Reference no: EM133365854

Assignment:

Overview

This is a story about Lilian, a client for whom you will be providing nursing care for during her stay at a Level 1 hospital in which you are employed.

Lilian is a 72-year-old retired Japanese woman who lives with her husband of 62 years. She arrives to the emergency department with worsening lower extremity pain that started 4 days ago. She appears to be in excruciating pain and unable to report a pain score. Her daughter Lisa who brought her to the emergency room reports that she has tried to manage her pain with acupuncture, various herbal products, and a few over the counter medications like ibuprofen and Tylenol. Today the pain became more severe, and her mental status seemed to drastically change which is why she brought her to the emergency room.

Lilian's vital signs were grossly abnormal and her physical exam findings were notable for rapid decompensation of the neurological system. Based on these findings, orders were placed for Lilian to be admitted to the medical intensive care unit. Unfortunately, the hospital is currently not allowing visitors due to the COVID pandemic therefore Lilian's daughter is not permitted to go with her mother as she is admitted to the hospital. Lisa becomes extremely upset and begs you to allow her to go with her mother.

Lilian was admitted for severe pain and neurological decompensation.

Lilian was admitted to the neurological step-down unit as opposed to the medical intensive care unit due to room availability. You are the nurse providing care for Lilian, but also have three other clients that you are caring for. You quickly realize that you are overwhelmed with the level of acuity in caring for Lilian, particularly because she has now become increasingly agitated, thrashing around, and trying to get out of her bed. Lilian is unattended and at risk of harming herself secondary to her altered mental status.

At 9 o'clock you have a total of 38 medications that need to be administered between your four clients within a 60-minute window. Unfortunately, it's currently 9:30 and you have only completed your physical exam on Lilian and one other client. The charge nurse steps in to help and calls the provider to ask for something to help calm Lilian. The charge nurse writes down what the provider plans to order once she has access to the electronic health record. This includes placement of restraints and intravenous midazolam as needed for agitation. You draw up the medication to realize that the peripheral IV came out while Lilian was thrashing around. While placing a bandage on the IV site, you notice blood on the sheets near her head. While inspecting her head you find a small laceration which appears to be from an uncapped needle that may have been left in her bed from the emergency room.

Tasks:

1. Define characteristics related to Lilian's altered mental status
2. What are the antecedents that lead to altered mental status in Lilian's case?
3. What are negative consequences of her impaired mental status?
4. Related concepts (list concepts and identity which can be affected by Lilian's altered mental health?)
5. Give some exemplars