Reference no: EM133598209
Situation - Foster Brooks is a 50-year-old who has been admitted to your unit for observation from the emergency department (ED). Mr. Brooks was sent to the ED by local police, who found him lying unresponsive along a rural road.
Background - Mr. Brooks was found by the local police lying unresponsive along a rural road. He is well known to him as he has a long history of alcoholism and has been brought to the ED in the past for the same reason. He stops drinking for a while, then something will upset him, and he starts all over again. He is also a smoker.
Assessment - Examination and x-ray studies are negative for any injury, and you are awaiting the results of the blood alcohol level and toxicology tests. He is not awake or coherent enough to give any history or to answer questions. He is very lethargic and responds only to a deep sternal rub, has a cachectic appearance, does not follow commands, and is combative when you are able to arouse him enough to get him to respond. He smells strongly of alcohol (ETOH) and has a distended abdomen and edematous lower extremities. His chest is barrel shaped, clear in the upper lobes, but diminished in the bases. His breathing is shallow. Heart tones are normal S1 & S2. His skin is yellowish but warm to touch. When you look at his fingers you note that he has clubbing of his fingers and well as dark brown stains on the pads of his fingers. His bowel sounds are normoactive and there appears to be no tenderness with palpation. His vital signs are HR - 100, BP - 160/80 (107), RR-10, T- 95.8? (35.4?), O2 saturation- 98% on 2L nasal cannula.
Some of the lab work drawn in the ED has come back. The blood alcohol level (BAL) is 320 mg/dL, and the blood ammonia (NH3) level is 160 mcg/dL. His total protein is 5.4 g/dL and albumin level is 2.0 g/dL.
Points to assess: Is this Acute or Chronic? Is the patient Unstable or Stable? Is this Urgent or Nonurgent?
Recommendation(s) -
What do you think are the primary alterations in health with this patient (diagnosis)?
What is the pathophysiology related to the patient's problems?
What are the risk factors for this patient, and do they contribute to the current primary problem?
What assessment(s) (expected finding) should be your focus? (Hint: Identify the relevant information first to determine what is most important.)??What signs and symptoms are commonly seen with this diagnosis?
What data should you analyze (laboratory and diagnostic procedures) and report to the health care provider? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.)??What lab values may be abnormal?
What would your plan (nursing care) and recommendation(s) be to the health care provider? (Hint: Consider all possibilities and determine their urgency and risk for this client.)
What intervention(s) (therapeutic procedures and/or medications) would be your priority with this patient? (Hint: Determine the desired outcome first to decide which interventions are appropriate and those that should be avoided.) Which intervention would be best for this patient?
What data/clinical information would you evaluate to support the plan to improve the patient's outcome? (Hint: Think about signs that would indicate an improvement, decline, or unchanged client condition.) What changes to the patient's condition would I expect to see happen or have happened?
What interprofessional care would be involved in the care of the patient? (Other disciplines - RT, ECG, social worker, etc.)
What patient education would be important for this patient?
Are there any specific safety considerations that should be included in your care?
What is a normal ammonia level, blood alcohol level, protein, and albumin level?
Why would Mr. Brooks ammonia level be elevated?
What are the expected findings as well as physical assessment findings?
What diagnostic procedures may be done?
What therapeutic procedures may be done for someone with cirrhosis?
What are the possible complications of cirrhosis treatment?
What is the worst possible/most likely complication(s) to anticipate based on the primary problem (to prevent death)?
What nursing assessments/interventions will identify/initiate EARLY to prevent this from developing?