BACKGROUND An 84-year-old female is brought in by family wit
BACKGROUND An 84-year-old female is brought in by family with… BACKGROUNDAn 84-year-old female is brought in by family with complaints of increased confusion and lethargy.Patient usually lives alone and is fully functional.Son reports that she has been increasingly confused and sleeping a lot at home.Son denies any fever.Patient complains of pain “all over” and responds to repeated s with “I think I’m sick”VITAL SIGNSBP 105/64, HR 115, RR 24, T 96°F, SpO2 92% Room AirPatient is alert, and oriented to person but thinks is it 1990PMH: HTN: MetoprololDM: InsulinOther meds: ASA, CalciumRESULTS OF DECISION POINT ONECorrect!Initial 12 lead EKG to assess myocardial functionCBC to assess WBC and potential anemiaBMP to assess electrolyte disturbance and potential for DKAUrinalysis to assess for potential infectionChest x-ray to asses for potential infection RESULTS OF INDICATED TESTSComplete Blood Count (CBC)WBC 3.4 k/ULHgb 9.3 g/dLHct 28%Platelets 250 k/ULDifferentialNeutrolphil 90%Bands 10%Eosinophil 0%Basophil 0%Lymphocyte 2%Monocyte 3% Basic Metabolic Profile (BMP)Na+ 132mEq/LK+ 3.7mEq/LHCO3 27mEq/LCl- 101mEq/LGlucose 1766 mg/dLBUN 55 mg/dLCreatinine 2.0 mg/dL Urinalysis (U/A)Color YellowClarity Dark/CloudySp gravity 1.042pH 6.2Total Protein negativeGlucose positiveKetone negativeBilirubin negativeHematuria positiveLeuk. Est. +++Nitrite +++ Urinalysis shows hematuria, positive nitrate, positive leukocyte esterase which all are indicative of a UTI.Elderly frequently have a low WBC and low body temperature in the presence infection.Chest x-ray is clear and EKG shows tachycardia but no arrhymia or myocardial hyposia.The patient remains confused and is becoming more lethargic. Follow up BP is 82/42. Serum lactate level is 4.5. What is your diagnosis now? SIRS (systemic inflammatory response syndrome) requires the presence of two of the four factors: Temperature less than 36.0 C or greater than 38.0 C Heart rate greater than 90 BPM Respiratory rate > 24 breaths per minute or PaCO2 < 32 WBC less than 4,000 or greater than 12,000; or Bandemia>10%To prepare:Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.You will be asked to develop a set of admission orders based on the patient in the branching exercise.The AssignmentUsing the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.Be sure to address each aspect of the order template and the orders as you would in the patient’s chartMake sure the order is applicable to the patientAny rationale you feel the need to supply should be done at the end of the order set – not included with the order We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.A minimum of three current, evidenced based references are required. Health Science Science Nursing NRNP 6566
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