Isis Phoenix

I thought this was a forum where students come together to discuss cases,as well as pertinent issues affecting the nursing profession;if it is not please accept my apology. The scenario is plain.....how do we proceed? Shouldn't we begin by looking at the current situation... physical,and psychological,her chart,labs,chest x-ray,and other pertinent diagnostic testing in order to rule out Anxiety? This is a topic to be discussed as not everyone see eye to eye,but together we can do a better job of constructing our nursing diagnosis,as well as taking care of the patient. “I do not have all the answers, but together we can find them.” (M Ecallawh

I have a correction of this post .....please see other. This is a case study, thanks for your kind cooperation. “I do not have all the answers, but together we can find them.” (M Ecallawh

Lung sounds are clear......

Ms.M is a 26years patient admitted to the medical/surgical ward for overnight observation RE: complaint of shortness breath since the last two weeks..... there is no significant medical history. The nurse she is assigned to measured her vital signs ....the findings are: BP 130/70, Pulse 82, RR 21 and non-labored, Temp. 98, O2 sat 98% on 2liters of oxygen, no complaint of pain, and no visible distress observed. Every 15 mins. Ms. M rings the call bell and reports that she cannot breathe; the nursing assessment reveals no significant deviation from the vital signs above. What action should we take regarding Ms. M's behavior? And what possible nursing diagnosis can we assign to her? "I do not have all the answers, but together we can find them." (M Ecallawh

Medical Management: RE: Dranger :For lowering the BP and improving profusion Nitro drip can be titrated until a satisfactory BP is achieved, or once the patient is intubated Morphine drip could be considered, although he may need more medication for hemodynamic support. NB. TX will be made according to the medical diagnosis. Nursing Management:Implementing orders, titrating medication, measuring vitals, obtaining EKG's, assessing,evaluating patient response, reporting to medical/nursing teams, and writing nursing notes etc. “I do not have all the answers but,together we can find them.” (M Ecallawh)

Even in the case of a MI the patient needs oxygen,an iv line ,and he would be placed on monitor as one of our participants mentioned. We would still need the vitals,medical history etc as well as alerting the medical,and respiratory teams.

This is a case study..... Proceed by using the ABC method, that is obtain the O2 Sat, give emergency Oxygen, alert the MD,and the Respiratory team for possible intubation ,and establish an IV line. “I do not have all the answers,but together we can find them.” (M Ecallawh) Thanks to all students,and nurses who have contributed answers to this thread.

Patient M. Dean is a 53 years old male with a DX of CVA with Left sided weakness who came to the ER to be evaluated for chest pain, and respiratory discomfort which started two days ago, but suddenly escalated .... RR. 9 irregular and guarded, HR. 130 and regular, BP. 180/90, Oral Temp. 101 degrees (F) He also denies injury related to accident, however he thinks that he may be having a heart attack. How do we proceed to evaluate this patient, and what possible diagnosis medical,as well as nursing diagnosis would be made?

RE: A patient vomiting at the hospital,or at a nursing home;not a pleasant situation,but as nurses we learn to manage it. Nursing: Maybe we could begin by looking at the age of the patient, medical history, current diagnosis,diet,food recently consumed, the frequency, color, and consistency of the vomitus. Measure the vital signs; determine if it is accompanied by fever, abnormal breathing, abnormal heart rate, diarrhea, pain, weakness etc. listen to the bowel sounds,examine the abdomen and rectal area, Collect samples, and report the findings to the MD. Obtain permission to establish an IV line. Place patient in semi Fowler's position, place a basin on the bed table for the vomitus, encourage good hand washing for the patient, and nursing staff, and the use of PPE such as a gown,gloves,goggles,and mask if the cause of the organism is unknown and if there is the chance that splashes will occur. Medical Management:Usual TX Labs, sample of vomitus, chest X-ray and possible x-ray of the abdomen, per rectal Compazine if there is no diarrhea, injectable Tigan, or IV Zofran, fluids and electrolyte replacement, and possible antibiotic depending on the organism found…as well as enteric precautions. “I do not know all the answers, but together we can find them.” (M Ecallawh)

Answers!Answers! Good insight....... Measuring a patient's vital signs,and examining the patient will reveal to the medical,as well as the nursing teams how to proceed;thus if the BP is high a drug protocol would be in place, it will be ordered,and implemented ,or it would be activated to prevent another stroke,likewise Oxygen will be provided if the O2 sat is low. I also forget to mention that hypoglycemia can also be mistaken for a stroke,so finger stick blood glucose level should be measured,as well as serum Hemoglobin A1C. The labs are collected to rule out/confirm a stroke,or differential diagnosis. "I do not have all the answers,but together we can find them." (M Ecallawh)

What I gather from the scenario above is that the patient is having a stroke, thus I would want to activate the stroke team, use the ABC method: check the O2 sat, and administer O2 if necessary, vital signs,neurocheck, check for facial symmetry, speech etc. place an IV in the unaffected arm, place the patient on monitor, obtain EKG, obtain order for CT scan, gather medical history...including family history, onset of symptoms, medication h/o …current and past meds including the use of blood thinners, recreational drugs, smoking, and diet; obtain order for blood work: CBC,CMP, PT/PTT/INR, Cholesterol panel,VDRL,FTA,Toxicology….serum or urine, Cardiac enzymes Troponin(CPK,CK)LDH , homocystine, and APL. With the collaboration of the medical, and nursing teams all tests, and TX should be done within a three hours’ time frame. "I do not have all the answers,but together we can find them." (M Ecallawh)

Addendum: Charting for another nurse This problem should be addressed via the facility's policy manual, and also a bulletin to be displayed conspicuously, then everyone will know it is not legal to chart for a colleague. However, if a nurse has assessed, and rendered care to a patient who is assigned to a colleague of hers, then she need to chart what she has done, and add her signature. E.g Patient B is assigned to Nurse M, however while she was in another room attending to a very sick patient....Patient B fell in the hallway ...the aide notified the charge nurse;knowing that Nurse M is busy looking after a very sick patient ...she assessed patient B, rendered first aid, notified the MD.,received orders via telephone, and implemented the orders then she charted, and signed patient B's chart...she also notified Nurse M about the occurrence, and what she has done...in order for her to do the follow up assessment. Scenario: It is not her patient, but since Nurse M did not render care...the charge nurse had to write, and signed the nurse’s note, because legally she is responsible.

This problem should be addressed via the facility's policy manual, and also a bulletin to be displayed conspicuously, then everyone will know it is not legal to chart for a colleague. However, if a nurse has assessed, and rendered care to a patient who is assigned to a colleague of hers, then she need to chart what she has done, and add her signature. E.g Patient A is assigned to Nurse M however while she was in another room attending to a very sick patient....Patient B fell in the hallway ...the aide notified the charge nurse;knowing that Nurse M is busy looking after a very sick patient ...she assessed patient B, rendered first aid, notified the MD.,received orders via telephone, and implemented the orders then she charted, and signed patient B's chart...she also notified Nurse M about the occurrence, and what she has done...in order for her to do the follow up assessment. Scenario: It is not her patient, but since Nurse M did not render care...the charge nurse had to write, and signed the nurse’s note, because legally she is responsible.

B. Crackles indicate the need to suction,while wheezes indicate air,and constriction of the airways in lung diseases e.g asthma, acute bronchitis,or allergy...in most cases a bronchodilator is used for asthma,acute bronchitis ,and epinephrine in the case of allergy induced Anaphylactic Shock.

Everybody has different learning styles, but definitely group study can enhance learning as each person contributes some aspect of the subject, or topic that others may overlook.