I am working on a case study for class and I am just wanting to make sure I am thinking along the right lines before I start going into major detail on everything. This is what I have so far. If you could provide any input that would be great. The thing I am struggling the most with is relating the lung cancer.
You are caring for a 56 year-old-client who has been hospitalized with chest pain. The client’s history includes diabetes, chronic renal failure (on peritoneal dialysis), history of Cancer of the lung, and alcoholism. He presents with jaundice of the sclera and skin. Striae are noted on the abdomen.
The client’s lab values are as follows:
Troponin (on admission) 1.5, ECG shows ST elevation in anterior leads
1. Create a CONCEPT MAP with the above information only. Include all areas on the map (all areas include– medical, pharmacology, risk factors, lab results, nursing problems and goals only). (20%)
2. What diagnostic tests do you anticipate and why? What will the nursing care be, including care pre/post testing and teaching?
a. 12 lead ECG
c. cardiac catheterization
i. Patient weight and BMI: determine if obesity is a potential risk factor
j. Cholesterol and Triglycerides: if elevated, would be a risk factor
k. liver Function tests
3. Is this client a candidate for tPA – why or why not?
The client is not a candidate for tPA because it has not been confirmed that a clot is the cause of his MI. Also, tPA is contraindicated in clients with CKD and elevated glucose levels greater than 400.
Ten (10) hours after admission, the client begins to hallucinate, and is screaming with pain in the abdomen. You suspect acute alcohol withdrawal. The MD is notified and the client is placed on Librium. You take over the peritoneal dialysis since the client is not able to himself. The current peritoneal return is slightly cloudy. Lab work at this time is as follows:
What disease process do you think this client may have? Defend your answer in detail.
Pancreatitis (elevated amylase, lipase and ammonia) ?
4. What medical treatment will this client require?
NPO, TPN IV, fluids IV, supplemental O2, Demerol for pain, histamine H2 receptor blocker (proton pump inhibitor), antacids, anticholinergics, antiemetic, parenteral antibiotics, NG tube, pancreatic enzymes (pancreatin)
5. Nursing care?
Turn q2h, encourage incentive spiromenter, daily weights, provide oral hygiene, monitor bowel sounds, vital signs q2h (BP, respirations, HR and O2), I&Os q8h, assess pain, HOB 30 degrees or greater, monitor H&H, WBC, Ca+, glucose, BUN, creatinine and K+ and monitor LOC and mentation. Teach client to avoid alcohol, caffeine, tea and nicotine and worsening S&Sx of pancreatitis: abdominal pain, clay colored stools and dark urine.
The client is treated for the above disease process and improves.
Four days after admission, the nursing assistant reports to you that the client is short of breath, HR 158 and B/P of 100/62. Assessment of the client reveals an irregular heart rate and O2 saturation of 89%.
6. What do you think is going on with the client at present? If there is more than 1 problem, only follow one of the problems that you have identified.
Heart Failure and atrial fib.
7. What treatment/diagnostic tests do you anticipate the MD ordering?
Digoxin: used in CHF clients when a. fib. Coexists
Amiodarone: to correct atrial fib. ?
8. In detail, what will the nursing care consist of for this client?
Monitor for edema
Monitor lung sounds and for JVD
Vital signs q15min
Assess for decreased tissue perfusion: capillary refill, peripheral pusles, color, temperature
Monitor LOC and mentation
Decrease workload on the heart: minimize activities and provide ample amount of rest between activities
Monitor digoxin levels