RESOURCE: The patient is postoperative day number one and is…

Question Answered step-by-step RESOURCE: The patient is postoperative day number one and is… RESOURCE: The patient is postoperative day number one and is admitted to the Medical-Surgical Unit with the following: • Acute kidney injury (AKI) secondary to hypovolemia • Increased intra-abdominal pressure secondary to an ileus • Nephrotoxicity due to vancomycin administration • Significant other is at bedside Patient history of present illness: • The patient presented to the Emergency Department (ED) one day ago with complaints of abdominal pain and yellow skin • Underwent an emergency open cholecystectomy for obstructive jaundice and showed progressive improvement until last night, when the patient began having the following symptoms: o A low-grade fever o Nausea o Vomiting o Urine output of 250 mL over 12 hours o Reports that he has not had a bowel movement in three days • The patient’s surgical wound is positive for methicillin-resistant staphylococcus aureus (MRSA) o Vancomycin started o Patient was placed on contact isolation This Simulated Clinical Experience (SCE) consists of four states that transition manually at the facilitator’s discretion. State 1 Initial Assessment: Vital Signs: • HR in the 110s • BP in the 90s to 100s/60s to 70s • RR in the 20s • SpO2 in the low 90s on room air • Temperature of 37.9C Other Assessment Findings: • Cardiac rhythm is Sinus tachycardia • Pulses weak bilaterally • Breath sounds are diminished • Bowel sounds are absent • Abdomen is firm and distended • Complaining of nausea and lower abdominal pain, rates pain 5 out of 10 • Vomited green and yellow emesis twice • Voided 15 mL of dark amber urine • Dressing on incision is dry, with a small amount of serous drainage • Awake, alert, and oriented to person, place and time • Anxious related to the vomiting • Pupils are equal, round and reactive to light and accommodation • Significant other is at the bedside, quiet, but appears concerned When the learner(s) request the lab results, the facilitator should provide the following report: • CBC: WBC 12, RBC 5.2, Hgb 12, Hct 36%, Platelets 92 • Chemistry: Na 150, K 5.2, Cl 116, CO2 18, Glucose 96, BUN 50, Creatinine 2.6   QUESTIONS:  1. Using the information in the patient history of present illness only:a. Identify a total of 10 things that are clinically significant and provide a rationale (this can be manifestations, procedures, interventions, treatments, etc.)2. Using the information in the State 1 initial assessment only:a. Identify a total of 20 things that are clinically significant and provide a rationale (this can be manifestations, labs, etc.)   Health Science Science Nursing Share QuestionEmailCopy link Comments (0)