Reference no: EM133220254
Joseph Deikel is a 78-year-old male admitted to a medical-surgical floor in an acute care facility. Three days before, he had visited his internist for nausea, vomiting, and a low-grade fever. At that time, he was provided with a prescription for promethazine (Phenergan) suppositories and returned home.
Mr. Deikel has a strong aversion to any medications taken rectally and did not use the suppositories. The vomiting continued for another 48 hours and was followed by dry heaves. He barely was able to get out of bed at this point and had to hold onto furniture for support. His son found him lying on the bathroom floor, and he was transported to the local emergency department (ED).
Abnormal findings in the ED include Mr. Deikel's
BP of 88/50, heart rate 114, temperature 100.1°F, oriented to person only,
serum Na+ 128, blood urea nitrogen (BUN) 44, and creatinine 2.1.
Intravenous fluids (IVF) of sodium chloride 0.9% were initiated at 140 mL/hr along with orders for multiple cultures.
On the medical-surgical unit, Mr. Deikel felt the need to urinate and attempted to get out of bed to go to the bathroom, and fell. His son left, and he was put into a posey vest restraint. When given a dose of intravenous (IV) antibiotics shortly thereafter, he yelled out in pain as his entire arm with the IVFs had a tremendous burning sensation, so as a means of "self-preservation" he pulled the angiocath and tubing out. He now found himself with both wrists restrained.
Instructions:
After reviewing the patients case answer the following questions. Support your answers with evidence based practice, use at least two nursing references.
- List the top 3 nursing diagnosis for the patient. (Use the technique/style, Nrs.Dx, R/T, A.E.B)
- What medical diagnosis would you expect the patient to have?
- Explain the meaning of the patient's lab values and vital signs.
- When are full bedrails (aka, siderails) considered a form of physical restraint?
- What can be a negative outcome of having full bedrails up, surrounding a patient?
- What psychological effects do you believe physical restraints can have on a patient?
- Find a nursing article on physical restraint's and their impact on patient's.