PLEASE HELP! Case Study Questions!

Daytonite, BSN, RN · Feb 2, 2009

p.t. is a married 30-year-old gravida 4, para 1203 at 28 weeks' gestation. she arrives in the labor and delivery unit at a level 2 hospital complaining of low back pain and frequency of urination. she states that she feels occasional uterine cramping and beleives that her membranes have not ruptured.

when you are given any patient what is the first thing you should do, the first thing? assess them. assessment involves collecting information about their history (review of systems), a physical exam and assessing their ability to accomplish their adls since we are nurses. you also must know information about their medical condition. when you are given a scenario like this you have to look for that information in the reading. this is a pregnant female, 28 weeks. which trimester is she in? she's just entered the third. look at her history. she's been pregnant 4 times. how many children has she had?

1203

? recheck that number. if she has a history of having lost children you need to find out what happened during her other pregnancies with those other children. a lot of things can go wrong that involve the loss of a fetus or the death of a newborn. you need to find out what the discrepancy is that is going on here because there is potential psychological and emotional concern going on as soon as physical symptoms occur.

1. based on the given info, identify the 2 most likely diagnoses for p.t.

a uti is not a nursing diagnosis. frequency of urination is a normal discomfort of pregnancy. so is the backache. you need to educate the patient of this.there is a diagnosis for that. there is also a psychosocial diagnosis for her concerns of delivering her baby too soon.

2. what other problems might be going on with p.t. that you should consider?

the statement by the patient that her membranes have not ruptured is an indication to me of her concern that she is in labor. yet at 28 weeks it is too early for her to be in labor. i would be concerned the she is thinking labor is beginning and why.

j.h. is a 2-week-old infant brought to the emergency department (ed) by his mother, who speaks little english. her husband is at work. she is young and appears frightened and anxious. through a translator, mrs. h. reports that j.h. has not been eating, sleeps all the time, and is "not normal."

1. what are some of the obstacles you need to consider, recognizing that mrs. h. does not speak or understand english well?

- language barrier - impaired verbal communication

fear (r/t language barrier and unfamiliar surroundings)

- deficient knowledge

case study progress: the ed physician orders the following lab work: cbc with differential; blood culture; complete metabolic panel (cmp); urinalysis (ua); and cerebrospinal fluid (csf) for culture, glucose, protein, cell count (following a lumbar puncture). j.h. is admitted to the medical unit with a diagnosis of rule out (r/o) sepsis and meningitis.

1. what lab values would you anticipate being above normal and why?

- csf - meningitis is an inflammation of the membranes, or meninges, and csf surround your brain and spinal cord, usually due to the spread of an infection

- cbc - elevated wbc (polymorphonuclear leukocytes), rbc shows the location of the infection

- protein content increased - proteins make up most of the immune system; produces hemoglobin

- higher levels of protein, wbc, rbc may point at bacterial meningitis

2. what would your priority nursing care include after his admission assessment?

- isolation precautions

- start antimicrobial therapy (iv infusion)

- maintenance of hydration (prevent cerebral edema) and ventilation

- reduction of icp

- control of temperature

- treatment of complications

3. j.h. is diagnosed with escherichia coli meningitis. his medical care plan will include 14 to 21 days of antibiotic therapy. in addition to monitoring his neurologic status, identify three things you will include in your care plan for j.h.

- monitor vital signs

- monitor i&o

- measure urinary output

- assess for open, bulging fontanels

- provide a quiet and dim environment

- maintain iv infusion

monitor and treat any seizure activity
monitor the temperature and treat as required
monitor for rash and treat as required
monitor for third spacing of fluids and treat as ordered

- check for complications such as shock, respiratory failure, and increased icp.

4. how will you involve his parents?

- encourage the parents to openly discuss their feelings

- inform parents of the child's progress and of all procedures, results, and treatments

- provide teaching about the infant's illness

5. what is the impact of hospitalization on j.h.'s growth and development?

- hospitalization usually requires infants to be confined to the hospital room

- separation from mother

- infant's illness related distress

hospitalization and illness at an early age is known to cause developmental delays in the following areas:

cognitive
social and emotional
communication
motor
self-help

government programming exists and encourages each state to test and provide support to parents

(

federal act pl 94-142 and the preschool incentive act pl 98-457 early intervention)

if you do a search for "early intervention" or "developmental delays" you will find lots of information about this.

savexpigoo · Feb 5, 2009

Thank you so much Daytonite! Very helpful information!