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While working on a medical surgical unit, I was assigned to an 82-year-old female for purposes of this paper we will call her (Mrs. M) with an admitting diagnosis of CHF, SOB, dehydration and a past medical history of dementia.
During my morning rounds I began my assessment of Mrs. M., and I noted that she had shortness of breath and she was making gurgling sounds. I immediately auscultated her lungs and noted bilateral wheezing throughout all fields, her heart was irregular and rapid and she had 2plus pitting pedal edema. I noticed she had an IV running at 125ml/hr, which I quickly stopped. The patient did not have orders for IV fluid there was only an order to KVO. I raised the head of the bed and paged respiratory to the floor.
I also called the patients primary physician and reported the situation. I informed the doctor that the respiratory team was at the patient’s bedside administering a nebulizer treatment and that the infusion was discontinued due to my findings. The patient’s primary physician arrived quickly to the floor to assess the patient. He ordered Lasix 20mg ...
Surgical Technologist are allied health professionals, who are an integral part of the team of medical practitioners providing surgical care to patients in variety of methods. Surgical technologist works under medical supervision of a surgeon to maintain a safe and effective conduct of surgical procedures in the operating room, making sure equipments function properly, and that the operative procedure is conducted under conditions that maximize patients safety.
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
Mrs. A is a 71-year-old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother 's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:
The nurse, a traveling nurse, was working on a unit and received orders for infusion of normal saline in a 7 month old. He saw a small bag of what appeared to be saline on the desk in the nurse’s station, with the manufacturer’s pre-printed labeling indicating that it was filled with normal saline. One key aspect, as described by the traveling nurse, was that he had encountered in other health systems that pediatric infusions were specified in small bags. Based upon these two perceptions, the nurse administered the infusion – despite the pharmacy applied label being on the other side of the bag. Needless to say, the child died shortly after receiving the infusion, despite resuscitation attempts. The infusion was actually prepared for his adult patient
In terms of her presenting complaint, she described herself as an active lady, who ran her own pub, but her recent symptoms rendered her unable to carry out her normal activities, such that her husband recommended she should go to hospital.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
The patient is a 55-year-old man admitted to the hospital for dehydration secondary to vomiting. The physical examination of the patient revealed dry mucous membranes and vital signs as follows: Pulse 110, blood pressure 100/60, and respirations of 20.
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
The author as a healthcare assistant working in the nursing home will present a scenario of Mrs. Keller (not her real name) who is confined in the dementia u...
I escorted her to a room, and helped her change into a gown. I understand that a 22-year old is capable of changing her own clothes, but I wanted to spend more time with her for further investigation. Auscultation of the lungs revealed bilateral clear and equal breath sounds, and heart tones were audible and regular. No peripheral edema was noted upon examination of her lower extremities, and she denied a history of similar symptoms or any medical issues in the past. Again, my nursing experience was challenged. Everything looked great, except this feeling remained that something was wrong. ER was busy that day, so I put in on order for a chest x-ray, and then told the doctor why she wanted to be seen. I told him that I ordered an x-ray, but something was not right about her skin color, not jaundiced, swallow, or cyanotic just not right, and I asked for basic lab work. The doctor felt lab work was not needed at that time, and I did not push the issue. I just thought to myself, “maybe he is right, and I have worked too many days in a row”. When the patient returned from the x-ray department, I met her at the room. I asked how
The patient was transferred into my care via the Emergency Assessment Unit for Surgical Patients (EAUS). I was given handover by the charge nurse who has already pre-a...
On my first day of week three clinical at 0830, client W and I were on our way to the dinning room and client B asked me to put his jacket on, so I told client W that I would meet him in the dinning room. After I helped Client B, I was on my way to the dinning room and nurse A told me that client W was experiencing difficulty breathing and we needed to give him his 0900 inhalers earlier. He was having audible wheezing and rapid respiratory rate. Therefore, we had to give client W his inhalers, SalbutaMOL Sulfate, which is a bronchodilator to allow the alveoli in the lung to open so th...
This paper will focus on the assessment and evaluation of two areas of human behavior management in which Hospital for Special Surgery Registration Physician Department needs to bring about crucial improvements.
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).
I went to the operating room on March 23, 2016 for the Wilkes Community College Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 7:30am-2:00pm. When we got their we changed into the operating room scrubs, placed a bonnet on our heads and placed booties over our shoes. I got to observe three different surgeries, two laparoscopic shoulder surgeries and one ankle surgery. While cleaning the surgical room for the next surgery, I got to communicate with the nurses and surgical team they explained the flow and equipment that was used in the operating room.