Reference no: EM133544375

Question

Mr. Lee is a 55-year-old man with a history of head trauma three months ago after falling from a ladder. He is seen in the emergency department today after experiencing a seizure at work. Mr. Lee received a loading dose of phenytoin in the emergency department and is admitted for a thorough work-up.

Upon arrival to the nursing unit, Mr. Lee is alert and oriented but lethargic. The following day, Mr. Lee has received two doses of phenytoin, and he has not had a seizure since admission. His lethargy has resolved. Midafternoon, Mr. Lee calls for the nurse. He shows the nurse his arms and hands and asks, "Look at these red splotches and blisters. What do you think this is from?" The nurse asks Mr. Lee if he has any other symptoms. He replies, "My eyes are itchy and burning and my throat is a little sore. Maybe I am allergic to the laundry detergent the hospital uses to wash the bed sheets." Assessment reveals symmetric reddish-purple macules and bullae on his arms, hands, chest, and back. Mr. Lee's vital signs are within normal limits except his temperature, which is 102.1°F (38.9°C).

1. Should the nurse be concerned that upon arrival to the nursing unit Mr. Lee is lethargic?

2. What is the rationale for prescribing phenytoin for Mr. Lee?

3. Mr. Lee's plan of care includes seizure precautions. Explain how the nurse implements these precautions.

4. What do you believe is the cause of Mr. Lee's skin condition?

5. Discuss three critical interventions upon diagnosing Mr. Lee's reaction.

6. Mr. Lee is transferred to the burn unit. Explain the rationale for this transfer.

7. Identify four treatment goals the nurse will include while documenting Mr. Lee's plan of care.

8. Mr. Lee's wife notices that the nurse checked the thermostat in Mr. Lee's room even though Mr. Lee did not express discomfort with the room temperature. Why was the nurse checking the temperature in the room?

9. Mr. Lee's laboratory results are hemoglobin (Hgb) 18 g/dL, hematocrit (Hct) 57%, potassium (K+) 6.5 mEq/L; his sodium (Na2+) level is 126 mEq/L; and his bicarbonate (HCO3-) is 15 mEq/L. Are these results within normal limits? If not, explain what is causing any abnormal result.

10. The nurse dons a protective gown, mask, gloves, and cap prior to changing Mr. Lee's dressings. Why is this precaution necessary?

11. Is Stevens Johnson Syndrome self-limiting or life threatening? Explain your answer.

12. Briefly discuss three potential complications the nurse will watch for as Stevens Johnson Syndrome progresses.

13. Mr. Lee's coworker comes to visit and brings a beautiful vase full of flowers from her garden. The nurse asks that the visitor not bring the floral arrangement into Mr. Lee's room. What is the rationale for the nurse's request?

14. Clients with Stevens Johnson Syndrome sometimes suffer long-term effects. Briefly discuss three long-term complications that may result.

15. Identify five nursing diagnoses appropriate for Mr. Lee's plan of care while being cared for on the burn unit. Prioritize the diagnoses you have identified.

16. While providing discharge teaching, what should the nurse tell Mr. Lee (and his family) about preventing a recurrence of this adverse medication reaction in the future?

17. What resource can the nurse suggest to help provide support once Mr. Lee is discharged from the hospital?