Reference no: EM133323605

Case Scenario

Overview and Introduction:

Mr ML is a 64-year-old Caucasian man who was admitted to the hospital and sent to your unit because of loss of taste, fever and non-productive cough that began 2 days ago as body malaise. Two hours ago he felt like "gasping for air". His daughter called 911, medic found him with O2 Sat of 82% and definitely in respiratory distress. He was eventually transported to the nearest hospital. Along the way, he had no improvement on 100% O2 by mask. He lost consciousness and was intubated.

His only medical problem is arthritis of both knees diagnosed 3 years ago. His been on prescribed Meloxicam and has been taking it for 2 years now. He does not smoke cigarette. He drinks 2 cans of beer per day until a month ago when his primary physician advised him to stop. He used to be a back country hiker until his arthritis worsened.

Father died of what looks like stroke. His mother has history of HNT and DM. His 73 years old eldest brother had stroke 4 years ago.

He was diagnosed with respiratory failure secondary to Covid-19 ARDS, he was initially admitted in the ICU. He was treated with In the ICU he got treatment of Remdesivir, dexamethasone and enoxaparin. He developed complications of MRSA VAP on the 6th day in the ICU treated with IV antibiotics. ARDS worsened and ECMO was considered but eventually scrapped. RMCA thromboembolic stroke diagnosed by CT angiogram on his 10th hospital day. Embolectomy through the right carotid artery was done and the clot was successfully removed. Subsequent follow up CT of the brain showed adequate brain perfusion through the RMCA. He developed severe sepsis and AKI while recovering from stroke. HD catheter was placed in the RIJ and dialysis was done daily. Finally on day 33 of hospitalization he was ready for weaning from mechanical ventilation. He was extubated but was unable to sustain spontaneous ventilation. Tracheostomy was placed and was mechanically ventilated again. PEG tube was place. a new PICC line was place on him in the right upper arm. On the 40th HD he was weaned from mechanical ventilation. Tracheostomy was maintained but he is now using Passy Muir Valve. He is now able to make conversation because of PMV. He is now on mechanically soft full diet on thin liquids. He was sent to the Medical Telemetry unit prior to discharge to an LTAC the next day.

For the last 24 hours, he has been afebrile, labs were normal except for K = 4.6.

Questions/Activities: Please explain throughly

Question 1. What is ARDS? Explain the pathophysiology.

Question 2. What is a thromboembolic stroke? In this patient, the RMCA was obstructed, what would be the expected neurologic deficit if transcutaneous embolectomy was not successful and explain why?

Question 3. The physician ordered you to change the indwelling Foley catheter, describe in proper order the sequence of action you need to do to implement safe insertion and prevent CAUTI. Also describe what is CAUTI and explain why it is part of the National Patient Safety goal.

Case:

The patient developed another stroke, and he failed the swallow evaluation done by the speech therapist. You are to use the PEG tube for giving several tablet medications.

Question 4. Describe the sequence of action for giving properly the medications thru the PEG tube.

Question 5. If a patient is on Dobhoff tube feeding instead of PEG, you found out that the feeding pump has been beeping for a while. The feeding tube is clogged. Describe the techniques of declogging the Dobhoff feeding tube. You are unable to declog and planned of removing and replacing. Describe the correct series of actions to safely place the new Dobhoff until it is deemed usable.

Question 6. In an SBAR format, make a call to the receiving facility for a nurse to nurse handoff report.

Question 7. Part of the nurses job is to maintain the line and prevent CLABSI. What is CLABSI? Describe the sequence of action you need to take to maintain the patency of the PICC line and prevent CLABSI.