Brief Patient History
Mr. P is a 24-year-old man who was water-skiing when he was hit by a boat. He was rescued from the water by friends. He was immobilized and transported to the hospital by paramedics called to the scene.
Clinical Assessment
Mr. P is admitted to the emergency department with abrasions and bruising to his head and shoulders. He is having difficulty breathing and is unable to move his extremities. He is complaining of neck pain and has a cervical collar in place. He is incontinent of urine and feces. There is no response to motor, sensory, or deep tendon reflexes from the neck to the feet. He is awake and is able to talk.
Procedures
Admission magnetic resonance imaging shows an incomplete spinal cord transection. Baseline vital signs are as follows: blood pressure (BP), 85/60; heart rate (HR), 48 (sinus bradycardia); respiratory rate (RR), 8; temperature (T), 99.3°F; O2 saturation, 88%. Glasgow Coma Scale is 10.
Medical Diagnosis: Incomplete spinal cord transaction and neurogenic shock are diagnosed.
Questions
Major outcomes for Mr. P include prevention of secondary injury, maintenance of tissue perfusion, and communication.
1. What problems or risks must be managed to achieve these outcomes?
2. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
3. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
4. What possible learning needs would you anticipate for this patient?
5. What cultural and age-related factors might have a bearing on the patient’s plan of care?
1)The risks or problems that should be managed to prevent secondary injury, tissue perfusion and communicaton are hypotension, sinus bradycardia, ventilaton and to monitor closely for autonomic dysreflexia which means sudden increase in blood pressure, concomitant injuries to be identified and treated.
2) surgery within 24 hours can reduce the complications associated with spinal cord injury, fluid resuscitation to improve blood pressure and use of ionotropic agents like dopamine, norepinephrine if blood pressure is not stabilized even after fluid resuscitation, other diagnostics like MRI brain and CT chest to be done to rule out subdural hematomas in brain and pneumothorax respectively.
Brief Patient History Mr. P is a 24-year-old man who was water-skiing when he was hit...
Brief Patient History Mr. Z is a 38-year old Hispanic construction worker who sustained a liver laceration after falling from a roof. He acquired an exploratory laparotomy for splenectomy and repair of the liver laceration 4 days earlier. His medical history reveals no chronic health problems, although he smokes 20 packs of cigarettes per year. Clinical Assessment Mr. Z is admitted to the medical intensive care unit from the telemetry unit with acute respiratory insufficiency and hypotension. He is using...
Brief Patient History Mr. V is a 42-year-old man with chronic viral hepatitis C. He has a Model for End-Stage Liver Disease (MELD) score greater than 25. Mr. V is in acute fulminant liver failure and is on the waiting list to receive a liver transplant. Mr. V was hospitalized 2 weeks ago with ascites, hepatorenal syndrome, and hepatic encephalopathy. He has been treated with diuretics, antibiotics, and laxatives. Before transplantation, he remained in the intermediate care unit and was...
Mr. B is a 63-year-old man who is clinically obese. He has a long history of chronic obstructive pulmonary disease (COPD) associated with smoking two packs of cigarettes a day for 40 days. During the past week, Mr. B has experienced a flu-like illness with fever, chills, malaise, anorexia, diarrhea, nausea, vomiting, and productive cough with thick, brownish, purulent sputum. Clinical Assessment Mr. B is admitted to the intermediate care unit from the emergency department with acute respiratory insufficiency. He...
Mr. B is a 63-year-old man who is clinically obese. He has a long history of chronic obstructive pulmonary disease (COPD) associated with smoking two packs of cigarettes a day for 40 days. During the past week, Mr. B has experienced a flu-like illness with fever, chills, malaise, anorexia, diarrhea, nausea, vomiting, and productive cough with thick, brownish, purulent sputum. Clinical Assessment Mr. B is admitted to the intermediate care unit from the emergency department with acute respiratory insufficiency. He...
Brief Patient History Mr. K is a 58-year-old white man admitted to the cardiac unit from the medical unit after cardiac arrest (VF). He was successfully defibrillated after one shock (biphasic at 200 joules). He has a history of hypertension, myocardial infarction, mitral valve regurgitation, atrial fibrillation, and hyperlipidemia. Mr. K was scheduled for mitral valve replacement and the maze procedure. Mr. K is a school administrator, is married, and has two daughters who live out of state. Clinical Assessment...
Mr. G is a 21-year-old man. He was a pedestrian crossing the street in a marked crosswalk when he was hit by a pickup truck traveling at approximately 40 miles/h (64 km/h). He was ejected onto the side of the road. There is visible external damage to the front passenger panel of the truck. On arrival, emergency medical services personnel determined the patient was awake, not following commands, restless, and agitated. His respiratory rate was 22 breaths/min, and breathing was...
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...
Brief Patient History Ms. J is a 40-year-old victim of a car crash. She was found conscious at the scene and pulled out of a burning car to safety by a passerby. The paramedics at the scene reported her as awake but disoriented and anxious. She is otherwise healthy and is the mother of a 5-year-old child, who was also rescued at the scene with no injuries. Clinical Assessment Ms. J is sent from the emergency department to the trauma...
Brief Patient History Mrs. G is a 54-year-old African American woman who has been having intermittent indigestion for the past month. She has a history of hypertension and hyperlipidemia. She was admitted as an inpatient on a medical floor for management of her blood pressure and is scheduled to undergo endoscopy tomorrow. Mrs. G suddenly becomes diaphoretic and complains of nausea and epigastric pain. Clinical Assessment The rapid response team is called to evaluate Mrs. G. When the team arrives...
Mr. Z is a 38-year old Hispanic construction worker who sustained a liver laceration after falling from a roof. He acquired an exploratory laparotomy for splenectomy and repair of the liver laceration 4 days earlier. His medical history reveals no chronic health problems, although he smokes 20 packs of cigarettes per year. Clinical Assessment Mr. Z is admitted to the medical intensive care unit from the telemetry unit with acute respiratory insufficiency and hypotension. He is using his accessory muscles...
> Where's the rest of the answers?
xboxgorgo18 Tue, Feb 1, 2022 6:17 PM