Remote Clinical
NURS 6973 Activity #1 (Group)
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Overview
This day focuses on care for an acutely ill patient in an emergency setting
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The objectives for the activities are:
• Provide safe nursing care to an adult patient in an emergency setting
• Evaluate objective and subjective assessment data
• Correlate laboratory values with potential patient problems
• Identify anticipated medical interventions
• Create a nursing plan of care based upon anticipated medical care
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Patient Case Study
Answer the questions below according to the clinical case study
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Synchronous Debriefing – Attend your clinical group’s Teams debriefing session
DML will occur at the end of your clinical day, together with your instructor and peers. Your instructor will provide you details regarding the time of the meeting.
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During the meeting, you should be prepared to discuss the assignment you completed during your clinical day.
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What to turn in?
See your clinical instructor for submission requirements for this week.
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Case Study
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Scenario
A 34–year old female comes into the ER stating she has been having abdominal pain, nausea, and vomiting for several days. Pain is 10/10.
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Patient Information
•PMH: Diabetes Mellitus, Chronic pain, GERD, Hypertension, Bipolar disorder
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•Current Medications: OxyContin, Prozac, Ranitidine, Synthroid, Zyprexa, Regular Insulin, Lantus, Lipitor, Lisinopril, and Multivitamin
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•Allergies: Benadryl, Imitrex, Augmentin, Phenergan, Lyrica, Reglan, Morphine, Compazine, Baclofen, Fentanyl, Gapapentin, Codeine Tramadol, Droperidol, Demerol, Protonix, Amoxicillin, Penicillin, Paramethasone, Clonidine, Tromethone
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Assessment Data
•Neurologic
•Alert, awake, and oriented X3
•Cardiac
•Peripheral pulses strong and present
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Vitals
Time | Temp | Pulse | Resp | BP | SPO2 | Pain |
1500 | 97.3 | 120 | 28 | 173/93 | 100% RA | 10/10 “All over” |
1530 | . | 116 | 26 | 168/92 | 100% RA | 9/10 “Chest” |
1700 | . | 108 | 18 | 156/88 | 100% RA | 9/10 |
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Labs
CBC | Result | Reference Range |
WBC | 15.3 H | 4-11 |
RBC | 3.56 L | 4.5-5.9 |
Hgb | 11.1 L | 13.0-17.0 |
Hct | 37.3 L | 39.0-51.0 |
Platelets | 257 | 150-450 |
Neutrophils (segs) | 81.7 H | 33-69% |
Lymphocytes | 10.6 L | 20-55% |
Monocytes | 6.0 | 3-8% |
Eosinophils | 0.5 L | 1-3% |
Basophils | 1.2 | 1% |
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Metabolic | Result | Reference Range |
Sodium | 120 L | 135-145 |
Potassium | 6.9 H | 3.5-5.0 |
Chloride | 95 L | 98-107 |
CO2 | 14.5 L | 21-32 |
Glucose | 1174 H | 65-99 |
BUN | 40 H | 10-20 |
Creatinine | 2.86 H | 0.5-1.4 |
GFR | 19 | >60 |
Calcium | 8.2 L | 8.4-10.2 |
Lipase | 11 L | 22-51 |
Total Protein | 5.6 L | 6.2-8.0 |
Albumin | 2.1 L | 3.2-5.5 |
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Arterial Blood Gases + Beta Hydroxybutyrate (BHB) | Result | Reference Range |
pH | 7.12 L | 7.35-7.45 |
paCO2 | 26 L | 35-45 |
paO2 | 95 | 75-100 |
HCO3 | 15 L | 22-26 |
spO2 | 97 | 94-100% |
BHB | 1.2 H | 0.0-0.5 mmol/L |
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Questions
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1)What four medical diagnoses do you anticipate based upon the data?
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2)What type of acid base balance would you classify the patient to have and why?
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3)Why was the patient hypertensive, tachypneic, and tachycardiac?
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4)Why was her glucose elevated? (give a pathophysiologic explanation)
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5)Why were the WBC and neutrophils elevated?
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6)Why was her carbon dioxide low?
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7)Why were the sodium and chloride levels low?
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8)Why was the potassium elevated?
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9)Why were the BUN and creatinine elevated?
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10)What is the BHB and what does it indicate?
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11)What interventions would you expect the ER provider to order?
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