Clinical II – SIM 4 – Case Studies
*to be carried out early within the semester
Case Search 1
Scenario
P.M., 24-year-extinct home painter, too ill to work the past 3 days. Arrived at your outpatient sanatorium along with his lady friend, he appears alert nevertheless acutely ill, with a median create & a deep tan over the uncovered areas of skin. He reviews headaches, joint effort, a low-grade fever, cough, anorexia, & nausea and vomiting (N/V), particularly after ingesting any fatty meals.
P.M. describes imprecise belly effort that started regarding the same time as the other complications. He states that he has been the usage of “loads of Tylenol” for his effort. His past scientific history finds he has no health complications, is a nonsmoker, & drinks “just a few” beers each evening to relax.
Notable signs are 128/84, 88, 26, 100.6 ° F (38.1 ° C); wide awake, alert, & oriented × 3; moves all extremities well with complaints of aching effort in his muscle groups; very shrimp scleral jaundice latest; coronary heart & lung sound definite & with out adventitious sounds; bowel sounds definite all thru belly & pelvis; & belly soft & palpable with out creep heaps. You existing moderate hepatomegaly measured on the midclavicular line; liver edge is with out trouble palpated & soft to palpation. P.M. mentions that his urine has been getting darker over the past 2 days.
1. Your institution uses electronic charting. In step with the health history and evaluation described within the scenario, which of the next systems would you label as “irregular” as you doc your findings? Stamp irregular findings with an X and present a temporary story.
X Irregular
☐ Neurologic:
☐ Respiratory:
☐ Cardiovascular:
☐ Gastrointestinal:
☐ Genitourinary:
☐ Musculoskeletal:
☐ Pores and skin:
☐ Anxiety:
Case Search Development
P.M. is manifesting key signs of hepatitis. Laboratory work is requested for identification of his staunch trouble.
2. Which key diagnostic tests will resolve precisely what form of hepatitis is latest?
Laboratory Test Results
Sodium
Potassium
Chloride
CO2
BUN
Creatinine
Platelets
Indirect bilirubin
Total bilirubin
Albumin
Total protein
ALT
AST
LDH
ALP
PT/INR
aPTT
Urine urobilinogen
Anti-HAV
IgM
HBsAg
140 mEq/L
3.9 mEq/L
102 mEq/L
26 mEq/L
10 mg/dL
1.3mg/dL
210,000/mm3
1.6 mg/dL
2.3 mg/dL
3.8 g/dL
6.5 g/dL
66 gadgets/L
52 gadgets/L
245 gadgets/L
176 gadgets/L
12 sec/1.06
32 sec
1.6 IU/L
Detrimental
Detrimental
Positive
3. Which of P.M.’s laboratory results namely level to liver illness?
4. What’s the difference between the hepatitis B floor antigen (HbsAg) and the hepatitis B floor antibody (HbsAb)?
5. What components in his history would possibly maintain compounded the increased ALT ranges?
6. Brooding regarding the predominant pathology of hepatitis, what form of food blueprint will you strongly assist P.M. to practice?
7. For each characteristic below, identify whether or now not it describes hepatitis A (A) or hepatitis B (B).
______a. Fecal-oral transmission.
______ b. Transmitted by sharing needles.
______ c. Transmitted by blood transfusions.
______ d. Vaccination is a three-shot sequence.
______ e. Illness is steadily gentle, reminiscent of a flulike an infection.
______ f. Indicators comprise anorexia, nausea, vomiting, fever, fatigue, and jaundice.
8. In P.M.’s case, the HbsAg is definite. This end result means that P.M. is contaminated with hepatitis B and is within the intense duration of the illness. Is this illness contagious? What precautions would you take while he’s within the sanatorium?
9. Pruritus is steadily associated with jaundice. What is going to you enact to ease this trouble for P.M.? Name 5 interventions.
10. How will you display camouflage to P.M. the likely progression of his illness?
11. P.M. resides at home along with his folks and 4 younger siblings. The youngest is 4 years extinct. His folks query how to pause the remainder of the family from getting hepatitis. What particular instructions will you give?
12. How will that these instructions are understood?
13. Given P.M.’s standard of living, what particular affected person instructing capabilities must you emphasize?
Case Search Development
P.M. is ready for discharge in just a few days, & he confides to you that he feels so “guilty” about having hepatitis and endangering his lady friend and family. He tells you he modified into once at a celebration and did now not mediate the one-time needle utilize would possibly misery him. He has lost his job because he’s not in any respect times in a spot to transfer assist to work & he hopes his family is now not too panicked to maintain him return home.
14. What action will you take?
Case Search 2
As a senior scholar it’s seemingly you’ll also be assigned to work with a preceptor within the emergency division. It is a remarkably busy day, & it appears as if every affected person, no topic chief complaint, has a effort with fluid, electrolyte, and or acid-notorious stability.
The major affected person you query is a thirty-seven-year-extinct landscaper who is dropped on the ED after collapsing on a job on the native nation club. He’s a runt bit pressured nevertheless can expose you he feels dizzy & authorized. His skin is flushed, dry, and with melancholy turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing prognosis of deficient fluid quantity.
1. Portray how each of the next would replace and the reason for the replace within the presence of deficient fluid quantity
Parameter
Expected Substitute
Rationale
Coronary heart rate
Blood rigidity
Serum hematocrit
Urinary output
Urine particular gravity
Weight
2. What’s steadily the first indicator that a particular person desires more fluids?
3. The ED physician orders IV fluids for this affected person. What forms of fluids are indicated for a fluid quantity deficit attributable to dehydration?
The preceptor tells you to transfer forward & provoke an IV place and originate the fluids. The fluid lisp is to originate 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a fall element of 15 gtt/mL.
4. This infusion will hobble by gravity as a replacement of an infusion pump. How many drops per minute once you time the infusion at to create certain the glorious hourly rate? (See Chapter 22 in “Calculate with Self perception)
5. The affected person has a “corpulent sleeve” tattoo on both fingers. Talk about about the implications of this finding and the technique it’s seemingly you’ll provoke the intravenous place.
6. You’ve gotten gotten effort finding a vein within the presence of the deficient fluid quantity. What recommendations can you utilize to relieve create a vein more visible/palpable?
7. After Half-hour of the infusion, the affected person states, “My arm the place the needle is feels silly.” What once you enact first? What extra records enact you will have from the affected person?
Just a few hours later the affected person is feeling better & is now oriented x 3. The ED physician desires the affected person to be drinking oral fluids with out effort earlier than being discharged from the ED.
8. Talk about about the recommendations to elongate fluid consumption which will likely be most acceptable to this environment.
9 The affected person is discharged after sufficient hydration. Discharge instructing involves ways to pause this from going down but again on the job. What key capabilities must the nurse comprise within the instructing acceptable to the job place?
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