NURS90053: Clients with Complex Health States - Medical Science Assignment Help

Assignemnt Task

EXAMINATION

Evie Williams is a 59-year-old female who is admitted to University Hospital (UH) emergency department (ED) via a medical helicopter retrieval service following a skiing accident. Evie was found by another skier just off the skiing track lying next to a tree. She was reported to be conscious, talking, able to move all limbs but dazed. Evie thought she had been lying in the snow for approximately 20 minutes. First Aid responders arrived approximately 15 minutes later where she was taken to the First Aid post for observation where she complained that she had a migraine, was tired and generally did not feel well. On standing, Evie collapsed with loss of consciousness for approximately a minute. Evie woke with a GCS of 11 (E3M3V5) and the air ambulance was called for transfer by medical staff and 65 minutes later, Evie arrived at the metropolitan ED.

Medical history:

Recent upper respiratory tract infection and laryngitis – treated with oral roxithromycin and oral prednisolone; Hashimoto’s thyroiditis; systemic lupus erythematosus (SLE) – diagnosed age 18; ulcerative colitis diagnosed age 20; hyperlipidaemia; gastroesophageal reflux disease (GORD); thrombocytopenia.

Current medications include prednisolone 2mg daily, levothyroxine 100mcg daily, sulfasalazine 2000mg daily, atorvastatin 20mg daily, esomeprazole 20mg daily.

Evie’s primary survey upon immediate arrival to the Emergency Department (ED) of University Hospital (UH) demonstrated the following:

A: Airway clear and patent.

B: Respiratory rate (RR) 20 per minute, shallow. Course crackles auscultated left and right upper lobe, breath sounds clear bilateral bases. SpO2 (finger probe) undetectable, 5L oxygen (FiO2 0.4) via Hudson mask

C: Heart rate (HR) 78 beats per minute, pulse thread. Blood pressure 123/80 mmHg. Skin is pale, cold peripheries with peripheral cyanosis. Capillary refill (CR) 4 seconds, poor skin turgor. 1L warmed Hartmann’s solution IVT currently running at 100mL/hr via 1 x IV cannula inserted right cephalic vein on the hand. S1, S2 heart sounds. FAST scan negative.

D: Glasgow coma score (GCS) 13 (E3 V4 M6). Disorientated to time and place. PEARL size 3+. Blood glucose level 5.3mmol/L.

E: Temperature 34.9 degrees Celsius. Dressed in ski clothing. Shivering. Bair hugger insitu. Arterial blood gas (ABG) pH 7.27, PaO2 83mmHg, SaO2 96%, PaCO2 31mmHg, HCO3 20, Base excess -2.2mmol/L, Lactate 2.1; Na+ 136mmol/L, K+ 4.3mmol/L, Ca+ 1.16, Cl- 100mmol/L. Creatinine 104 µmol/L.

Question 1. (approx. 250 words)

The above data outlines what is involved in the primary assessment of Evie. From this information, rationalise two actual/priority problems and one potential problem. Underpin your responses with possible underlying pathophysiological causes to justify your decision making. Link to other signs and symptoms as applicable.

Question 2: (approx. 175 words)

 Evie has a past medical history of thrombocytopenia. Discuss the association and implications of this condition regarding both relevant past medical history and applicable primary survey data.

Question 3: (approx. 250 words)

A head/neck/spine/abdomen/pelvis computed tomography (CT) scan was performed on Evie with the findings of a moderate traumatic epidural haemorrhage. She is admitted to the neurosurgical high dependency unit from theatre post operative craniotomy with an extra ventricular drain (EVD) in situ and intracerebral pressure (ICP) monitoring. On assessment, her pupils are 4mm+, GCS 13 (E3M4V6), BP 162/50mmHg, HR 62 regular, RR 12, SpO2 95% High Flow Nasal prongs (HFNP) oxygen flow 7L/Flow setting 25L/min administering FiO2 0.48, Temp 36.2 degrees Celsius, intracerebral pressure (ICP) 18mmHg . Evie is drowsy from the anaesthetic and disorientated however is able to verbalise responses to your pain assessment, noting mild headache 3/10 pain score.

Considering the anatomical location and current HDU management of the intracerebral bleed, discuss and rationalise the potential signs or symptoms of neurological, respiratory, and haemodynamic deterioration in Evie that would trigger escalation or intervention. Underpin your response with pathophysiological causes to justify your decision making

Question 4: (approx. 175 words)

Two days later in the HDU, Evie complains that she is feeling nauseous, lightheaded and has her normal sharp oesophageal reflux like discomfort in the epigastric area. Vital signs are BP 101/60mmHg, T36.3, RR 18, SpO2 93% on 3L nasal prongs (NP), HR 65 regular, GCS 14 (E4M5V6). You perform an ECG and a venepuncture for the following blood tests. The results are below:

Considering relevant data from Evie’s physical assessment above, blood test results and ECG analysis, analyse these findings in your response with pathophysiological detail. From your findings and incorporating evidence-based guidelines, rationalise two immediate nursing management strategies that you would implement in collaboration with your preceptor RN.

Question 5: (approx. 175 words)

During her admission, Evie has developed an exacerbation of her ulcerative colitis and has subsequently been commenced on Total Parenteral Nutrition (TPN) via right internal jugular (IJ) triple lumen central venous device for nutritional deficit. During your shift you note the TPN has run out and the replacement bag has not arrived from pharmacy yet. In addition, Evie suddenly develops shortness of breath and hypotension while the infusion pump alarms ‘air in line’.

Identify and rationalise two immediate actions/interventions that you would undertake (before escalating to your preceptor) in this scenario, while linking causative factors underpinning these signs and symptoms.

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