475 CASE SCENARIO. COMMUNUNITY PNEUMONIA (PNA)

KINGDOM OF GOD HOSPITAL LOS ANGELES,CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 65years years old man.

Admitted 01/18/21.

Status: Inpatient admission.

Location: Surgery department.

Room 62118.

Account # Q00993228 .

MR# :Q000696944.

Attending doctor: Don’thate,Big.

Patient name: Rainny,Jessy.

Resuscitation Status: Full Code.

Allergy: Tylenol,Zithromax (Rashes).Weight:130lbs.

Height :5feet 5inches.

Primary diagnosis: PNEUMONIA/ Community Acquired Pneumonia.

Secondary diagnosis: Hypertension/HLD/DM/ Asthma.

Diet: Carb controlled cardiac diet.

20 guage Left ac Saline lock. C/D / I.

Zosyn 3.375gm IV Q8hrs x 3days.

Accucheck: Qac/Qhs.

Plan:

Discharge home with po antibiotics. Continue blood sugar check before each meal and before bedtime.

474 CASE SCENARIO.RIGHT FALL/HUMERUS FRACTURE .

KINGDOM OF GOD HOSPITAL, LOS ANGELES, CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX. Age/Sex: 74years old female.

Account number :Q00499924.

MR # Q000659936.

Admission date: 03/22/21.

Status: Inpatient.

Location: Med/Oncology.

Room:42113.

Allergy: NKDA.

Attending doctor: Tumtum,Worry.

Patient name: Mrs Popcornse Genesis.

Resuscitation Status: Full code.

Primary diagnosis: Fall/Right Humerus fracture.

Secondary diagnosis: chronic afib,dm,htn,hypothyroidism ,gerd,gastritis.

Weight:260lbs.

Height: 5feet 4inches.

Isolation Status:Standard precautions. Transportation: Bed.

Is patient at risk for falls: No.

Do you have advance Directive:No. Copy placed on the chart .

Fell while drinking.

Alert and oriented x4.

Humidify 02 @2liter nc.

Diet: Carb controlled Cardiac diet .

Consultation:Orthopedic consult. Black eyes/ nose due to bruises from fall.Drank.

BAC level =0.16 % ( normal BAC level is 0.08%)

Laboratory tests:

WBC:12.9.

H/H11.3/35.8%.

K=3.9.

NA=139.

Medications :

Catapress 0.1mg po daily ( On hold)Low blood pressure 89/56,Pulse 64,Respiration 20.

02 saturation 95% with 2liter with humifier NC.

Dilaudid 0.5mg IV Q3hours prn pain.

Norco 10/325mg po Q4hours prn pain.

Zofran 4mg IV prn nausea/Vomiting.

Zosyn 3.375gm IV Q8hrs.

Merrem 1gm IV Q8hours.

Plans:

Doctor Saveme,Jonathan want to discharge patient home with home health services. Splint applied to right Humerus fracture.

WHAT ARE THE COMMON CLINICAL SIGNS OF INSULIN DEPENDENT DIABETES MELLITUS?.

(1)Polyuria with possible involuntary urination of children at night.

(2)Polydipia( Increased thirst)and polyphagia.( Excessive hunger)

(3) Blurred vision.

(4) Noticeable weight loss.

(5)Dry skin.

(6)Fatigue. (Extreme mental and physical tiredness)

NURSING RESPONSIBILITIES:

(1)Keep side rails up to prevent falls. Pad the hard surface floor to prevent physical injuries. Monitor intake and output. Give adequate fluids and IV fluids.Document what goes in and what comes out.

(2) Monitor vital sign to prevent hypotension,and cardiac issues.

(3)Monitor levels of consciousness. and assessment of neurological status.

(4) Monitor laboratory tests for hypokalemia, low blood sugar.

(5) Give low dose of insulin as ordered by the doctor.

(6)Encourage frequent ambulation and turn and reposition to maintain skin integrity.

(7) Education, education and education of patient family and patient. What are their level of education, experiences and learning needs. Do not judge them,educate them.Each individual stresses differently, so minimize their stress from lack of knowledge.

(8) Assessment of their psychological and emotional needs is very important because the initiatial diagnosis will be shocking them and can lead to panic, fears and uncertainty.

(9) Provide a positive environment for learning. Educate them on what to do such as monitor blood sugar, hypoglycemia and hyperglycemia signs,insulin injection, meal planning, skin care and exercise.

(10)Teach one skill at a time to prevent learning exhaustion and not more than 15 to 20minutes for each session. Information should be very simple to understand. From the known to the unknown,that is from simple to complex.

HOW DO PARENTS RESPOND WHEN THEIR CHILD IS HOSPITALIZED?.

Parents will show a wide variety of responses which include:

(1)Fear of the unknown because they are not sure if their child will fully recover from the ailment.

(2)Guilty: Patents feel guilty as if it is their fault. I remembered that I blamed myself for not being there 24/7.

(3)Uncertainty: Parents experience with hospitalization often afftect their judgments. If they have precious bad experience it will affect their judgment.

(4)Anxiety: Parents looking for blame and finger pointing.

It is the responsibility of parents to provide reassurance to their children throughout their hospitalization.

Parents should provide emotional support, let your sick child feel comfortable while receiving treatment.

Nurses Responsibilities:

(1)Arrange for appropriate school play activities for the child.

(2)Provide privacy to the child.

(3)Explain and help the child to understand hospital routines.

(4)Provide concrete explanation of any procedures. Don’t leave room for ambiguity.

(5)Place the child in the hospital room with compatible roommate.Age appropriate.

473 CASE SCENARIO. FELL AT HOME/ UROSEPSIS.

KINGDOM OF GOD HOSPITAL ,LOS ANGELES,CALIFORNIA 900000. INTERDISCIPLINARY KARDEX.

Age/Sex 69years.Female.

Account number: Q004388939.

MR# :Q00087563498.

Date of admission:02/20/21 @0320am.

Status: Inpatient admission.

location: MedTelemetry.

Room 42113.

Allergy: PCN.

Weight : 160lbs.

Height :5ft 4inches.

Primary diagnosis: Urosepsis.

Secondary diagnosis : Osteoarthritis/DM,HTN,HYPOTHYROIDISM/Depression.

Isolation status: Standard precautions.

Is patient at risk for falls:Yes.

Do you have advance Directive:No .Copy of advance Directive on the chart.

Is patient at risk for Suicide: No.

Skin integrity: No.

Transportation : Stretch.

MRI done (-)CT Scan done(-)

Lumbar puncture done.Diet: Cardiac Heart Health diet.Glucerna shake 1can TID.

Encough patient to try to eat more. Standby assisst.

D545NS c 20mEqkcl at 75ml/hour.

(+) Bowel movement. Voiding well.

Laboratory tests: WBC:11.9.

H/H:10.3/32.0%.

K=4.3.

NA=142 .

Medications:

Rocephin 1gm IV Q24hours.

Zosyn 3.375gm IV Q8hrs.

Vancomycin 1mg IV Q24hours.

Norco 10/325mg po Q4hours prn pain.

Zofran 4mg po Q4hours. Zofran 4mg IV Q4hours prn nausea/Vomiting.

Plans:

Discharge to: Calm and Beautiful Behavioral Health facility, Los Angeles California 900000.

474 CASE SCENARIO.FALL:L2,FRACTURES, NSTEMI.

KINGDOM OF GOD HOSPITAL , LOS ANGELES,CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 83years female.

Account number: Q009897234.

MR# Q000798678454.

Admission Status: Inpatient admission.

Location MedTelemetry.

Room :45012.

Attending doctor : Don’thate,Big. Allergy:NKDA.

Primary diagnosis: L2,L3 Fracture ,NSTEMI. Secondary diagnosis:Dementia, Failure to Thrive.

Isolation Status: Standard Precautions.

Is patient at risk for falls: Yes.

Do you have advance Directive:No.Copy of advance Directive on the chart .

Room air with saturation of 95%.

Cardiac Heart Health diet.

Alert and oriented ×1,vocal but does not make sense.Pulled out saline lock.

New saline lock 20guage,patent/clean/dry left arm.

Performed Straight catheter as ordered 800ml of clear yellow urine. Straight catheter Q6hours.

Incontinent of stool x2 during day shift. Laboratory tests:

WBC:8.1 .

H/H:9.0/27.2%.

Medications:Norco 10/325mg po Q4 prn pain.

Dilaudid 0.5mg IV Q3hours prn pain.

Zosyn 3.375gm IV Q8hrs.

0.9NS at 75ml/hr left forearm 20guage,patent/clean/dry.

472 CASE SCENARIO. INTRACTABLE NAUSEA/VOMITING/FAINTING.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 92years old male.

Account number Q002696229.

MR#Q00004335697.

Admitted 05/23/21 @02am.

Status: Inpatient admission.

Location: General Surgery department. Room:62014.

Attending doctor: Tumtum,Worry.

Patient name: Paulinus Firewood.

Resuscitation status: Full Code.

Weight: 150lbs.

Height:5feet 6inches.

Allergy: NKDA.

Primary diagnosis: Intractable nausea/Vomiting/ Fainting.

Secondary diagnosis:Prostate cancer 2009,HTN,CVA,HTN,HYPOTHYROIDISM, COPD,ASTHMA, CKD.

Alert and Oriented ×2.Dementia.

Isolation Status: Standard Precautions.

Is patient at risk for falls: Yes( Age/language/Dementia)

Do patient have advance Directive: No .

Copy of advance Directive on the chart.

Risk for Suicide: No.

02 at 2liters NC. Respiration:rales,rhonchi,coughing out blood, refused CPAP machine.

Doctor aware.

Left pacemaker.Abdomen distended.

Voiding frequently 100ml amber colored urine. Patient is very weak,reposition frequently. Redness to his buttocks. Nonblanchable. Laboratory tests:

WBC= 5.9.

H/H=11.3/33.8%.

K=3.9.

NA=136.

Bun=19.

Medications:

Levaquin 500mg IV Q24hours.

Norco 10/325mg po Q4hours prn.(crush medication and mix with apple sauce.)

Right sided weakness.

Right wrist saline lock.

Diet: Cardiac Heart Health diet.

Nectar thicken liquid. Ensure Bid.

Family member: Johnsone Firewood.

Phone number 555-555-5555.

Patient belongings taken home by his son.Plan: Discharge home with God Choice Home Health Services.

471 CASE SCENARIO. ETOH WITHDRAWAL /ABDOMINAL PAIN.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 65years.Male.

Account number :Q00369693.

MR#: Q000991123.

Admission Status :Inpatient admission. Admitted: 06/03/21.

Location:Medical/Surgical .

Room :36112.

Resuscitation status: Full code.

Primary Diagnosis: Etoh withdrawal; Abdominal pain.

Laboratory tests:

WBC: 4.9.

H/H14.3/43.8%.

K=3.6.

NA=135.

CIWA Protocol level :5.

Ativan 2mg IV Q8hrs.

NS @ 75ml/hr.

Voiding well using the urinal.

Bowel movement × 2.

Diet : Regular diet.

Tolerating diet well.

Plans:

Discharge in am.

Follow up with his Primary care physician in two weeks.

470 CASE SCENARIO. SMALL BOWEL OBSTRUCTION.(SBO)

KINGDOM OF GOD HOSPITAL, LOS ANGELES,CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 59years Female.

Account number Q00069696.

MR# Q00444546678.

Admitted: 01/10/21.

Status: Inpatient admission.

Location :MedTelemetry.

Room 43117.

Attending doctor: Tumtum,Worry.

Patient: Gonben,Frankincense.

Resuscitation status: Full code.

Allergy: NKDA.

Primary diagnosis: SBO.

Secondary diagnosis: Anxiety/ Lupus/ DM,HTN,HYPOTHYROIDISM/ Irritable bowel syndrome.

Isolation Status :Standard Precautions.

Is patient at risk for fall.No.

Do patient have advance Directive:No.

Copy of advance Directive on the chart.

High risk for suicide: No.

Room Air ,02 saturation of 94%.

NPO× Ice chips.

Surgical intervention today @ 1800 .

Consent signed.Exploratory laparotomy possible bowel resection by doctor: Forgetmenot,Jenije MD.

No flatulence.

No bowel movements.

Abdominal Xray done today.

NGT to left nare.

Ngt to low continuous suction with dark green drainage. Emptied 400ml.

Flush ngt with 20ml of water Qshift.

Transportation: Bed.

Laboratory:

WBC: 4.4.

K:3.4.

H/H 12.8/39.0%.

Laboratory in am:

Cbc with differential,BMP,MG.

20MEQKCL .Replaced.

Medications:

LR at 125ML/Hour left forearm 20guage,patent/clean/dry.

Morphine sulfate 2mg IV Q3hours prn pain. Dilaudid 0.5mg IV Q4hours prn pain.

Zofran 4mg IV Q4hours prn nausea/Vomiting.

469 CASE SCENARIO. MULTIPLE LOWER EXTREMITIES FRACTURES.

KINGDOM OF GOD HOSPITAL, LOS ANGELES,CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex Age/Sex 28years old Male.

Account number Q00093299.

MR# Q64450006654.

Admitted 04/12/2105pm.

Status: Inpatient admission.

Location: Trauma Department.

Room 60021.

RESUSCITATION STATUS :Full code. Primary diagnosis:Motor vehicle accident.Fell asleep and hit the tree/ Bilateral acetabular fractures, facial laceration.

Isolation Precautions: Standard Precautions.

Is patient at risk for falls: Yes. Star falling, yellow signs in place.Yellow gown and yellow ID.

02 @2liter NC. Saturation of 94%.

Do patient have advance Directive:No. Copy of advance Directive on the chart.

Allergy: NKDA.

Operating Room:Facial fracture surgery today. ORIF Right ankle 04/01/21..Splint with IMMOBILER in place.

High income.Not quality for support.

NPO × MEDICATION.

Facial stitches removed. Right zygomatic complex fracture repaired .

Voiding well using the urinal.

Bowel movement ×2 today.

External fixation right leg.

Laboratory tests:

WBC:12.2.

H/H9.4/28%.

K:4.2.

NA 137.

Medications:

Merrem 1mg IV Q8hrs.

Vancomycin 1gm IV Q12hours.

Dilaudid 0.5mg IV Q3hours prn pain.

Norco 10/325mg po Q4hours prn pain.

Flexeril 5mg po Q8hours prn muscle spasms. 0.9NS @ 125ML/Hour.

Urinal at the bedside.

Plans:

Discharge to Acute Rehabilitation when stable.