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Case Scenario
John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID.
Summary:
Given case: 53 years old, male
History of
- Type-1 diabetes mellitus,
- CAD ( Coronary Artery Disease)
- PAD ( peripheral artery disease)
- Cigarette smoking 40 packs per year
COMPLAINTS:
- 6 weeks ago, he developed a wound in his left heel.
- Despite antibiotics, patient developed a gangrene infection.
ADVISE:
- To undergo BKA ( Below knee amputation) of left lower extremities
MEDICATION:
Daily insulin, aspirin 325 mg /day, pletaal 100 mg BD
Post-operative Data:
Post-operatively, Mr. Doe goes to the Post Anesthesia Care Unit (PACU) where he is extubated and begins to awaken from surgery. He is drowsy but arousable; tends to move and be restless. His expected blood loss is 800 cc. He has an IV in his right arm infusing D5.45%iL at 100 cc/hr. Post-operative labs are drawn and sent. His vital signs: BP100/60mmHg, PR-92bpm, RR-22cpm; and his dressing is slightly soaked with blood and with a removal drain at the site.
Main Question:
What post-operative assessments and immediate post-operative interventions should be performed for Mr. Doe?
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- John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Preventing complications of surgery is an important part of all surgical patient care. What preoperative While Mr. Doe is in the Operating Room, what considerations will be taken to ensure Mr. Doe’s safety and positive outcome? Identify 2 IntraOp nursing diagnoses for Mr. Doe teaching does Mr. Doe require in order to prevent complications? Give 3-4 examples)Case Scenario John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Dr. Ramos is Mr. Doe’s surgeon and Dr. Reyes is Mr. Doe’s anesthesiologist. Both come to see him and discuss the surgery the evening before. How does the nurse ensure informed consent? What must the patient consent to for the procedure to be done? (Discuss in 5-6 sentences)Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Please make 1 intraoperative NCP with 1 diagnosis
- Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: During the admission assessment, the nurse questions Mr. Doe to determine if there is a latex allergy or sensitivity. Why is this essential to the patient’s safety? What symptoms would the nurse question Mr. Doe about in order to determine this? (Discuss in 3-5 sentences only)Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Mr. Doe was very restless the evening before. He verbalizes to his wife that he is “scared to death” and worried about losing his foot. She asks the nurse what can be done to help him. How will the nurse address the psychological comfort of Mr. Doe? (Discuss in 2-3 sentences only)Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. What preoperative testing is appropriate for Mr.Doe? (Give at least 4 priority examples) Note to Tutor: Thank you so much, Ma'am/Sir
- Patient C., 32 y/o, was delivered unconscious to the intensive care department. The patient has a medical history of diabetes. Insulin was not found. The breathing is noisy, of Kussmaul’s type; acetone breath, the skin is dry, turgor is lowered, the facial features are sharp, periosteal reflexes are absent, eye ball tone is lowered. Blood contains 1.2 mmol/l of lactic acid (norm - 0.62-1.3 mmol/l), glycemia - 29 mmol/l. What kind of coma can be suspected?A. KetoacidoticB. Brain comaC. HyperosmolarD. HypochloremicE. LactacidemicN.H. is a 76-year-old male admitted to the hospital through the emergency department. He fell outside his home. It appears that he may have sustained a fracture to his left hip. He has a history of type 2 diabetes mellitus and has a 40 pack-year smoking history that is now complicated by chronic obstructive pulmonary disease. Data Collected (use only those that apply) Complains of excruciating pain and tenderness in left hip Pain not relieved with morphine BP 166/94 mmHg Diaphoretic and pale skin Respiratory rate 36; crackles, expiratory wheeze X-ray of left hip reveals extracapsular fracture Hematocrit 30%; hemoglobin 15g/dL; WBC 15,000/uL Discussion Questions: Considering the nursing process, list in order the steps in transferring patient from bed to chair post operatively.RON is suspected of DKA. Formulate a plan of education for Ron's wife, so she will better understand his condition and be able to assist him to manage those days when is unwell. What areas would you cover? How would you ascertain her understanding?
- Patient 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 comaCase Scenerio A.B. is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in 2015, he had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 118–127 mg/dl, which were described to him as indicative of “borderline diabetes.” He also remembered past episodes of nocturia associated with fast foods- pizzas and KFC. At the time of initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken. Referred by his family physician to the diabetes specialty clinic, A.B. presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon. He…tein X Case Studies.docx X + rl=https://wheatland.orbundsis.com/einstein-freshair/Videos/0216D9403D0ED43358766A676D8A4817/Case+Stuc TCentral | NBA... a Amazon.com: Onlin... (6) The Reason Why... Isaiah Blames Zora... Beyond The Lights... Case Study, Chapter 26, The Digestive System Mr. McArthur is hospitalized with pancreatitis and cholecystitis. Neither his gallbladdernor his pancreas are functioning normally at this time. The client is placed on a NPO (nothing by mouth) diet order, given intravenous fluids and pain medication. The nurse is aware that the pancreas has two functions: one being endocrine, secretion of hormones to assist with glucose control and the other being exocrine, aiding the digestive system. Mr. McArthur is scheduled for gallbladder removal in the morning to treat the cholecystitis. (Learning Objective 4) 1. The client asks what his gallbladder does. What is the nurse's best response? 2. The client also asks how the pancreas works to help with digestion. What…