hi guys, i was wondering if anybody couldl help me out with an assignment i have been presnted with.. i have no idea where to begin and how to get ot started you see i have all the information but dont know how to get it started if that makes sense... fron the case scenario i am to establish what nursing intervention she needs and what could be causing her to have those symptoms any feedback would be much appreciated thank u so much.
catherine wilkes a 22 year old unemployed single mother was admitted 2 days ago through emergency department for collapse for investigation. on arrival at triage it was noted that catherine had her two-year old child at her side and both appeared unkempt. catherine's observations were taken at triage and her blood pressure was report as 75 mmhg / not detectable. her speech was incomprehensible, but all limbs were equal in power and pupils were equal and reacting to light. she was promptly transferred to the cubicle area.
whilst in emergency department she underwent a physical examination and blood work up. her speech at this time had improved but was slurred. she was reluctant to discuss her family history.
health status: non smoker
moderate alcohol intake
ulcerative colitis for 6 years
ileoanal anastomosis 14 months ago
observations: temperature 360c
bp now 90/60
respirations 22 breaths per minute
pulse 130 beats per minute
o2 saturation 100% on room air
physical assessment: weight 45kg
height 160 cm
bruises to lower limbs
chest clear
abdomen soft, non tender
blood results:
bgl 7.2 mmol sodium 124 mmol/l
hb 116 g/l potassium 5.2 mmol/l
hct 0.38l/l chloride 89 mmol/l
rcc 4.8 x 1012/l bicarbonate 23 mmol/l
mcv 78 fl anion gap 17
wcc 16 x 109/l urea 10.3 mmoml/l
esr 34 mm/hr creatinine 0.12 mmol/l
crp 31 mg/l
catherine reported to the medical officer that she had felt nauseous and dizzy all day and that she had not voided the entire day.
while catherine was getting into a hospital gown her medications fell out of her pocket. the nurse asked her if she was taking the medications but catherine did not reply. the nurse took the medications to the medical office and they both noted that the medications were:
prednisolone 25mg bd orally
medazine 1 gram bd orally
part two
further blood tests revealed:
prolactin 1211mu/l
cortisol 1066 nmol/l
protein 86 g/l
albumin 31.6 g/l
ggt 113 u/l
alt 36 u/l
it was noted by the nurse that catherine was previously on mesalazine 250 mg orally tds for ulcerative colitis. she discussed this with the medical officer who withdrew the order for medazine 1 gram and recommenced her on her previous dose of mesalazine
the medical officer reported that catherine to undertake a short synacthen test (sst).
