25years old female is brought in to Emergency room by Premieres home 🚑ambulance due to Assault left 3rd PIP open dislocation/Etoh.Fracture of third middle finger. She is highly intoxicated, uncooperative, multiple bruises and abrasion to her face,arm,hand,legs,and all over her body.Multiple contusion on her head. She was Assaulted by multiple other females.The fight was over a boyfriend. Alert and oriented x2 ( Self and place),injured third mild finger. Blood alcohol level 1.08,contusion to left lower and upper perorbital.Allergy : PCN.Regular diet.
Assist to bathroom.Full code,risk for fall,standard precautions. Weight 135lbs.Height 4ft 11inches.
Consultation: Plastic Surgery consult. General Surgery consult, Orthopedic surgery. Infection disease consult. Lactated Ringers with 20meqkcl at 75ml/hour right forearm 18guage clean, dry and intact.CIWA protocol. Belonging list done.No advance Directive. Copy of advance Directive on the chart. Informed Consent signed,dated and in the chart.Transportation method: Bed.02 at 2liter NC with Saturation of 95%.
Laboratory results : WBC 24.2.H/H 14.0,42.5.
K 3.5.NA 142.Lactic acid 2.2.
Urinalysis: clear amber urine.
NPO after midnight. Surgery Tendon Repair by doctor Abraham Godson,MD.
Medications Reconciliation done.
Skin intergrity impaired.
Medications: Norco 10/325mg po Q6hours prn moderate pain. Dilaudid 0.5mg IV Q3hours prn severe pain. Zofran 4mg IV Q4hours prn nausea/Vomiting.Heparin 5000units subQ Q12hours. SCD Bilateral lower extremities.
Toradol 30mg IV Q8hours prn pain.Ativan 2mg IV Q6hour withdrawal symptoms prn.
Ativan 1mg IV Q4hours scheduled.
Kefzol 1gm IV Q8hours scheduled.
Zosyn 3.375gm IV Q8hours scheduled.
Tylenol 650mg po Q4hours prn temperature. Morphine sulfate 2mg IV Q6hour prn severe pain.
Discharge plans: Patient will be discharged home after surgery and medically stable.
1.Why is patient on CIWA Protocol?.( Clinical Institute Withdrawal Assessment-Alcohol Revised)
2.Pharmacy requested patient weight and height before sending medications .💊What is the significance?.
3. What is informed consent?.Why do patient need it before surgery, blood transfusion or other invasive procedures?.
4.Why is plastic Surgery consultation?.
5 .Why is it that infection disease doctor is consulted?.What laboratory results are they looking at?.
6. You’re getting patient ready for surgery. What sequence will you use when doing the abdominal examination?.
A.Inspection, auscultation, percussion and palpation. – correct
B.Inspection,percussion, auscultation, palpation.– wrong.
2.CASE SCENARIO: ASTHMA EXACERBATION, UPPER RESPIRATORY INFECTION.(URI)
A 42years old male came to emergency room with wife.S/P Asthma Exacerbation, Upper Respiratory Infection. “Asthma is a Respiratory disorder that is characterized by recurring episodes paroxysmal dyspnea, wheezing on expiration/inspiration due to constriction of the bronch, Coughing and viscous mucoid bronchial secretions.The episodes is precipitated by inhalation of allergens or pollutants, Infection, cold air, vigorous or emotional challenges or stress”.Mosby Medical dictionary page 136.
Full code ,alert and oriented x4. Standard Precautions. Patient is not at risk for falls. Patient does not have advance Directive. Copy of advance Directive on the chart.02 at 2liter NC with Saturation of 93%F.Allergy: NKDA. Weight 185lbs, Height 5feet 5inches.Standard Precautions. Diet Cardiac heart health diet. Saline lock left forearm 20guage clean dry,intact. Echocardiogram done.Solumedro given ,Prednisone 20mg po daily scheduled from tomorrow. Uses urinal at bedside. SCD Bilateral lower extremities.
QUESTIONS AND ANSWERS ON FLUID, ELECTROLYTE AND A CID- BASE BALANCE.
In nursing understanding fluid ,electrolytes and acid base are important in terms of dietary modification, fluid modification of intake and output, medications administration total parental nutrients, blood and blood products replacement in terms of managing or resolving fluid, electrolytes and acid based balances.The importance of understanding the laboratory tests and results cannot be overemphasized.
1.What Ions develop a positive charge?.
Correct Answer C.
2. What liquids hold a substance in solution?.
Correct answer A.
3.What substances are capable to release electrically charged Ions when dissolved in a solution?.
Correct Answer B.
4.The doctor orders Hypotonic solution for one of his patients. And the nurse recognized that hypotonic solution is given for what?.
A.Restoration of fluid in the intracellular space. B.To correct abnormal blood pressure to be normal.
C.To restore the kidney perfusion.
D.Decrease nausea and Vomiting in patient withdrawal symptoms.
Correct Answer A.
5.What is the liquid that is constituent of blood or fluid found within the vascular system?.
Correct answer A.
Rationale: The intravascular fluid is the whole blood volume which include white blood cells, red blood cells, Platelet, and Plasma.The most important component of the overall blood fluid is the intravascular fluid.
B,C,D are wrong answers.
Thank you very much.
I appreciated your time.
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