CASE SCENARIO:GUNSHOT WOUND TO THE LIVER.2ND CASE SCENARIO: ANEMIA, GI BLEEDING.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/ Sex 35years years old man is brought in to Emergency room by ambulance due to gunshots to his liver.Attending doctor Tommy Holbib.Patient name: Watermelo,Michael .Resuscitation Status Full code.Primary diagnosis: GSW/ Abdomen/ Right Hemothorax/ fracture right diaphragm. IV portable Chest Xray in am.Secondary diagnosis:No medical history. Isolation Status: Standard Precautions. Risk for fall: No.Suicidal risk: No.Do patient have advance Directive: No.Copy of advance Directive on the chart.Diet Regular diet.Allergy:NKDA. Weight 135lbs.Height 5feet 3inches.

Alert and oriented ×3.

Transportation method : Bed.

Right Chest tube .

Patient will have surgery in two days. NPO after midnight night before the surgery- ORIF right hand. Right chest tube to 20Cm suction.Right Chest tube intact and dressing in place.

Right Ac saline lock intact.

D545NS at 50ml/hour after midnight while NPO.

Skin intergrity impaired: Yes.

Lovenox 40mg SubQ Q24hours.

Kefzol 1gm IV Q8hours scheduled.

0.9NS flush Q8hours.

Norco 1tablet 10/325mg po Q4hours prn moderate pain.

Dilaudid 1mg IV Q3hours prn severe pain. Zofran 4mg IV Q4hours prn nausea vomiting. Tylenol 650mg po Q4hours prn temperature. Morphine sulfate 2mg IV Q6hour prn severe pain.

Laboratory tests :CBC with differential, Comprehensive Metabolic panel, Coags, LFT at 05am .

Questions:

l. What is one of the functions of the chest tube ?.

A.Prevention of escape of air from pleural space.

B.Removal of air from the pleural space.

C.Encourage negative alveolar pressure. D.Equalization of air cavity pressure.

Correct Answer B.

2.What is the cause of flail chest?.

A.Hematoma.

B.Congestion of the lung.

C.Pneumothorax.

D.Multiple rib fracture.

Correct Answer D.

2nd Case Scenario.A 78years old female was brought in to Emergency room by her son due to black stools ×2weeks,fatigue and generalized body weakness, no history of bleeding, normal colonoscopy few years back.Admitting Diagnosis: Anemia, GI bleeding. Hemoglobin <7.0.Secondary diagnosis: Hypertension, high cholesterol. Resuscitation Status Full code. Weight 200lbs.Height 5feet 6inches. Isolation Status Standard Precautions. Patient is at risk for fall, no suicidal risk noted. Assist to bedside commode.Patient does not have advance Directive. Copy of advance Directive is on the chart.Diet NPO after midnight. Allergy NKDA. Transportation method: Bed.02 at 2liter NC with Saturation of 92% .

Doctor orders:EGD(Esophagogastroduodenoscphy)

for further evaluation and treatment of your gastrointestinal disorder in am by doctor Dogood,James.Protonix 40mg IVP Bid.Paxil 75mg po(Hold)Coreg 12.5mg po daily scheduled Aspirin 81mg po(Hold). Dilaudid 0.5mg IV Q4hours prn severe pain.GI consult stat.Transfuse 2units of PRBC two hours apart.Transfuse slowly.Monitor H/ H. K level 3.4mEqkcl.Replaced with 40mEqkcl.

Questions and Answers. :

The RN has started the first uinit of PRBC because hemoglobin is less than 7.00.

What is the best action from the nurse after the first uinit has started?.

A. Absolutely nothing RN leaves the patient room.

B.Return to patient room at the end of blood transfusion.

C.Blood bank did all the required monitoring. D.The RN should stay with the patient for 15minutes after the blood transfusion has started to monitor transfusion reaction which is usually during first 15minutes that transfusion started.

Correct Answer D.

2. What will be your reaction if your patient is having problems the transfusion. What will you do as RN,and who do you call?.

A.Call her son and let him worry about it.

B.Call the case manager because she handles all cases.

C.Call the supervisor and let her/him know.

D.Stop the transfusion immediately and call the primary care physician or call the doctor on call for the patient.

Correct Answer D.

3.What is the normal potassium level?.A. Normal level is 2.9 to 3.5.

B.5.0 to 6.0mEqL.

C.5.0 to 6.5mEqL.

D.3.5 to 5.00mEqL.

Correct Answer is D.

Rationale: Potassium is one of the electrolytes of the body.It supports the heart and help the muscle to contract.It helps maintain normal level of fluid in the cells of the body. So it need to be checked and replaced. We receive potassium in some of the foods that we ear.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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