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Asked by ceeceelee18
1.      Arthur Thomason Room 301
Arthur Thomason, 56 year old MVA victim, fourth day post op with a splenectomy and femur repair. He is experiencing new onset of shortness of breath and has a nasal cannula with 2L of Oxygen in place. He is restless with slight confused, but is easily orientated with attempts from nurse. Temperature spiked during the night to 102.4, BP now 146/94 which is slightly elevated, Respiration’s at 30 bpm and slightly labored, heart rate 102 versus 84 from last night shift. Skin cool to touch and appears pale. His coughing, to clear his airway, appears ineffective. Recent chest X-ray shows diffuse bilateral interstitial infiltrates in all lobes. Recent blood gases demonstrate falling PaO2 (hypoxemia) and increasing CO2 ( Hypocapnia). Mr Thomason is anxious and from the shift before is obviously worsened in overall condition.
2.Ramona Stukes, 69 yr-old, third day post-op cholecystectomy. Non-significant past medical history. No known allergies (NKA). Vital signs -Temp 98.6, BP 114/62, P 100, RR 20, SaO2 94%. Neuro WNL, alert, and cooperative. Skin warm and dry, daily dressing changes, T-tube without drainage. NG tube to low suction possibly D/C’d today after Dr. Levine rounds. Today’s incentive spirometry Tidal Volume is 1250ml, improvement over yesterday’s 900ml. NPO with small amount of ice chips only. Today’s weight 226. IV D5 1/2 NS with 20 KCL @ 125 ml/hr in left forearm. Last pain medicine 2hrs ago at 1300(Demerol 50mg/ Zofran 4mg IV). Ambulates with assistance. Dr. Levine
3.Robert Sturgess, 81yrs-old, Dx- Metastatic CA of Colon, Hx of diabetes. Palliative care. No Known allergies (NKA). Vital signs- Temp 98.7, BP 114/67, P 115, RR 20, SaO2 98%. Neuro WNL alert and cooperative. Skin warm and dry, all vital signs in WNL except 115 pulse, which is normal for him. Blood Glucose 85, 1 unit of insulin sliding scale for coverage. ADA diet, intake 25%. Demerol 25mg SIVP for pain, patient reports 7/10 on pain scale. Patient and family upset regarding dx. Dr Donofrio
Predicting
What are you on alert for today with this patient?
Predicting
What are the important assessments to make?
Predicting
What complications may occur? What could go wrong?
Managing
What interventions will prevent complications?Â
Arthur Thompson Room 301
Why is this important?
Why are these assessments important?
Relate the assessment data to the potential complications that may occur.
How will the interventions prevent complications?
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