Why did this client become confused and combative

Reference no: EM133612920

Assignment

Course Competency

Select appropriate nursing interventions for clients with disorders of the urinary system.

Instructions

You are an LPN working on a medical-surgical floor in a team that consists of an RN and a medical assistant. Read through some of the chart entries over a 48-hour period and answer the questions at the end. Please make sure you cite any sources using APA format. You will find when there is a major clue.

0130: Admission nurses note (RN): Client arrived via EMS from long-term-care for evaluation of "low blood sugar." Pt. arrived confused (alert and oriented X 1) and is a known diabetic. Finger stick was 45. Orange juice and crackers, given repeat finger stick 104. Pt now alert and oriented X 4. Report from the charge nurse at the long-term-care facility indicates that the client has been having frequent bouts of hypoglycemia.

0530: (RN) Foley catheter inserted for incontinence--pt. "too weak" to get up to the bathroom and is experiencing bouts of incontinence.

600 mL clear yellow urine noted. The nurse indicates that the ER is "very busy" and "short-staffed." 0545 (Admitting Physician) See history and physical. Pt. admitted to the medical-surgical service for evaluation of recurrent hypoglycemia.

View the ER chart before the pt. is transferred to the floor:

0730: (RN) Report is given to RN on 3 North.

Emergency Department Chart

Client: Mabel Simpson
DOB: 4/23/1941
Admission Date 8/16/2019
Medical Diagnosis: recurrent hypoglycemia
Allergies: None

Vitals/ Data Collection: Temp.- 97.3 PO
History: Diabetes (insulin dependent)
Medications: Insulin R titrated to finger sticks
Allergies: None

Vitals/ Data Collection: Pulse- 68
History: Hypertension
Medications: Furosemide 20 MG twice per day
Allergies: None

Vitals/ Data Collection: Respirations- 18
History: Atrial Fibrillation
Medications: Warfarin 5 Mg Mon, Wed, Fri 2 Mg Tues, Thurs
Allergies: None

Vitals/ Data Collection: Blood Pressure- 122/86
History: Rheumatoid Arthritis
Medications: Enalapril 5 Mg once per day
Allergies: None

Vitals/ Data Collection: No C/O pain
History: Mild Heart Failure (class 1)
Medications: Proventil inhaler as needed for wheezing
Allergies: None

Vitals/ Data Collection: Alert and oriented X 4
History: Former Smoker- smoked 1 pack per day X 40 years- last smoked 10 years ago
Medications: Methotrexate 2.5 Mg per day
Allergies: None

Vitals/ Data Collection: Lungs: No adventitious sounds
History: Appendectomy as a child
Medications: Tylenol 650 Mg as needed for pain or fever
Allergies: None

Vitals/ Data Collection: + Bowel sounds
History: Mobility (baseline): able to ambulate slowly with minimal assist
Clear yellow urine draining from Foley catheter in adequate amts.
Medications:
Allergies: None

Vitals/ Data Collection: Clear yellow urine draining from Foley catheter in adequate amts.
History:
Medications:
Allergies: None

8/16/2019
10:00: (RN) Pt received on 3 North. Alert and oriented X 4. Fingerstick 81. Eating breakfast. Offering no complaints.

8/17/2019 (Medical Assistant)
0130: Sleeping Soundly

0700: (LPN) alert and oriented Finger stick 124. Offering no complaints. Medications given as ordered. Foley catheter draining cloudy yellow urine- RN notified.

1100: (Case Manager note): Pt. alert and oriented. Blood sugar stable. Will speak to the physician about discharge tomorrow morning.

1300: (Physical Therapy): Ambulated to the hallway 200 feet. Ambulates slowly- baseline as per long-term-care facility charge nurse. Recommend physical therapy after discharge, however, ambulated well enough for discharge.

1600: (LPN) Pt found to be confused (alert and oriented X 1). RN notified. Fingerstick 130. Vitals 97.5 (axillary), 110, 24, 98/64

1800: (Medical assistant) 400 cc's emptied from catheter bag.

0100: (RN) Pt confused and combative. Attempting to pull out her IV and repeatedly removing her gown. Pt's physician was paged- ordered Lorazepam 1 MG IM. Medicated as ordered and slept the remainder of the night with no incident.

0700: (RN) Pt awake and alert but combative. Finger stick-124. Vitals: 98.9 (axillary), 116, 28, 90/55

1730: (LPN) Unable to administer medication. Pt appears extremely confused. RN notified.

1200: (LPN) Pt's daughter at bedside. Daughter indicates that her mother is not normally confused and is concerned that she may have had a stroke and notes that her mom feels "very warm." RN notified. Foley catheter draining cloudy urine.

1230: (Medical Assistant) Vital signs: T 103.6 (rectal), P=130, BP=84/43, resp rate=28

1300: (RN) Rapid response called (because of the change in condition) and client transferred to the ICU.

Update: The client spent 3 days in the ICU but unfortunately did not recover.

Answer the following questions:

Question A. Why did this client become confused and combative? (5-10 sentences)

Question B. What pivotal decision made in the ER directly caused this client's worsening condition? (1-2 sentences)

Question C. What type of incontinence did this client have? Explain your answer. (5-10 sentences)

Question D. What factors in the client's medical history contributed to the client's change in condition? (5-10 sentences)

Question E. How did communication (or lack thereof) contribute to the poor outcome for this client? (5-10 sentences)

Reference no: EM133612920

Questions Cloud

Describes an assessment of the needs of the client : Describes an assessment of the needs of the client(s) and why you feel this project would be beneficial to improve health outcomes.

Since composting is aerobic process : Since composting is an aerobic process, what do you need to do to create compost from your own organic waste?

What is the sample standard deviation : PSY3402 Single-Factor Practice, Texas State University - What is the Independent variable in the study described above? What are the levels of the independent

Write a one-page summary of what the agency does : Write a one-page summary of what the agency does, who it affects and how it is utilized. Examples of agencies include JC, AHRQ, QSEN. You may also find agency.

Why did this client become confused and combative : Why did this client become confused and combative? What pivotal decision made in the ER directly caused this client's worsening condition?

Provide critical care to patients with severe : ICUs are specialized hospital departments that provide critical care to patients with severe or life-threatening illnesses and injuries.

How sketch would change if the sample size was increased : Explain how the sketch would change if the sample size was increased and compute relevant statistics and give your position on the Null hypothesis

Software development process : A description of the core activities in the software development process. An explanation of why the testing stage of systems development is so important.

Describe social institutions and impact on the individual : Dr. Hahn asks her students to describe social institutions and their impact on the individual. One of her students writes extensively of her gender,

User Account

All Pages