Learner Brief: Emergency Department 0400Pre-Sim Skills review: Be prepared to performSet up of IV fluids

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Question Answered step-by-step Learner Brief: Emergency Department 0400Pre-Sim Skills review: Be prepared to performSet up of IV fluidsStan Checketts, a 52 year old patient has just arrived in the ER with complaints of severe abdominal pain, nausea, vomiting over the last few days. His abdomen is distended. A small bowel obstruction is suspected. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt dizzy and weak all evening. He thought it might be the flus, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment, orders have been written, labs have been drawn and an IV placed. Lab results have not arrived yet.IV startNG tube placementFoley InsertionConnection to appropriate wall equipmentOxygen set-upMedication administrations: IVPre-Simulation Preparation Questions:1.    Name 4 causes of Small bowel obstruction.2.    What are the defining characteristics of small bowel obstruction?3.    Explain to the patient why a Nasogastric tube is needed prior to potential surgery.4.    What diagnostics tests would you expect to be used to in this case?5.    What type of tube will be used? What is low intermittent suction and how is it set up? What setting are appropriate in this case?6.    Explain why a small bowel obstruction will cause dehydration?7.    Describe the fluid and electrolyte/ acid base imbalances would likely be caused due to a small bowel obstruction with severe emesis.8.    What variations to lab values might you expect for this scenario?9.    Why is an IV fluid bolus needed in this situation and what complications can occur as a result of an IV fluid bolus administration?10. What equipment should be connected and used to monitor the patient for complications that could result from Health Science Science Nursing NUR 1212 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step A 44-year-old woman presents to the emergency department with... A 44-year-old woman presents to the emergency department with complaints of blood-tinged productive cough, sudden onset of chills, shortness of breath, and intractable back pain. Her symptoms began 5 days ago with a productive cough, nasal congestion, and sore throat after returning from a trip to Great Britain. Two days ago, she visited her primary care physician and was started on prednisone 20 mg once daily and levofloxacin 750 mg once daily for 5 days. Background and Past Medical HistoryPrescribed drugs and over-the-counter medications did nothing to relieve the patient's symptoms. She does not recall the names of over-the-counter medications but states she was taking a "gel capsule." She reports worsening of shortness of breath and describes having chest pain with inspiration and back pain. She has cough-associated emesis and chills. Her cough produces rusty sputum. Other details in her history are as follows:Reports history of diet-controlled diabetes and a hysterectomy 4 years agoDenies the use of tobacco, alcohol, and illicit drugsReports being in a motor vehicle crash 2 years ago with back injuryTakes Percocet 10 mg/625 mg every 4 to 6 hours at home Respiratory AssessmentLung soundsRateColorCapillary refillOxygen saturationPhysical Assessment1. What would you expect to find when completing a physical assessment?Physical AssessmentAnticipated FindingsUse this column to describe the link between assessment findings and related pathophysiology. Indicate the pertinent positives and pertinent negatives of the condition using the information presented.Vital signs:T 38.2 °C P 106/regular RR 28 BP 91/57 O2 saturation on room air 88% Height, weight, and waist circumference:5′4″, 180 lb, 33″ waist General appearance:Pale, dry mucous membranes,uncomfortable Skin  Eyes:PERRL Ears and hearing:No complaints Nose and sinuses  Mouth:Teeth in good condition Neck  Lymph nodes  Thorax and lungs:Rhonchi RLL; crackles on inspiration  Heart:Tachycardia Peripheral circulation  Abdomen:Bowel sounds active × 4 quadrants Musculoskeletal:  Back pain 10/10 Neurologic   2. What are your priority assessments and why? What are the safety concerns for the patient?3. Labs and tests are completed. What lab values are abnormal and what is the explanation for the abnormalities?WBC: 14,080 Hematocrit: 42.7%Platelet count: 174,000Coagulation studies: Normal Basic metabolic panel: Normal without anion gap Arterial blood gas on 3 L/min by nasal cannula:pH: 7.36Pco2: 45 mm HgHco3: 23 mmol/LPo2: 60Sao2: 92%ECG: sinus tachycardia without evidence of ischemiaCXR: "RLL consolidation consistent with RLL pneumonia"  AdmissionThe patient is admitted to non-ICU care with the following orders:Start patient on IV 0.9% normal salineCeftriaxone 1 g IV every 12 hours for 7 days after pan culture and blood work sent to labBroad-spectrum antibiotic that covers gram-positive and gram-negative bacteriaCephalosporinAzithromycin 500 mg IV daily for 3 days Gram-positive macrolideBlood glucose 152Regular insulin administered per sliding scaleHydrocodone/acetaminophen 5/325 mg orally every 4 hours as needed for pain4. What other orders would you anticipate? 5. Develop three nursing diagnoses related to the pathophysiology of this, as informed by the findings of your assessment and the preceding lab values. In other words, link the pathophysiology to what you anticipate will happen with the patient. Use the following table to guide the process.Alteration in Condition (Pathophysiology) Critical Thinking and Clinical Decision MakingApply your knowledge of pathophysiology to the clinical decisions you will make as you plan for client care. Using critical thinking to guide the process, link the pathophysiology to the clinical plan of care. Consider, "What do I anticipate will happen with this patient?"Impaired gas exchange Risk for infection Fluid status  Health Science Science Nursing NURS 440 Share QuestionEmailCopy link Comments (0)
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