CASE SCENARIO IN MEDICAL SURGICAL NURSING CHEST INJURY Pre-Hospital… CASE SCENARIO IN MEDICAL SURGICAL NURSING                                                                        CHEST INJURY Pre-Hospital DataMarlin Ponce, a 19 years old student at OLFU, was going to her school to pay her dues at the Accounting office, when suddenly a victim of stabbing while outside the campus. This all began when a stranger approached her and asked her for some money which occurred immediately after this man saw her. What started out as a verbal argument and she refusing to give this stranger her money, eventually resulted in a physical violence. Marlin sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple. She was transported to emergency department at the nearby hospital NEDHI by the bystanders who witnessed the incidence. He was noted to be awake and alert throughout the entire transport, but in an agony of the pain she was experiencing from the stab wounds. After several hours of observations, Marlin, at this time began complaining of a new subscapular pain, or pain between the shoulder blades. The doctor was alarmed for the following reasons: Patients with diaphragmatic injuries and irritation from the blood frequently exhibit referred pain in this distribution. If the knife wound had projected inferiorly penetrating the diaphragm, there was also a high likelihood of intra abdominal injuries. Therefore, it was decided that the patient required surgical exploration, and the patient was taken to the operating room. Emergency Room  Assessment: The patient complained of some pain in her left chest and shortness of breath while she is moving from the stretcher onto the examination table. The nurse placed cardiac monitors, blood pressure-cuff and oxygen saturation probe on her. Vital signs result as follows: Heart rate – 8am 91b/min, 84b/min,72b/min, 101b/min, 64b/min, 92b/min, 71b/min, 89b/min, 62b/minBlood Pressure – 140/90, 130/70, 120/80, 140/90, 130/70, 120/80, 140/90, 130/70, 120/80, 140/90Respiratory rate – 26, 18, 30, 21. 18, 24, 35, 24, 20, 16, 35, 23, 30, 16, 18, 20Temperature – 37.2’C, 38.1, 36.3, 37.2’C, 38.2, 36.5, 37.5’C, 36.1, 36.3, 37.2’C, 36.1, 37.3I and O monitoring8am total – I = NPO O = 1500cc; I = NPO O = 200cc; I = 1,000 O = 150cc; I = 1,500 O = 2000cc;  Past Medical/Surgical History: Allergic Rhinitis, Asthma Family History: Father is diabetic, Mother has hypertension Medications: Medication for pain and antibiotic ( make your own order for pain and antibiotic) make an drug study. Inhalers as needed Allergy: Pain Medications such as IBUFROPEN (Alaxan, Gardan etc.) Chest X-ray: Left sided hemo-pneumothorax An upright CXR was done. Marlin need to be sat up because she had an isolated penetrating injury to the chest, and the mechanism of injury did not warrant spinal precautions. Due to this isolated nature of her injury a pelvis and lateral C-spine films were unfortunately not obtained. Medication for pain and antibiotic (decide and make your own order for pain and antibiotic) make a drug study. Initial Survey: Airway – There is patent airway as demonstrated by her ability to complain or talk.Breathing – There is decreased breath sounds at the left base.Oxygen mask with 100% FiO2 was placed; & an oxygen saturation of 98% was obtainedCirculation – There is no active external bleeding observedExposure – The patient’s were cut off and removed to examine for other injuries  Secondary Survey:EENT:(-) lacerations,(-) hematomas (-) fractures palpatedNeck: midline trachea, (-) JVD, (-) crepitusChest: clear on right, single stab wound to the left chest in the mid-axillary line in the 4th intercostal space, no crepitus, no bleeding, decreased breath sounds at the left baseCardiac: Normal RR, normal S1 and S2 Abdomen: soft, non-tender, non-distended, with presence of abdominal soundsExtremities: warm to touch, (+) distal pulsesNeuro: GCS 15, (-) focal deficits, awake, GCS 13, GCS 14, GCS15, GCS15Laboratory and other pertinent studies. Blood Work Ordered:Coagulation PanelCompete blood count (CBC)Arterial blood gasToxicology screen S:1. What is the best nursing diagnosis for Marlin’s case?2. As the student nurse assigned to Marlin, how will you manage her pain?3. What is the purpose of the Arterial blood gas analysis ordered by Marlin’s attending physician? How will you prepare Marlin for this test?4. What are the significance of the different blood ( Coagulation panel, CBC etc.) work ordered by the doctor?5. Why is ABG is being ordered? State your reasons.6. Which of these 2 diagnostic procedures does apply to Marlin’s case? Give your reasons.A) Open laparotomy B) Diagnostic Laparoscopy  Health Science Science Nursing NCMA 219

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