Question

Pt-1 Jennifer Hoffman is a 33-year-old female brought to the Emergency Department by her neighbor. She has a history of asthma since childhood with multiple emergency visits within the last year. She appears to be in respiratory distress, struggling to breathe. She is unable to speak other than simple one-word statements. An infusion of normal saline has been started at a keep-open rate.

PT-2 A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt "dizzy" and "weak" all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn.

PT 3-Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago. The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin breakdown.

Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD), chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.

Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been within normal limits and are performed weekly. Results from yesterday's labs are in the chart. She is on a regular diet with nutritional supplement and has been eating the majority of her meals since admission. She requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate. Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In preparation for her dressing change, she was medicated for pain half an hour ago.

1.   In what ways are the patients similar?

2.    In

what ways would their nursing care be similar?

3.    In

what ways are the 3 patients different?

4.    How

would their care be different? Why?

Answer 1

1) pt -1 Hoffman is in a severe acute at of asthma as he talks in words and in distress

Pt 2 is in severe dehydration

Pt 3 is has a venous ulcer has a history of DVT and Braden score of 16 which indicates at risk

All the patients require close monitoring and care

2) their care would be similar because all are treated as emergency their vitals are monitored frequently and symptomatic care will be given any exacerbation of their condition must be taken care

3,4) the patients are different from other due to their age , severity of diseases ,their present status

Pt 1 is an emergency situation

Pt 2 is in severe dehydration so he should be rehydrated as by the protocol and electrolytes level should be tested and maintained

Pt 3 ulcer is taken care but the discoloration of the legs indicates later stages of varicose veins skin care is important as these may have eczema it's due to the accumulated heamoglobin care like compression stockings , physical activity is also important as the patient is obese and has sedentary lifestyle