James Smith Case Study - Nursing Assignment Help

Assignment Task:

James Smith, 67 year old Background Mr. James Smith was a 67 year old man who had been living in an aged care residential service for the past two years. 

Medical history 

- poorly controlled type 2 diabetes mellitus

- right above knee amputation secondary to necrotizing fasciitis (two years ago) 

leaving him wheelchair bound, - renal calculus and - chronic obstructive pulmonary disease (ex-heavy smoker), - chronic pain, - previous excessive alcohol intake and - vancomycin resistant enterococcus (VRE) positive. - no documented history of dementia (confirmed by family there had been no dementia) 

Presentation to regional private hospital emergency department On presentation, Mr. James Smith was noted to be nauseous and dizzy with poor oral intake and hypoglycaemia (BSL 2.9mmol at 12:45pm). At the nursing home at 7:30pm, his observations were recorded as blood pressure 105/75; pulse rate 93 and temperature 36.8. The nursing home staff were concerned as he appeared unwell, was vomiting and not having any oral intake. The ambulance was called and he was transported to a regional private hospital emergency medical centre. On arrival there at 8:15pm, Mr. James Smith was triaged as Category 4 (meaning he was to be medically reviewed within one hour). The triage nurse documented a two day history of lethargy, vomiting (several times) and diarrhoea (x1). Mr. James Smith reported the room was spinning when he sat up, and his eyes were hurting. His observations taken at 8:20pm were documented as respiratory rate 20; oxygen saturation 99% on room air; blood pressure 105/55; heart rate 95; temperature 35.8 and patient alert. His BSL was 3.6mmol at 8:30pm. 

Bloods were taken at 9:00pm in anticipation of testing (they were sent with the pathology courier at 10:00pm prior to Mr James Smith being medically reviewed). An hour later his observations were documented as respiratory rate 19; oxygen saturation 97% on room air; blood pressure 100’s/60’s; heart rate high 80’s; temperature 36 and patient alert. His BSL was 5.3mmoL. He was reviewed by a locum emergency medical officer, Dr Way at 10:34pm. On examination he was noted to look very dry, afebrile (temperature 36.8), mildly hypotensive (blood pressure 102/70), had a sinus tachycardia (90-116 beats per minute) and mild hypoglycaemia (BSL 3.6). He was described as ‘talking nonsense’ but cooperative. Heart and lung examinations were normal. His abdomen was soft and non-tender and he had passed a soft bowel motion. Dr Way diagnosed acute renal failure caused by infection. She considered he needed rehydration and admission. Dr Way ordered blood tests, urine microscopy and intravenous fluids and contacted the nursing home at 10:50pm seeking further collateral history. 

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