A triage nurse in the emergency department is on shift when…
A triage nurse in the emergency department is on shift when a 4-year old is carried into the ED by their grandparent. The child is not breathing, and the grandparent states the child was stung by a bee in a nearby park while they were waiting for the child’s parent to get of work. Rapid onset of which condition would lead the nurse to suspect that the child is experiencing anaphylactic shock?
Read DetailsCase Study Question #1: The nurse cares for a 72-year-old fe…
Case Study Question #1: The nurse cares for a 72-year-old female admitted to the medical unit with dehydration and secondary diagnosis of mid-stage Alzheimer’s disease. Phase Sheet Name Theresa Peters Gender F Age 72 Weight (lbs/kg) 122 lb (55 kg) Allergies NKA Nurses’ Notes DAY 1 1800: Client admitted from ED to medical unit for dehydration after several days of poor PO intake where she appeared to briefly lose consciousness this am after breakfast. Retired for several years as seamstress and husband passed away last year. Now lives with daughter/family due to recent diagnosis of middle stage Alzheimer’s disease, history of mild hypertension & gastroesophageal reflux. Daughter notes appetite has diminished in past 2-3 weeks, and it is hard to get her to drink enough fluids even in the warmer weather. She has been more “down in the dumps” the past few weeks. Client has been unsteady on her feet due to dizziness and increasingly weak. P: 104 and B/P 102/62 (sitting) & 94/55 (standing). Skin & mucous membranes dry; tenting noted. Admission BUN & creatinine elevated. Foley inserted and draining concentrated amber urine. Provider notified; ordered fluid challenge of 500 ml normal saline. Alert/oriented to name only, answers questions, pleasant, cooperative, asking for daughter. Vital Signs Time 1800 T ◦F/ ◦C 97.8 F /36.5 C P 104 RR 20 B/P 102/62 Pulse oximeter 97 Oxygen Room air Laboratory Report Lab Results @ 1400 (ED) Reference Range Sodium 145 135 to 145 mEq/L Potassium 5.0 3.5 to 5.0 mEq/L Glucose (fasting) 72 Normal
Read DetailsA 75-year old client is receiving an IV infusion at 125mL/ho…
A 75-year old client is receiving an IV infusion at 125mL/hour. During your assessment, you notice engorged neck veins, and an increased blood pressure. The client is also reporting feeling increased shortness of breath. What is the priority intervention?
Read DetailsThe nurse is caring for a client who is exhibiting signs and…
The nurse is caring for a client who is exhibiting signs and symptoms of hypovolemic shock following injuries from a motor vehicle accident. In additions to normal saline, which crystalloid fluid should the nurse prepare to administer?
Read DetailsYou are caring for an 80-year old client with a cerebrovascu…
You are caring for an 80-year old client with a cerebrovascular accident that has caused right-sided paralysis. The IV in her left arm is infiltrated. You are going to have to restart the IV. Where will the new IV site be located?
Read DetailsA 74-year old female is admitted to the Emergency room with…
A 74-year old female is admitted to the Emergency room with increasing dyspnea, productive cough, and fatigue. Nurses’ Notes 1000: Client arrives in Emergency Department with worsening shortness of breath over the past week, strong productive cough with green-tinged sputum, and fatigue. Client has a history of chronic obstructive pulmonary disease -emphysema; has been using their “relief” inhaler at home with no relief of symptoms. Client lives independently at home and states they smoke approximately 1 pack of cigarettes per day. Ambulatory, alert and oriented x 4. Has coarse crackles auscultated in bilateral lower lung fields with a barrel chest appearance, using accessory muscles, expiratory wheeze on auscultation. Client states they have “less room” to take a deep breath. Clubbing noted in all digits bilaterally. 1015: Client has increasing dyspnea, prefers to be sitting up in the chair. Requesting “rescue inhaler.” The provider has been notified. IV started. Ipratropium bromide and albuterol nebulizer treatment started. Vital Signs Time 1000 1015 Oral Temp 99.0 F (37.2 C 99.0 F (37.2 C Pulse 104 108 Respiratory Rate 27 30 Blood Pressure 157/86 159/88 Pulse oximeter 91% room air 90% room air Pain 0 0 Provider ordered Medications (ER): Medication Dosage/Frequency/ Route Ipratropium bromide and albuterol 3mL(0.5mg ipratropium bromide 2.5 mg albuterol) nebulizer treatment 4 x a day. First dose now. Acetaminophen 500 mg x 1 PO PRN for moderate to severe back pain Methylprednisolone sodium succinate 40 mg IV push x 1 dose now Amoxicillin/clavulanate 875 mg/ 125 mg PO every 12 hours Albuterol sulfate 2.5 mg/3 ml nebulizer every 4 hours PRN Which medication do you anticipate that the nurse will give first?
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