Patient with Hematologic Disorders and Oncologic Emergencies
Brief Patient History
Mr. L is an otherwise healthy, 23-year-old African American man who presents with a week-long history of diarrhea, nausea, and vomiting after attending a barbecue last weekend.
Clinical Assessment
Mr. L is admitted to the critical care unit from the emergency department with hypotension, fever, and leukocytosis.
Diagnostic Procedures
His vital signs are as follows: blood pressure of 65/42 mm Hg, heart rate of 145 beats/min (sinus tachycardia), respiratory rate of 35 breaths/min, and temperature of 102.4° F. His white blood cell count is 25,000/mm3 with 15% bands, lactate level is 7 mmol/L, prothrombin time is 25 seconds, and platelet count is 22,000/mm3. Blood cultures reveal gram-negative bacilli.
Medical Diagnosis
Mr. L is diagnosed with severe sepsis and disseminated intravascular coagulation.
Questions
1.Expected outcome
Patient will exhibit vital signs within normal range
Patient will maintain optimal fluid balance
Patient will be free from infection
2. Patient's problems or risks
Elevated temperature
HR over 90, RR over 20
Hypotension
Decreasing platelet count
Increase in WBC( leukocytosis)
High lactic acid
3. Interventions for the problems identified
Monitor and document vital signs
Prompt lab draws
Appropriate administration of IV fluids as ordered by physician.
Optimize fluid volume status
Assess , monitor cardiac output
Assess, monitor and support oxygen status
Prevent infection, maintain aseptic techniques
Provide cooling blanket, decrease room temperature or provide cold sponge bath to decrease the temperature
4. Interventions for optimal functioning and wellbeing of the patient.
Assess and nutritional status of the patient.
Prevent the complications of sepsis such as Acute Respiratory Distress Syndrome, thrombosis , brain damage.
Provide side rail for the patient bed to prevent falling
Communicate with and educate patient and loved one to prevent unnecessarily worrying about patient's condition.
5. Learning needs of patient
Importance of hand washing and basic hygiene
Early seeking of health care in case of illness
Sepsis , its causes and risk factors
Food poisoning symptoms
Cultural and age related factors
The nurse should aware about her own culture and her patients culture and age group. As he is an African American, it is important to establish a trust. Understand his religious faith. As he is a young person he can accept changes due to hospitalization and treatment. Health education also Will be effective.
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