Nursing

/ #Nursing, #nursing homework help


RapidReasoning: ClostridiumdifficileColitis

 

ChiefComplaint/HistoryofPresentIllness:

Mindy Perkins is a 48-year-old woman who presents to the ED with 10-15 loose, liquid stools daily for the pasttwo days. She completed a course of oral Amoxicillin seven days ago for a dental infection. In addition to loosestools, she complains of lower abdominal pain that began two days prior. She has not noted any blood in thestool. She denies vomiting or fever/chills. She is on Prednisone for Crohn’s disease as well as Pantoprazole(Protonix)forsevereGERD.

 

 

PastMedicalHistory:

  • Crohn’sdisease
  • GERD
WILDAPainScale(5thVS)
Words:Crampy
Intensity:7/10
Location:GeneralizedthroughoutRLQ-LLQ
Duration:Persistentsince onset 2daysago
Aggravate:

Alleviate:

None

 

YourInitialVS:

 

 

 

 

 

 

 

YourInitialNursingAssessment:

 

 

 

 

T:100.2(o)

P:92

R:20

BP:122/78

O2sats: 98%RA

OrthoBP’s:  Lying:122/78 HR:92

Standing:120/70HR:114

 

GENERAL APPEARANCE: appears weak and uncomfortable. Easily fatiguedRESP:breathsoundsclear withequal aerationbilat.,non-labored

CARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all extremitiesNEURO:alert&orientedx4

GI/GU: active BS in all quads, abdominal soft/tender to palpation in lower abdomen-no rebound tenderness orguarding

MISC:Lipsdry,oralmucosa tackywithnoshinysalivapresentinthe mouth

NursingInterventions:

  • OrthostaticBP’s(EDstandingorder)
  • EstablishPIV(EDstanding order)
  • Initiateentericprecautions(EDstandingorder)

 

PhysicianOrders:

  • 9%NS 1000mLIV bolus
  • Hydromorphone(Dilaudid) 1mg IVP
  • difficile
  • BMP, CBC
  • Vancomycin 250 mg PO

o1000mg/20mL…determinedosagetoadminister                                    

  • Admittothe medicalunit

 

Lab/diagnosticResults:

  • difficile:Positive

 

  1. What data from the chief complaint, VS &nursing assessment is RELEVANT that must berecognizedas clinicallysignificanttothenurse?
RELEVANT data:Chiefcomplaint:

 

 

 

 

VS/assessment:

Rationale:

 

  1. What lab/diagnostic results are RELEVANT that must be recognized as clinically significant to thenurse?
RELEVANTDiagnosticresults:Rationale:

 

  1. Whatisthemost likely primaryproblemfor thispatient?

 

 

 

 

  1. Whatistheunderlyingcause/pathophysiologyof the primary problem?

 

  1. Whatnursingprioritywillguideyour planof care?

 

 

 

  • Whatinterventionswill youinitiatebasedonthispriority?
NursingInterventions

1.

 

 

2.

 

 

3.

 

 

4.

 Rationale:

1.

 

 

2.

 

 

3.

 

 

4.

 ExpectedOutcome:

1.

 

 

2.

 

 

3.

 

 

4.

 

  1. What is the relationship between the following nursing interventions/physician orders and yourpatient’sprimarymedicalproblem?
Nsg. Interventions/MDorders:

OrthostaticBP’s

(EDstandingorder)

 

 

EstablishPIV

(EDstanding order)

 

 

Initiateentericprecautions

(EDstandingorder)

 

 

0.9%NS 1000mLIV bolus

 

Hydromorphone (Dilaudid) 1 mgIVP

 

Stool culture for C. difficileBMP

CBC

Vancomycin 250 mg POAdmittothe medicalunit

Rationale:ExpectedOutcome:

 

  1. What body system(s) will you most thoroughly assess based on the patient’s chief complaint andprimary/priorityconcern?

 

 

 

 

  1. Whatistheworstpossiblecomplicationtoanticipate?(startwithA-B-Cpriorities)

 

 

 

 

  1. What nursing assessment(s) will you need to initiate to identify and respond to quickly if thiscomplicationdevelops?

 

 

 

 

 

 

 

  1. Whatisthepatientlikelyexperiencing/feelingrightnowinthissituation?

 

 

 

 

 

 

 

 

  1. Whatcanyoudotoengage yourselfwiththis patient’sexperience andshowthattheymattertoyou as a person?