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Discussion

Please help me answer my case study!

hi! i'm a newbie here. i am a nursing student and i have a case study that i need to answer but i'm having a hard time figuring out the answers. maybe anyone of you can help me out. here's the case study and the questions below it (my answers were in "orange" though im not sure...thanks in advance :bow:! here it is:

64 year old female admitted for cholecystitis. secondary diagnoses of dm type 2, hyperlipidemia and chronic kidney disease. after surgery she had high uncontrolled pain. nurses encouraged use of the incentive spirometer and splinting of the abdomen while deep breathing. her lung sounds were decreased at the bases on both sides. she was waiting to be discharged following her surgery. she developed bilateral edema +2 in her lower extremities on post op day 5 and was placed on lasix bid. her o2 sats while on 2l nc were only reaching 92-93%. we ambulated her without the nc and half way down the hall she complained of dizziness and had to sit down. her o2 was still at 93% without the nc. the client lives alone and is very anxious to get home because she has already been here 10 days.

1. what could be happening to this patient? - fluid retention d/t chronic kidney disease that led to development of bilateral edema +2 in her lower extremities, sob, lightheadedness

2. what would you sbar to the doctor?

3. what nursing actions would you expect the doctor to order? - monitor o2 levels, change pt's positions slowly, monitor strict i&o, don't ambulate until the o2sat is stable

4. the patient asks why she got so dizzy while walking, what would you tell her? - she got dizzy because of the low amount of oxygen in her blood.

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  • Author

hi! i'm a newbie here. i am a nursing student and i have a case study that i need to answer but i'm having a hard time figuring out the answers. maybe anyone of you can help me out. here's the case study and the questions below it (my answers were in "orange" though im not sure...thanks in advance :bow:! here it is:

64 year old female admitted for cholecystitis. secondary diagnoses of dm type 2, hyperlipidemia and chronic kidney disease. after surgery she had high uncontrolled pain. nurses encouraged use of the incentive spirometer and splinting of the abdomen while deep breathing. her lung sounds were decreased at the bases on both sides. she was waiting to be discharged following her surgery. she developed bilateral edema +2 in her lower extremities on post op day 5 and was placed on lasix bid. her o2 sats while on 2l nc were only reaching 92-93%. we ambulated her without the nc and half way down the hall she complained of dizziness and had to sit down. her o2 was still at 93% without the nc. the client lives alone and is very anxious to get home because she has already been here 10 days.

1. what could be happening to this patient? - fluid retention d/t chronic kidney disease that led to development of bilateral edema +2 in her lower extremities, sob, lightheadedness

2. what would you sbar to the doctor?

3. what nursing actions would you expect the doctor to order? - monitor o2 levels, change pt's positions slowly, monitor strict i&o, don't ambulate until the o2sat is stable

4. the patient asks why she got so dizzy while walking, what would you tell her? - she got dizzy because of the low amount of oxygen in her blood.

64 year old female admitted for cholecystitis. secondary diagnoses of dm type 2, hyperlipidemia and chronic kidney disease. after surgery she had high uncontrolled pain. nurses encouraged use of the incentive spirometer and splinting of the abdomen while deep breathing. her lung sounds were decreased at the bases on both sides. she was waiting to be discharged following her surgery. she developed bilateral edema +2 in her lower extremities on post op day 5 and was placed on lasix bid. her o2 sats while on 2l nc were only reaching 92-93%. we ambulated her without the nc and half way down the hall she complained of dizziness and had to sit down. her o2 was still at 93% without the nc. the client lives alone and is very anxious to get home because she has already been here 10 days.

1. what could be happening to this patient? - fluid retention d/t chronic kidney disease that led to development of bilateral edema +2 in her lower extremities, sob, lightheadedness

2. what would you sbar to the doctor?

3. what nursing actions would you expect the doctor to order? - monitor o2 levels, change pt's positions slowly, monitor strict i&o, don't ambulate until the o2sat is stable

4. the patient asks why she got so dizzy while walking, what would you tell her? - she got dizzy because of the low amount of oxygen in her blood.

sats in the low 90's, while not terrific, are not bad. no need to keep her on bedrest unless the dizziness occurs also with o2 while ambulating. grab a portable tank and try it. when you sbar to the doc you would tell him/her just what you said in #1: bilat pedal edema, sob, lightheadedness. include that she ambulated without the o2.

I think the decreased fluid volume due to the diuretics could be contributing, but I am only another student, so what do I know?

I would get a blood pressure for sure.

She sound like the dizziness can be attributed to CHF. I'm surprised nothing in your post contained getting a BP. What was the sound of her lungs? Wet? I would not suggest complete bedrest for a post/op patient that can ambulate. Slow and steady carry o2 and a w/c whlie walking. There is so much I would be doing.

agree with queen216. sounds like she might be going into CHF. she's obviously volume overloaded. i'd put her on oxygen, get a set of VS, and listen to her lungs. also, i noticed there was nothing mentioned about her breathing pattern. if she' in CRF, is she responding to the lasix dose she's getting? if her pain wasnt well controlled early on post op, she probably had atelectasis that didn't improve. She might also need some aggressive pulmonary toilet.

agree with queen216. sounds like she might be going into CHF. she's obviously volume overloaded. i'd put her on oxygen, get a set of VS, and listen to her lungs. also, i noticed there was nothing mentioned about her breathing pattern. if she' in CRF, is she responding to the lasix dose she's getting? if her pain wasnt well controlled early on post op, she probably had atelectasis that didn't improve. She might also need some aggressive pulmonary toilet.

I agree, you should focus on. In no particular order...

1. Breathing.... rate, and quality. rate at rest and rate when active. Do a lung assessment (it doesn't hurt as my instructor once told me. LOL)

2. I/O .... I/O .... I/O.... She is on lasix. Are they working? SAVE THE PEE PEE/ MEASURE THE PEE PEE.. LOL Again listen to lungs... also wil tell you if kidney function is impaired

3. Blood pressure... Fainting, lightheaded.... I'm thinking, moving too fast for bp to adjust or orthostatic hypotension. Or dare I say, internal bleeding?

4. LOOK AT THE SURGICAL SITES (thats why hospital gowns are easy access!) Are and signs of inflammation or infection present?

5. Is the ABD distended?

**** Just a little lesson I learned, "a full bladder, will cause trouble" :uhoh3:

Wow! That actually sounds like a useful case study with a practical focus (as opposed to vague NCLEX style questions with limited practical utility)! Kudos to your program/instructor!

I agree, you should focus on. In no particular order...

1. Breathing.... rate, and quality. rate at rest and rate when active. Do a lung assessment (it doesn't hurt as my instructor once told me. LOL)

2. I/O .... I/O .... I/O.... She is on lasix. Are they working? SAVE THE PEE PEE/ MEASURE THE PEE PEE.. LOL Again listen to lungs... also wil tell you if kidney function is impaired

3. Blood pressure... Fainting, lightheaded.... I'm thinking, moving too fast for bp to adjust or orthostatic hypotension. Or dare I say, internal bleeding?

4. LOOK AT THE SURGICAL SITES (thats why hospital gowns are easy access!) Are and signs of inflammation or infection present?

5. Is the ABD distended?

**** Just a little lesson I learned, "a full bladder, will cause trouble" :uhoh3:

I also want to add, CHECK THE GLUCOSE LEVEL!!!

If kidney's are impair consider Dialysis Tx to remove excess water and waste.

  • Author

Thank you so much guys!!!

  • Experts

nursing school actually gives you a method to work in order to go about getting the answers to at least 3 of the questions. it's called the nursing process and it has a very practical application for us since it is a problem solving method. you merely apply the steps of the nursing process to the situation at hand in the sequence they occur.

  1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use - in this case just identifying the problem will be fine since i assume you are not writing a care plan)
  3. planning (write measurable goals/outcomes and nursing interventions - assuming you are not writing a care plan, your answer to question 3 is part of the planning stage)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

assessment and critical thinking of this case study patient should include the following data:

  • lung sounds were decreased at the bases on both sides
  • high uncontrolled pain
    • question? is she getting anything for pain and if so what and what are its side effects?

    [*]developed bilateral edema +2 in her lower extremities on post op day 5

    [*]o2 sats while on 2l nc were 92-93%

    [*]ambulated without the nc and half way down the hall she complained of dizziness and had to sit down. her o2 was still at 93% without the nc

    [*]lives alone and is very anxious to get home

    [*]had surgery (cholecystectomy)

    • respiratory complications of general anesthesia can include atelectasis, hypoxia, pneumonia, pulmonary embolism
    • complications of a cholecystectomy can include peritonitis, wound infection/sepsis, ileus

    [*]has type ii diabetes

    • symptoms of hypoglycemia are fatigue, impaired coordination, light headedness, headache, hunger, diaphoresis, tremor

    [*]has hyperlipidemia

    [*]has chronic kidney disease

    • while this is a nonspecific medical diagnosis, some possible signs and symptoms you might expect to see are either hypotension or hypertension, altered levels of consciousness, peripheral edema, cardiac arrhythmias, and bibasilar crackles
    • some cardiac arrhythmias cause dizziness

what could be happening to this patient? after considering assessment data, a number of things: hypoglycemia, activity intolerance, maybe a cardiac arrhythmia

what would you sbar to the doctor? sbar is a mnemonic for a technique for calling doctors that means situation-background-assessment-recommendation. they are the steps you follow when reporting a change in a patient's condition to a physician.

  • situation - verify that the md knows this pt, if not, provide brief history, get directly to the point, relate what events prompted you to call, be specific and state the problem, what is it, when it happened or started, and how severe, if the situation is urgent, say so
  • background - give pertinent background information which usually includes admitting diagnosis, date of admission, list of current medications, allergies, iv fluids, and labs, most recent lab results (provide the date and time test was done and results of previous tests for comparison), most recent vital signs, code status
  • assessment - what your assessment of the situation is or state what you think the problem is and your primary concern
  • recommendation - what your recommendation is, or what you think the patient needs to address the situation, or what orders you want from the doctor

what nursing actions would you expect the doctor to order? check vital signs and blood sugar before activity. have patient do deep breathing and coughing before activity.

the patient asks why she got so dizzy while walking, what would you tell her? it could be a couple of things. she's had surgery and been inactive for 10 days so she's out of physical condition. she's had some fluid accumulation that might be putting some stress on her heart although she has been on a diuretic for 5 days. we need to monitor her blood sugar to make sure it is in control.

uhm.. not yet a nursing student.. im about to be sooner..

as I am reading those articles above... something flashed into my mind that.. you are really the one.. to TAKE GOOD CARE OF YOUR PATIENTS>> you should be well known to the other functions of the body/ health.. to give due care and analysis to the patient..

Even though im not yet a nursing student.. and even though i havent encounter such case studies like that... im really looking forward to be a good one.. i wish I can too, handle those..

Im just having an advanced researching.. reading all about stuffs behind Nursing.. those articles will sooner be a great help... I wish..

Nursing is an interesting course but I will be careful.. Someday..time will come.. its gonna be the new generation's turn..

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