Answered step-by-stepWilliam Brown, a 79-year-old patient fr
Answered step-by-stepWilliam Brown, a 79-year-old patient from the nursing home, is…William Brown, a 79-year-old patient from the nursing home, is being transported to the emergency department. The patient is reporting increasedpain, redness, and tendernessin his left lower leg. The nursing staff reports has had general malaise and a low-grade fever for the past two days. He answers s appropriately, showing nosign of cognitive dysfunction. The staff nurse reports his medical history includes hypertension controlled with metoprolol and lisinopril, and type 2 diabetes treated with metformin. The nurse from the nursing home reports current vital signs are as follows: BP 96/58 mmHgHR, 118 beats per minuteRR, 28 breaths per minuteSpO2, 93% on 2L NCTemp 100.7F Patient Arrival: The emergency department nurse notes that the patient’s his face is flushed, he is somewhat confused, and he appears to be anxious. His vital signs are now: BP 91/50 mmHg, MAP 66 mmHg, HR, 128 beats per minute; RR, 32 breaths per minute; and Temp 101.1F, GCS is 14. Prioritize the nurse’s assessment 1-5 and anticipated interventions.Prioritized assessments Anticipated interventions1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Refer to the Managing Sepsis and Septic Shock article: What is the patients QSOFA score? _____________________________________________ What does it indicate? ________________________________________________________ What should be done next? __________________________________________ Diagnostic Results: The physician orders diagnostics for Mr. Brown, results are below. Complete Blood Count (CBC) WBC HGB PLTs % Neuts BandsCurrent: 18.5 13.1 250 85.2 3 Metabolic Panel (CMP) Na K Gluc. Creat.Current: 147 5.2 172 1.6 Lactate PT/INR GFRCurrent: 5.4 2.6 45 Urinalysis + UA Micro Color: Clarity: Sp. Gr. Protein Nitrite LET RBCs WBCs Bacteria EpithelialCurrent: Tea Clear 1.050 NEG NEG NEG <5 <5 NEG None ECG CXR ResultsCardiac silhouette slightly enlarged. No infiltrates present. Prioritize the 3 most concerning diagnostic findings and their clinical significance Most Concerning Diagnostic Clinical Significance1. 2. 3. Where did the infection likely originate? ________________________________ Prioritize the following admission orders for Mr. Brown. Priority number Physician Admission Order Strict I &O: Place FoleyCatheter with drainage to gravity Continuous cardiac monitor Nasal cannula at 4L/min 18 G IV access x 2. If LactateLevel = 2 - repeatlactate level in 4 hrs and in AM and notifyMD O2@4-6L NC, titrate to keep O2 sats>92% Give 0.9% NormalSaline 1000 mL IV x2 over 60 min If SBP remains < 90 mmHg or MAP <65 mmHg after saline bolus,begin Norepinephrine 1-12mcg/min to maintain SBP >90mmHg or MAP =65mmHg Diltiazem 360mg PO daily Warfarin 5mgPO daily Blood Cultures x 2 stat UA and Urine Cultures Vancomycin 2gIVPB q 12 hours Morphine 1 -2 mg IV Q1h PRN mild pain;3-4 mg IV Q1h PRNmoderate pain; 5 mg IV Q1h PRNsevere pain Vital Signs Q 15 min with continuous pulse oximetry Clear liquid diet BSG q 4 hours Sliding scale insulin protocol. Metformin ER 1000mg PO daily @1700. Acetaminophen 1000 mg PR every 6 hours PRN for fever >101 Identify 5 complications Mr. Brown is at risk for and the assessment findings that indicate the complication. Complication Assessment findings indicating complication1. 1. 2. 2. 3. 3. 4. 4. 5. 5. Identify 5 specific objective evaluation criteria the nurse will utilize to determine if Mr. Brown is improving (This is the same as the evaluation part of Stickman). Evaluation Criteria1. 2. 3. 4. 5. Health ScienceScienceNursingNURSING 112Share
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