Question

Case Study #5

Mrs. Lemone is a 69-year-old woman who has been brought to the emergency department by ambulance with a change in mental status. She is noted to have a temperature of 104° F and is yelling loudly while aggressively thrashing her arms. Her daughter reports that at her baseline, Mrs. Lemone is oriented to person, place, and time, and that she is well enough to perform all ADLs without assistance. Her medical history includes mild hypertension controlled by 20 mg of hydrochlorothiazide taken once daily. Her daughter expresses concern about the cost of treatment because her mother does not have much money.

Questions (10 points total)

1. Based upon an immediate nursing assessment of Mrs. Lemone, which plan of care for her condition would the nurse anticipate? (2 points)

2. List two actual NANDA nursing diagnoses for this patient. Include etiology (“related to”) and as evidence by. (2 points)

3. What diagnostic tests will the nurse anticipate to be ordered and why? (2 points)

Case Study continued:

Mrs. Lemone is diagnosed with a severe urinary tract infection. The nurse administers IV fluids, antibiotics, and antipyretics as ordered.

4. What are the outcomes of these interventions should the nurse expect? (2 points)

5. When preparing for discharge, what patient teachings should be discussed and why? (2 points)

Answer 1

1.a) Identify factors present including seizure history, recent ECT therapy, episodes of fever or pain, presence of accute infection (especially urinary tract infection in elderly patient), exposure to toxic substance, traumatic events; changes in the envionment, including unfamiliar noises, excessive visitors ------>baseline information assists in developing a specific plan.

b) Closely monitor lab results. Monitor laboratory values , nothing hypoxemia, electrolyyte imbalances , BUN or Cr, ammonia levels, serum glucose, signs of infection, and drug levels(including peak or trough as appropriate).------>Once changes in her mental status recognized , it is necessary to identify and treat the associated underlying causes.

2. a) Changes in mental status related to thermoregulation as evidenced by patient temperature is 104 degree fahrenheit.

b) Hyperthermia related to infections as evidenced by her labs.

3. a) Given appropriate clinical settings, rapid antigen testing for influenza should be obtained early in the course of patient with fever and altered mental status because it is easy to collect, can aid in the diagnosis and can rule out multiple causes right away.

b) Blood and urine analysis for assess any infection.

4. a) Client will maitain core temperature within normal range.

b) Client will be free of urinary tract infections.

5. a) Insruct the patient to take increased oral fluids ( 2 to 3 liters a day if no complications).------> Fluid intake facilitate urine production and flushes bacteria from the urinary tract.

b) Educate the client to void often every 2 to 3 hours a day and completely empty the bladder.------->This will prevent bladder distention, facilitate flushing of bacteria and avoid reinfection.