Case study help Please!

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Hi everyone. I am working on a case study for MED Surg II. Its been going along good, and now I'm stumped. The patient has diabetes, renal failure, alcoholism, chest pain etc... One of the questions had a set of data that let me to the conclusion that he has pancreatitis. Now four days later he has improved, but presents with the following when checked....HR 158, BP 100/62, irregular HR and O2 of 89%. Anyone have any idea what could be going on with him now? Any help would be appreciated. Once I conclude what he probably has going on, I can move on to the other questions, but would like to see what people think so I can research those areas to come to a conclusion. Thanks!

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Arrhythmia second to ETOH withdrawl?

Usually doesn't present that late out but it does happen.

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Hi,

I've yet to take med surg II, but why is his O2 so low? At first I was thinking he's bleeding somewhere because the bp is on the low side and HR is up. Then I'm thinking PE because of the O2 at 89%, chest pain, and he has diabetes and probably poor circulation, but I'm not sure. You didn't mention he had a wound or surgery. I looked up kidney failure and found uremic syndrome can be a complication that causes pleural effusion. That seems to fit his assessment findings. I used an online source because I don't have my text book available. Sorry that my thoughts are all over the place but I hope that helps!

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Hi,

I've yet to take med surg II, but why is his O2 so low? At first I was thinking he's bleeding somewhere because the bp is on the low side and HR is up. Then I'm thinking PE because of the O2 at 89%, chest pain, and he has diabetes and probably poor circulation, but I'm not sure. You didn't mention he had a wound or surgery. I looked up kidney failure and found uremic syndrome can be a complication that causes pleural effusion. That seems to fit his assessment findings. I used an online source because I don't have my text book available. Sorry that my thoughts are all over the place but I hope that helps!

Irregular heart beat and tachycardia can cause low O2 and hypotension. Look up alchohol withdrawl.

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Irregular heart beat and tachycardia can cause low O2 and hypotension. Look up alchohol withdrawl.

Oh Ok. When I think of ETOH withdrawal, I think of tremors, n/v, anxiety and DTs.

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Irregular heart beat and tachycardia can cause low O2 and hypotension. Look up alchohol withdrawl.

Agree.

Decreased blood flow to heart---> decreases oxygen supply and increases oxygen demand.

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I am not given the reason why his 02 is low. I looked up uremia and hadn't thought about that one at all. Also seems to fit for alcohol withdrawal, I just need to figure out if this stuff is still possible four days out. I assume that it is. This is a hard one for me because it looks like it could be so many things. Thanks everyone for the help! It is so appreciated that people take the time out to help me think of things!

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Oh Ok. When I think of ETOH withdrawal, I think of tremors, n/v, anxiety and DTs.

Those tend to be the most well known signs of withdrawl but they also tend to be early and mild signs. Now if he had pancreatitis I would expect him to have been on some heavy duty pain management meds, now that has resolved the meds are pulled back maybe revealing withdrawl.

Alcoholism is a major cause of pancreatitis (44%)

For you Nursing students what does the pancreas have to do with Diabetes Mellitus?

Diabetes, pancreatitis, chest pain, renal failure...I HIGHLY recommend researching the pathology of alchoholism...very important considering this will compose about 30% of your patients in your future career.

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BUSTED!!!! Getting the care map done before the test? HAHA!

We're doing the exact same thing!!

We are just as stumped..... The patient is already being treated for ETOH withdrawal with librium. So would it still be ETOH withdrawal?

So what do you all think?!

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What about bleeding from the acute pancreatitis? Doesn't pancreatitis have a huge risk of internal bleeding??

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What about bleeding from the acute pancreatitis? Doesn't pancreatitis have a huge risk of internal bleeding??

What S/S of bleeding do you see?

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BUSTED!!!! Getting the care map done before the test? HAHA!

We're doing the exact same thing!!

We are just as stumped..... The patient is already being treated for ETOH withdrawal with librium. So would it still be ETOH withdrawal?

So what do you all think?!

What does Librium do and what is the pathology of ETOH withdrawl? I gave you a hint earlier when referring to resolving the pancreatitis.

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