Mrs. Juana Dela Cruz is a 46-year-old woman who has been having financial difficulties since her husband died five years ago. She was recently involved in a motor vehicle crash (MVC) in which she drove over a curb and hit a telephone pole. She did not sustain any significant injuries in the MVC. Juana’s daughter, Maria, returned home at 8:00AM as she forgot something for work only to find her mother sitting on the floor with a decreased level of consciousness. Maria was able to shake her mother awake and with slurred speech, Juana told her she drank three large glasses of antifreeze (ethyleneglycol) as soon as Maria left for work; this was around 7:00AM, as Maria recalled, thus, she called the emergency medical services to transport Juana to the local emergency department. Upon arrival at the emergency department, Juana had a temperature of 36.1°C. Her other vital signs were as follows: BP 135/85mmHg, PR 68bpm, and RR 24cpm. Her ABGs on a 15-liter-per-minute non-rebreather revealed a pH of 7.19, PaCO2 of 13 mmHg, PaO2 of 359 mmHg, bicarbonate HCO3 of 5 mEq/L, and oxygen O2 saturation of 100%. Juana was prescribed to receive succinylcholine chloride, levalbuterol, lorazepam, propofol, and etomidate in the emergency department. She was eventually intubated and put on a mechanical ventilator on assist-control mode with breath rate of 28, VT of 650mL, oxygen 70%, and a PEEP of 5. Her oxygen saturation was 92% at the set FIO2. Her physical examination revealed no abnormal findings. The neurological exam, though, wasdeferred because Juana was intubated and sedated. An electrocardiogram shows Juana was in a normal sinus rhythm and a chest X-ray was also ordered for her. Her urinalysis showed a specific gravity of 1.010; a small amount of occult blood, 3-5 white blood cells per high-power field (HPF); a few bacteria per HPF; and a moderate amount of uric acid crystals and urine calcium oxalate crystals. A urine culture and colony count were negative for growth. Her blood alcohol level was noted be less than 10 mg/dL. Her ethylene glycol level was, at that moment, 36 mg/dL. CBC was within normal limits (WNL), except for MCV of 79.2 μm3 Troponin level was 0 ng/mL, CK was 182 U/L, and CK-MB was WNL. Serum osmolality was at 392 mOsm/Kg. Herelectrolytes are WNL, except for a serum bicarbonate of 7 mEq/L. She has an anion gap of 29 mEq/L, BUN of 25 mg/dL, and creatinine of 1.4 mg/dL. Her liver function tests were WNL. The attending physician was then considering a diagnosis of acute renal failure. Juana was subsequently admitted to the intensive care unit (ICU) and prescribed with IVF of normal saline with 2 ampules of bicarbonate at 125 mL per hour. Other medications prescribed for her include: • 4-methylpyrazole (Fomepizole) IV every 12 hours, • thiamine 100 mg IM, and • levalbuterol (Xopenex) nebulization treatments. In the ICU, at the bedside, a Quinton dialysis catheter was surgically inserted in the right internal jugular vein for emergency dialysis. A chest x-ray was performed after catheter insertion. Juana had repeated creatinine and BUN labs drawn two days after admission. The results showed a creatinine of 4.7 mg/dL and a BUN of 24 mg/dL. A day later her creatinine was at 8.5 mg/dL with a BUN of 57 mg/dL. Potassium levels, on the other hand, 48 hours after admission was at 4.0 mEq/L; and 72 hours after admission, 4.2 mEq/L Create at least 2 nursing care plans based on your assessment that needs to be prioritized
Mrs. Juana Dela Cruz is a 46-year-old woman who has been having financial difficulties since her husband died five years ago. She was recently involved in a motor vehicle crash (MVC) in which she drove over a curb and hit a telephone pole. She did not sustain any significant injuries in the MVC.
Juana’s daughter, Maria, returned home at 8:00AM as she forgot something
for work only to find her mother sitting on the floor with a decreased level of consciousness. Maria was able to shake her mother awake and with slurred speech, Juana told her she drank three large glasses of antifreeze (ethyleneglycol) as soon as Maria left for work; this was around 7:00AM, as Maria recalled, thus, she called the emergency medical services to transport Juana to the local emergency department.
Upon arrival at the emergency department, Juana had a temperature of 36.1°C. Her other vital signs were as follows: BP 135/85mmHg, PR 68bpm, and RR 24cpm. Her ABGs on a 15-liter-per-minute
non-rebreather revealed a pH of 7.19, PaCO2 of 13 mmHg, PaO2 of 359 mmHg, bicarbonate HCO3 of 5 mEq/L, and oxygen O2 saturation of 100%.
Juana was prescribed to receive succinylcholine
chloride, levalbuterol, lorazepam, propofol, and etomidate in the emergency department. She was eventually intubated and put on a mechanical ventilator on assist-control mode with breath rate of
28, VT of 650mL, oxygen 70%, and a PEEP of 5. Her oxygen saturation was 92% at the set FIO2.
Her physical examination revealed no abnormal findings. The neurological exam, though, wasdeferred because Juana was intubated and sedated. An electrocardiogram shows Juana was in a
normal sinus rhythm and a chest X-ray was also ordered for her.
Her urinalysis showed a specific gravity of 1.010; a small amount of occult blood, 3-5 white blood cells per high-power field (HPF); a few bacteria per HPF; and a moderate amount of uric acid crystals
and urine calcium oxalate crystals. A urine culture and colony count were negative for growth. Her blood alcohol level was noted be less than 10 mg/dL. Her ethylene glycol level was, at that moment,
36 mg/dL. CBC was within normal limits (WNL), except for MCV of 79.2 μm3
Troponin level was 0 ng/mL, CK was 182 U/L, and CK-MB was WNL. Serum osmolality was at 392 mOsm/Kg.
Herelectrolytes are WNL, except for a serum bicarbonate of 7 mEq/L.
She has an anion gap of 29 mEq/L,
BUN of 25 mg/dL, and creatinine of 1.4 mg/dL. Her liver function tests were WNL. The attending physician was then considering a diagnosis of acute renal failure.
Juana was subsequently admitted to the intensive care unit (ICU) and prescribed with IVF of normal
saline with 2 ampules of bicarbonate at 125 mL per hour. Other medications prescribed for her
include:
• 4-methylpyrazole (Fomepizole) IV every 12 hours,
• thiamine 100 mg IM, and
• levalbuterol (Xopenex) nebulization treatments.
In the ICU, at the bedside, a Quinton dialysis catheter was surgically inserted in the right internal
jugular vein for emergency dialysis. A chest x-ray was performed after catheter insertion.
Juana had repeated creatinine and BUN labs drawn two days after admission.
The results showed a creatinine of 4.7 mg/dL and a BUN of 24 mg/dL. A day later her creatinine was at 8.5 mg/dL with
a BUN of 57 mg/dL. Potassium levels, on the other hand, 48 hours after admission was at 4.0 mEq/L; and 72 hours after admission, 4.2 mEq/L
Create at least 2 nursing care plans based on your assessment that needs to be prioritized.
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