Question

R.D is a 51-year-old male who comes to the emergency department with complaints of weakness and abdominal pain. He reports he is homeless. His medical history includes Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteria of the nares.

Subjective Data

• Reports he does not drink or eat food consistently
• Says he has no family or any social support
• Had “a drink or two a little while ago”

Objective Data

Physical Examination

• Blood pressure 144/86, pulse 92, temperature 98.2°F, respirations 24
• Height 6’1”, weight 170 lbs
• Heart rhythm irregular
• Oxygen saturation 89% on room air
• Alert oriented to person and place
• Capillary refill sluggish in lower extremities, normal in upper extremities
• 2+ edema in lower extremities

Discussion Questions

1. What health history information would you obtain from R.D.?

Answer:

R.D health history information are: Complaints of weakness and abdominal pain.

              Has Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteria of the nares. Has 2+edema in lower extremities.   Low oxygen Saturation level (89% on room air)

2. Describe what R.D.’s physical assessment should include.

Answer:

3. Based on the clinical manifestations that brought R.D. to the emergency department, what diagnostic tests you would expect to be ordered and what each would contribute?

Answer:

4. What factors in R.D.’s history place him at risk for anemia?

Answer:

5. What are the priority nursing diagnoses for R.D.?

Answer:

6. What resources might be available to this R.D. after he is discharged from the hospital?

Answer:

Answer 1

■The physical assessment should include

• His urine output to rule out if it is associated with renal issues
• Assess for cyanosis,dyspnoea due to decreased oxygen saturation
• Assess the BMI to measure nutritional status

■The major history of not eating food or starvation has placed him at risk of being anaemic.

■Impaired gas exchange related to decreased oxygen saturation as evidenced by low oxygen saturation

Acute pain in abdomen related to decreased food and fluid intake as evidenced by verbalization

Ineffective tissue perfusion related to altered heart beats, increased blood pressure as evidenced by sluggish capillary refill

■Some of the resources which can be available for RD after discharge are

• Federal funding for homelessness program
• Emergency shelter
• Drop in shelter