Case study 2
PLEASE READ THE CASE STUDY CAREFULLY AND COMPLETE THE QUESTIONS ON THE FOLLOWING PAGES
Mrs Lucy is an 86-year-old woman who presents to the Emergency Department at 0300 hours following a trip and fall at home as she was ambulating to the toilet. She has a history of hypertension, atrial fibrillation and is taking regular warfarin. Her BP is 102/50mmHg, HR: 110 beats/min and RR: 22 breaths/minute, Temperature 38.8. She is complaining of pain in her left wrist and left ankle. There is obvious swelling to her left ankle, and she is unable to weight bear. Mrs Lucy is the carer for her husband who is aged 89 and has dementia. On arrival her GCS was 15/15, however, it is now 0500 and her GCS has decreased to 14/15 as she appears to be disorientated to her location and is attempting to climb out of bed. She has an IV cannula in her right cubi-fossa and bloods have been sent.
What signs and symptoms did Mrs Lucy present with that could contribute to her fall during the night? Link this to your A-E assessment findings and discuss 3 nursing interventions and how you would manage Mrs Lucy's care.
(250 words) Ensure you link your information to the case study.
Mrs Lucy is for admission as she has sustained a left ulna fracture and has a soft tissue injury to her ankle. She is waiting for a ward bed to become available. Mrs Lucy is complaining of feeling hot and uncomfortable - blood results are not yet available, however, based on her clinical signs and symptoms, it appears that this has progressed to a systemic level and indicates sepsis.
Discuss the pathophysiology of sepsis and the potential signs and symptoms that Mrs Lucy has or could develop. Your answer should demonstrate how the normal physiology is altered, how her vital signs may be altered and why. In addition, provide a discussion of immediate management for Mrs Lucy in the Emergency Department.
Mrs Lucy has deteriorated, her BP is currently 90/50, her HR: 115. The medical team have reviewed her and would like to commence an infusion of Metaraminol. She will be transferred to a High Dependency Unit when a bed becomes available.
Please explain how this medication (pharmacologically) works and how her condition may change with this medication. You should discuss complications or adverse effects. In addition, why has Mrs Lucy's anti-hypertensive medication been withheld? Your answer should include nursing considerations and what assessments and interventions you would do as a Registered Nurse caring for this patient.
Mrs Lucy is concerned about her husband being left alone at home as he has dementia, and she is his primary carer. What is your responsibility as a Registered Nurse and how will you manage this problem? Please ensure you make reference to the Registered Nurse Code of Conduct and Standards of Practice. Discuss what ethical legal issues this may raise for the Registered Nurse.