use from Table 3-1 on page 37 of your text)? Explain how you decided what techniques would be most helpful.Part 2—The care of a patient immediately postop in the Post Acute Care Unit (the PACU)Jake’s operation took 2 hours. Estimated blood loss during surgery was 750 mL. He received one unit of packed red blood cells in the OR. His vital signs (VS) during the operation were stable.Because of his active bleeding, surgeons performed an open abdominal approach. Jake comes to you in the Post-Anesthesia Care Unit (PACU) sleepy, with two IVs of LR (Lactated Ringers) running, an NG tube, and a foley catheter. He has a dry sterile dressing over his abdominal incision. Jake’s vital signs are as follows: BP 116/82; HR 98; RR 20; T 97; oxygen sat 94% on room air. He had labs drawn just as he was leaving the OR, and the results come back as follows:CBC WBC 9800 (4500-11,000 mm3) Hgb 14 (m 13-18 g/dL; f 12-16 g/dL) Hct 43 (m 42-52%; f 35-47%) Platelets 300,000 (150,000-450,000 mm3)Chem Na 140 (135-145 mEq/L) K 4.0 (3.5-5.0 mEq/L) Mg 2.4 (1.8-3.0 mg/dL) Cr 0.9 (0.7-1.4 mg/dL) Ca 9.4 (8.5-10.5 mg/dL) BUN 16 (10-20 mg/dL)A is for Airway, B is for Breathing, C is for Circulation.1. How would you initially assess Jake with the above in mind? Prioritize your assessment, keeping in mind the surgery that Jake had.Jake received blood while in the OR.2. Why can you not replace blood loss with only intravenous fluids?Some of Jake’s lab results are different after surgery than they were in the ED.3. Why do you think there are differences in the postoperative lab results? What happened between Jake’s initial admission and the end of surgery that explains the differences? Part 3—The care of a patient on arrival back to the floor from the PACUJake has returned to your medical floor following his recovery in the PACU. 1. What do you expect to hear in report from the PACU nurse, either on the phone or in person? (and if you didn’t hear this, you would certainly ask about it).2. List 3 short-term goals for your care of Jake, reflecting your priority-setting. 3. For each goal listed above, what would be 1-2 nursing actions you would take to achieve that goal? 4. For each goal listed above, how would you evaluate the goal had been reached—what assessments would you perform to determine if your actions had achieved each short-term goal? Part 4—The care of a surgical patient ready to be discharged to homeJake is being discharged to home the day following his surgery. His IV is discontinued, and he is drinking clear liquids. He has active bowel sounds on auscultation of his abdomen, and he is doing well using the incentive spirometer. Jake will have to care for his surgical incision and change his dressing at home. 1. List 3 long-term goals for Jake as he prepares to go home; and describe specifically what teaching you would do to help Jake achieve those goals. Health Science Science Nursing NURS 130 Share QuestionEmailCopy link Comments (0)
