Name: Date: Case study 76: Endocrine INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do notassume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as is and you will need to rewrite it. Scenario Y.L., a 34-year-old Asian woman, comes to the clinic with complaints of chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with over-the-counter medication. …show more content…
Her most current vital signs (VS) are 118/60, 88, 18, 99.40 F (37.40 C). The medical director ordered a postvoid catheterization, which yielded 100 mL of cloudy urine that had a strong odor, and several lab tests on admission. The results were as follows: Laboratory Test Results Complete metabolic panel (CMP): Within normal limits except for the following results: Urine culture and sensitivity results are pending. 1. What condition do the assessment findings and lab reports point toward? 2. The medical director makes rounds and writes orders to start an IV of D51/2 NS at 75 m/hr and insert a Foley catheter to gravity drainage. Because M.Z. is unable to take oral meds, the medical director ordered ciprofloxacin (Cipro) 400mg q12h IV piggyback (IVPB). Is the type of fluid and rate appropriate for M.Z.'s age and condition? Explain. 3. While administering the IVPB ciprofloxacin, which adverse effects might occur? (Select all that apply.) a. Hypotension b. Headache c. Drowsiness d. Restlessness e. Nausea f. Tendon rupture 4. You enter the room to start the IV and insert the Foley catheter and find that the NAP has taken the patient to the bathroom for a bowel movement. M.Z. asks you to help her, and, as you open the door, you observe the patient wiping herself from back to front. What do you need to do at this time? 5. Because M.Z. has been having diarrhea, what special
A patient/resident with an indwelling catheter also has a catheter drainage bag, as well, that all
4:35 p.m.: B/P 110/62, Oxygen saturation is 92%. Nurse J and the LPN on duty receives the emergency transport patient, and they are also discharging two other patients. ED lobby is congested with new patients.
Lack of appetite: Based on the history taken from the patient, she has a lack of appetite, going so far as to consuming just a grilled chicken sandwich and water over the course of an entire day. The lack of appetite came around the same time as her fatigue and may play a role in it. Her
It was a typical Thursday on CVCU. The day was steady, but nonetheless, busy. The charge nurse aid I would be receiving a patient, post cardiac catheterization laboratory (cath lab) in room nine. I wasn’t long after, indeed I saw the cath lab team approaching with the patient. I met them in the room and I early introduced myself to Mr. E.H. I noticed, immediately, that he seemed indifferent. Meanwhile, we collectively settled him, by placing him on the monitors and assessing his procedure site.
She denies heat intolerance, diarrhea, recent weight loss and excessive sweating. She denies excessive caffinated beverage intake.
At today’s visit she is accompanied by her husband. She is awake, alert and oriented times one. She denies pain, chest pain, and shortness of breath. The husband reports that the patient appears stable at this time, but she is not eating as much as she used to. She reports that she is able to dress herself, feed herself and shower herself. The husband reports that it is increasing difficulty to get her to her doctor appointment and that she wonder at time. No acute distress noted. KPS 50%.
Cohen RPh, MS and is titled “Make sure You Have the Right Tubing”. This article explains the situation of a 78-year-old woman who has suffered from a stroke and has an indwelling urinary catheter and a gastrostomy tube (for tube feedings). During shift change the oncoming nurse noticed a milky white fluid in the patient’s urine collection bag. It was later determined that this fluid was from the Kaopectate the was administered earlier that day. When the nurse administered the medication, she stopped the tube feeding and instead of disconnecting the gastrostomy tubing she disconnected the urinary catheter tubing. The medication then went directly into the patient’s bladder. The patient was fine and the physician prescribed another medication for bladder irritation. The article states two ways to prevent this error from occurring are labeling all tubes and/or following tubes from the distal to the proximal end before administering any feedings or
History: Sadie has been experiencing an decrease in appetite accompanied by an increase in thirst. Subsequently, she has been urinating more frequently. She appears fatigued. Sadie has a history of IBD (inflammatory bowel disease), and is currently being treated for the condition.
7. If this will be an out-patient procedure or if you will need to stay in a hospital for any length of time
The first day, my preceptor and I took on four patients (two ALC patients, one pediatrics with psychiatric illness, and one patient with Parkinson's disease). We split the workload so we each had two patients. I had the pediatrics patient and patient with Parkinson's disease. It was nice to start with small patient load to help ease into getting back into the routine of the Medical Surgical floor. On the first day, I got to attempted to insert an IV into a patient’s
Urinary retention. I had a lengthy discussion with the patient regarding his bladder dysfunction and urinary retention. He is to increase his catheterization to
E: Initially, the nurse explained to us why the procedure was being completed. The patient was experiencing urinary retention which is a result of the bladder’s inability to empty fully (Wood, 2014, p. 1118). Additionally, there was a doctor’s order for a specimen collection. First, the nurse began the process by prepping for the procedure, this entails explaining the procedure to the patient, cleaning the perineal area and setting up all the materials required. Following, the nurse lubricated the tip of the catheter to decrease the friction while inserting the catheter through the urethral meatus. Then the nurse retracted the labia to expose the urethral
The most likely diagnosis I selected for the patient is diabetes mellitus type 2. The clinical presentation of diabetes mellitus type 2 includes an insidious onset where patients are initially symptomatic. The patient may present with pruritus and neuropathic complaints of numbness and tingling. Other complaints include polydipsia, polyuria and nocturia. The presentation of an infection such as vaginitis caused by candidiasis or a non-healing skin infection is often the first complaint (Dunphy et al., 2015). The patient’s history of her present illness includes a three-month history of fatigue, which she complains of not having much energy for daily activities as she once did. Complaints of increased urination along with increased feelings
Today I started out by shadowing a licensed practical nurse. She was in the mist of giving the residents their noon medicine doses. For reference, a resident receives an antibiotic everyday for bacteriuria(MT1). Another resident received pain medication for nephrolithiasis, while he waited for the stone to pass. Apparently, one of the residents refuses to take her vitamins, so the LPN dissolved it in coffee. Later on, I started shadowing a certified nurse aide. She was in the process of preparing a resident for a bed bath(IC). The resident had a Foley catheter which the CNA emptied and cleaned. The catheter helped the resident with urinary retention. Urinary retention is when the bladder does not empty all the way or at all. It is caused by
Lastly, for postrenal results from bilateral obstruction, accidental liagtion of ureters, bladder obstruction, or urethral obstruction.