What is this clients major presenting health problems? - page 2

Hi nurses My case study is as follows: I have an 85 year old patient, he has been admitted with abdominal pain (liver region) that has been constant for the past week, be has been vomiting and has not had any food or fluids... Read More

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    No.......think about what you need to think about, which is more important? Which one of these pieces of information.....could kill him first? It won't matter that your patient has a fever if they don't have a B/P. Take a deep breath and read very carefully what I have written. I have given you ALL the information you need to solve this question

    Don't over think this......you don't need a medical diagnosis to make your nursing mind work.

    I gave you the order in which to think about first......
    Looking at this information......as a nurse what would alarm you when you went in first thing in the morning that you would come out of the room and say....I need to call the MD? What would kill them first (Maslows Hierarchy of needs)
    What would alarm you first.....

    BP 90/50, HR 110 bpm, RR 28/min
    vomiting and has not had any food or fluids in 2 days.
    39.3C,
    abdominal pain
    feverish
    confused and forgetful
    refusing treatment
    English is poor
    weighs 53kg
    Have you studied Maslow's yet? If you do not replace the patients volume......their blood pressure will continue to drop and if they do not have a blood pressure they will die...Although they have a fever....if you correct the volume you may correct (partially) the fever.

    It can be a toss up which you fix first...the temp is 102.7. However in this patient because of the SBO, vomiting and inability to take fluids for days prior to admission....... this becomes the most important in this patient. I know it's hard when the patient isn't in front of you too look at and see what alarms you the most.
    This leaves his low BP and pain to take care of - it can also be contributing to his confusion/nausea.
    You are almost there.....you even see that after treating the fever you are still left with hypotension/shock with confusion.....which continues to threaten this patients life.

    While fever can cause a patient to become confused (common in the elderly)......dehydration can also cause confusion.....hypotension/shock and death. Even if this patient is septic.....the hypotension would need to be addressed for septic patient require high volumes of fluid.

    In the real world .....you would further assess fluid status like the mucous membranes, skin turgor, and urine output. As well as a variety of blood work at your disposal to help your thought process. You would be doing these interventions essentially simultaneously.

    This patient has a bowel obstruction.....they are vomiting any gastric/intestinal contents. They are unable to take any fluid because it comes right back out. (like a plugged toilet.....if you try to put anything in....it comes right back up). They are in pain from this obstruction and they have become confused, restless, anxious, agitated. He has also developed a fever.

    As the nurse...you see this sweet little old man with an anxious family....you can barely hear his blood pressure because it is so low, he is dehydrated, in pain...with a fever. Which would make you the most concerned.

    Don't over think this......you don't need a medical diagnosis to make your nursing mind work.
    Last edit by Esme12 on Feb 25, '13
    marsy82 likes this.

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  2. 1
    Dehydration will cause fever. Why is that? What are the ways your body regulates its temperature? Merely giving some antipyretic (which is part of a medical plan of care, not a nursing plan of care) will not fix that. Keep thinking.
    Esme12 likes this.


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