CI Group: Group Members:

Instructions: All question apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, they should be listed in order of priority or significance. Please write clearly. Scenario: Mrs. R.K. is an 85 year old woman who lives with her husband, 87. Two nights before her admission to your unit, she awoke with heavy, substernal pressure accompanied by epigastric distress. The pain was reduced somewhat when she rolled onto her side but did not completely subside for about 6 hours. The next night she experienced the same chest pressure. The following morning, Mrs. R.K.s husband took her to the doctor and she was subsequently hospitalized to rule out MI. Labs were drawn in the ED. She was started on O2 2Lpm and given non enteric coated ASA 325mg. An IV was started. You obtain the following information from your nursing history and physical exam: Mrs. R.K. has no history of smoking or alcohol use; has been in good general health with the exception of osteoarthritis of her hands and knees and some osteoarthritis in her spine. Her only medications are ranitidine, ibuprofen for bone and joint pain, and herbs. Her admission V/S are 130/80 mmHg, 88 bpm, 18 cpm, 37.2 C. Her weight is 52 kg and height is 163 cm. Moderate edema of both ankles is present, but capillary refill and peripheral pulses are 1+. You hear a soft systolic murmur. She denies any discomfort at present. 1. Give at least 2 reasons an IV would be inserted. What kind of IV fluid would you expect to be running and at what rate?

2. Why is a nonenteric coatedASA specified? What would be a contraindication to administering ASA?

3. Mrs. R.K. becomes fatigued during the admission process and you decide to let her sleep. When she awakens, what additional history and physical information should you obtain r/t her admitting diagnosis? HISTORY

PHYSICAL EXAM

4. List seven lab/diagnostic tests you would expect were drawn or conducted in the ED; suggest what each may contribute.

5. Differentiate between pain of cardiac origin and that of noncardiac origin.

6. Look up Mrs. R.K. height and weight for her age, compute her BMI. Is she considered overweight? Why or why not?

7. Florence Nightingale frequently emphasized the value of good observation skills in nurses. Explain how a good nursing assessment can contribute to understanding the cause of her symptoms.

CI Section:

Group Members:

Instructions: All question apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, they should be listed in order of priority or significance. Please write clearly. Scenario: P.R., a 31 year old woman, contracted an upper respiratory tract infection, developed a high fever, and began to experience progressive ascending paralysis. She was admitted to the local hospital, diagnosed with Guillain Barre syndrome. She was intubated and mechanically ventilated. Her V/S are 110/70, 134, 12, 101 F. The placement of her PEG tube was confirmed by abdominal x-ray. Her total parenteral nutrition (TPN) was discontinued yesterday, and she was started on enteral nutrition (EN). The consulting dietitian calculated P.R.s need at 2800 cal/24 hrs. P.R. is 54and weighs 123 lb. 1. What is ascending paralysis?

2. Identify and discuss at least two factors that would influence the physicians decision to place P.R. on EN.

3. Pulmonary aspiration is a risk with enteral feedings, although the risk is substantially reduced with duodenal placement. Identify 4 measures that can be taken to minimize the risk for aspiration.

4. Identify 5 strategies for preventing bacterial contamination of the feeding formula and tubing.

5. It is a common belief that diarrhea (defined as >3 liquid stools per day) is a natural consequence of EN administration. Discuss whether this is a true statement.

As P.R/s nurse, you are concerned about meeting her needs for fluids, oral hygiene, skin integrity and activity. 6. Discuss 5 indicators that would help you assess fluid status.

7.You assess P.R.s skin every 4 hours. Identify three treatment goals in relation to skin/positioning.

8. What 4 strategies will facilitate the expected outcome of maintaining skin integrity?

LEVEL 4 SECTION B

Please get the cases from Miss Hannah. B1 (Dales) answer Case 1 B2 (Ouano) answer Case 1 and 2 B3 (General)- answer Case 1 and 2. Go to the library and answer the posted questions after each scenario. Submit your output tom, November 29, 2011 before 5pm. Thank you.

Ms. Ouano