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Mr. J, 40- years old, is admitted with severe left-sided pain of the abdomen. Urinalysis reveals
microscopic hematuria, and IVP shows partial obstruction of the left ureter by a 3 – 4 mm stone.
He complains of nausea and appears pale, diaphoretic, and very anxious. Temperature: 39.5
0C,
Pulse: 98 per min, BP: 162/88 mmHg, Respiration: 26 per min. Skin – cool and moist
Identify TWO problems faced by Mr. J. Illustrate a care plan for each the identified problems by
using the PIE format.
Step by step
Solved in 2 steps
- Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time, he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years but quit 3 years ago. The ABG analysis of Mr. H suggests uncompensated respiratory alkalosis with mild hypoxemia, with base excess of -1 in her arterial side, whereas -4 in her venous side. Part 1: Her actual arterial-venous oxygen content difference (Ca-vO2) is 5.31 mL/dL. (Normal range considered here is 3.5 to 5 mL/dL) Part 2: Patient's actual oxygen extraction ratio (O2ER) was 29%. (Say normal range is 20-28%) What is clinically happening to the patient?Mr. B is a 57-year-old man who was admitted yesterday after starting to pass black stools. He has a two-day history of severe stomach pains and has suffered on and off with indigestion for some months. He is a life-long smoker, with mild chronic heart failure (CHF) for which he has been taking enalapril 5 mg twice daily for 2 years. He also recently started taking naproxen 500 mg twice daily for arthritis. He works a stressful job and drinks large amounts of caffeinated coffee daily. Yesterday his hemoglobin was reported as 9.3 g/dL, hematoocrit 30%, RBC's 3.2, platelets 162, INR 1.1 with Liver Function Test normal. He was mildly tachycardic (110 bpm) and had a slightly low blood pressure of 100/77 mmHg and was given 1.5 L of saline. He has just returned from an endoscopy this morning and has been newly diagnosed as having a bleeding duodenal ulcer. They took a biopsy to determine if he is positive for H-pylori. He has been written up for his usual medication for tomorrow if he is…S.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered. The nurse is assessing the patient’s pulses. Which locations should the nurse check? What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs
- S.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered. What subjective information should the nurse obtain? The nurse is assessing the patient’s pulses. Which locations should the nurse check? What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legsPatient C: An 18 y/o healthy female presents for a routine physical examination. Patient has great difficulty producing a very small volume of urine despite not having urinated since early morning. During discussion with physician it is revealed that she has had only 2 cups of coffee and a donut to eat all day 1) What are the abnormal findings? 2) What is your diagnosis? 3)What suggestions might you have for this patient? 4) Why does the body form concentrated urine? and where in the kidney does urine concentration occur? 5) Why is an extended water fast a bad idea?Mr S. is a 45-year-old man who has just been admitted to the ICU postoperative cardiac surgery. He has had an uneventful coronary artery bypass graft with no complications in the operating room. He is intubated and placed on complete mechanical ventilation. His vital signs are: blood pressure (BP) 150/90 mm Hg, heart rate 86 beats per minute, respiratory rate 12 breaths per minute, and temperature 35.3°C The target systolic BP for Mr S. is less than 130 mm Hg and the surgeon’s postoperative orders include BP medications and intravenous morphine sulfate for pain. In addition, the surgeon prescribes an nonsteroidal anti-inflammatory drug, ketorolac, to be administered to the patient once it has been determined that they are not bleeding excessively and have acceptable renal function. The ICU where Mr S. is admitted has a respiratory therapist (RT) on staff. This RT is aware that mechanical ventilation is very uncomfortable for patients. There is a standing order in the ICU that heart…
- a)What is the diagnosis for this patient? b. how can the cardiac outputbe compensated, and what has failed here. c. What is the diuretic aiming to achieve? and what is the most likely nature of the surgical repair based on the severity of the issue and theage of the patientPatient R., 32 y/o, was delivered with complaints of fatigue, decrease of appetite, intensification of pigmentation in the open areas of the body, palms of the hands, cyanosis, losing weight, nausea and vomiting. The symptoms began to aggravate during 1-2 weeks after acute poisoning. Objectively: arterial pressure – 60/30 mm column of mercury, pulse – 140 beats/minute, skin turgor is lowered, the colour is dark with intense pigmentation of the elbows, scars, skin folds on the palms; clearly low levels of sodium and chlorine, high levels of potassium in the blood; glycemia – 4.3 mmol/l. What is your diagnosis?A. Addisonian crisisB. Uremic coma C. Brain comaD. Acute cardio-vascular insufficiencyE. Hypoglycemic comaMrs. Condif is a 35-year-old female who presents to the emergency department with the chief complaint of severe right sided flank pain which began one day ago. She reports feeling nauseated and has vomited once today. Mrs. Condiff does not show any outward appearance of pain but is having some difficulty sitting still. She states, “I feel the need to constantly walk around.” Upon further questioning, the client reveals a history of dysuria, urgency, and frequency of urination. As the nurse obtains a history, she notes that the client has no facial grimace and is not making eye contact. The client states, “I am sorry to come in with this pain, I have tried to treat it at home with Creeping Charlie but it just did not help.” Case Study Nursing assessment findings include pale, moist skin, costovertebral tenderness, and restlessness. Her vital signs are blood pressure 142/90, pulse 110, respirations 22, and temperature of 99.8°F (37.7°C) Oxygen saturation is 98% on room air. The emergency…
- Mr. Eliot presents to the office for routine follow-up. He is under treatment for hypertension and congestive heart failure with enalapril and a diuretic. His blood pressure is under acceptable control, and he has no symptoms of heart failure at present. He does complain that he has been coughing frequently in the past few months. History and examination reveal no other cause of a chronic cough, so you decide to discontinue his enalapril and start him on losartan.1. Describe the likely cause of the cough. 2. Explain the effect of enalapril on his nutritional care. 3. Describe enalapril and explain its mechanism of action.For iron deficirncy anemia, write Causes and PathophysiologyPatient presented to the emergency department with a chief complaint of feeling weak, tired, and lethargic. The patient states, "I've just been feeling run down and I don't know why." She also states that she is currently on diuretics and has a history of type I DM, HTN, and stage 3 chronic kidney disease. According to her caregiver and family, she has had difficulty breathing on minimal exertion and constantly appears "winded" even at rest. She reports that she is currently unable to ambulate and has been feeling lethargic for three days. According to her family, since her discharge from the hospital one month ago her respiratory status has not returned to normal. She also reports having a history of muscle cramping in her lower leg, but currently there is none present. She has been using 2L of oxygen via nasal cannula and just a few days ago her Lasix dose was doubled to help manage her CHF symptoms. She reports her quality of life has significantly declined in the last month and she…