Help with case study

when you are dealing with a patient and their problem(s) you always, always, always (can i yell it any louder?) follow the nursing process whether you are actually writing a care plan or performing the action without doing the written documentation. i repeat. . . you always, always, always follow the nursing process whether you are actually writing a care plan or performing the action without doing the written documentation. the steps of the nursing process which is the problem solving method that we use for all things nursing. those steps, in sequence are:

1. assessment (collect data)
   
2. determination of the patient's problem(s)/nursing diagnosis (assemble abnormal assessment data)
   
3. planning (determine goals/outcomes and nursing interventions)
   
4. implementation (initiate the care plan)
   
5. evaluation (determine if goals/outcomes have been met)

an elderly women became unresponsive on board. there was no doctor. according to her family she started to "jerk" and then became unresponsive. after you determine that cpr is not necessary, you start taking a history. she has had a recent heart operation, is a diabetic, is on a blood thinner and is on lasix.

right off the bat, the scenario is starting to give you some assessment information. medical history is part of the assessment. you also begin to organize the abnormal data you are discovering:

• the patient began "jerking"
  
• she is now unresponsive

think about what the implications and complications are of. . .and which might apply to the situation at hand that you need to assess for. . .

• having recently had heart surgery
  • cardiac arrhythmias
    
  • stroke
    
  • myocardial ischemia or infarction
    
  • pulmonary embolism
    
  • wound infection

  [*]being diabetic

  • potential for hypoglycemia whose symptoms are
    • fatigue
      
    • restlessness
      
    • irritability
      
    • weakness
      
    • mental disturbances
      
    • delirium
      
    • seizures
      
    • coma

    [*]potential for hyperglycemia whose symptoms are

    • polyuria
      
    • polydypsia
      
    • polyphagia
      
    • dry mucous membranes
      
    • vision changes
      
    • hunger

  [*]being on anticoagulants

  • hemorrhage due to over dosage
    • bleeding gums
      
    • petechiae
      
    • ecchymosis (bruising)
      
    • epistaxis

  [*]being on diuretics, specifically lasix

  • circulatory collapse
    
  • electrolyte disturbances
    • particularly metabolic alkalosis which causes drowsiness and restlessness

    [*]dehydration

    • hypotension
      
    • weakness

1. what do you immediately request from the cabin attendant?

a first aid kit and any medical equipment they have on board.

2. comment on your liability.

this varies from state to state. in my state i am covered by a good samaritan law if i go to the aid of someone needing emergency aid and i render care in good faith. but i do have to follow standards of care.

3. you start assessing the systems most at risk (name 2 and give rationale).

here i would rely on maslow's hierarchy of needs if i didn't know where to begin. his priority of physiological needs are as follows:

• the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxygenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
  
• the need for food and water
  
• the need to eliminate and dispose of bodily wastes
  
• the need to control body temperature
  
• the need to move
  
• the need for rest
  
• the need for comfort
  

my interpretation of that would be to assess the circulatory system and the neurological system because the patient is now

1. unresponsive
   
2. has had heart surgery and may have collapsed because of an arrhythmia
   
3. may have had a stroke preceded by a seizure

4. describe your assessment of these two systems in detail.

i leave that up to you.

more data: her vital signs are bp 140/70, apical pulse 84, slightly irregular and she has a pacemaker, r 18. she is still slightly disoriented (so, she has regained consciousness). slight edema is found (where?), but all the systems are wnl.

1. what is your second nursing intervention(hint: inform)

well, i'm confused here. where's the question regarding the first nursing intervention? my first intervention would be to check her blood sugar since the physical assessment was wnl and the patient is a diabetic. if the second intervention is to inform, it would be to talk with the patient and family about diet and blood sugar. also, she probably needs some postop teaching regarding complications following heart surgery that she needs to be aware of.

2. based on the history, the assessment and the medications you suspect that the following (name 2) occurred. give your rationale.

the patient had either:

• a hypoglycemic reaction
  
• fainted from an arrhythmia

3. name the intervention that would correct both suspected conditions.

• administration of oj
  
• rest

4. what must you check prior to treating the patient (name 2). give rationale.

• blood sugar level
  
• vital signs, peripheral pulses, heart sounds

5. state the education(name 3) that would be appropriate for the patient and the family.

you do this part.

6. state the education (name 1) that would be appropriate for the airline.

i don't know what to respond here. most airline personnel receive first aid training and do know how to respond to these emergencies.